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An evidence-based multidisciplinary approach to the management of hepatocellular carcinoma (HCC): the Alberta HCC algorithm.

https://arctichealth.org/en/permalink/ahliterature138629
Source
Can J Gastroenterol. 2010 Nov;24(11):643-50
Publication Type
Article
Date
Nov-2010
Author
Kelly W Burak
Norman M Kneteman
Author Affiliation
Department of Medicine, University of Calgary, Alberta. kwburak@ucaglary.ca
Source
Can J Gastroenterol. 2010 Nov;24(11):643-50
Date
Nov-2010
Language
English
Publication Type
Article
Keywords
Alberta
Algorithms
Carcinoma, Hepatocellular - diagnosis - pathology - therapy
Catheter Ablation - methods
Evidence-Based Medicine
Humans
Liver Neoplasms - diagnosis - pathology - therapy
Neoplasm Staging
Abstract
Hepatocellular carcinoma (HCC) is one of only a few malignancies with an increasing incidence in North America. Because the vast majority of HCCs occur in the setting of a cirrhotic liver, management of this malignancy is best performed in a multidisciplinary group that recognizes the importance of liver function, as well as patient and tumour characteristics. The Barcelona Clinic Liver Cancer (BCLC) staging system is preferred for HCC because it incorporates the tumour characteristics (ie, tumour-node-metastasis stage), the patient's performance status and liver function according to the Child-Turcotte-Pugh classification, and then links the BCLC stage to recommended therapeutic interventions. However, the BCLC algorithm does not recognize the potential role of radiofrequency ablation for very early stage HCC, the expanding role of liver transplantation in the management of HCC, the role of transarterial chemoembolization in single large tumours, the potential role of transarterial radioembolization with 90Yttrium and the limited evidence for using sorafenib in Child- Turcotte-Pugh class B cirrhotic patients. The current review article presents an evidence-based approach to the multidisciplinary management of HCC along with a new algorithm for the management of HCC that incorporates the BCLC staging system and the authors' local selection criteria for resection, ablative techniques, liver transplantation, transarterial chemoembolization, transarterial radioembolization and sorafenib in Alberta.
Notes
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PubMed ID
21157578 View in PubMed
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Approaches to empiric ablation of slow pathway: results from the Canadian EP web survey.

https://arctichealth.org/en/permalink/ahliterature122276
Source
J Interv Card Electrophysiol. 2012 Nov;35(2):183-7
Publication Type
Article
Date
Nov-2012
Author
Avishag Laish-Farkash
Mohammed Shurrab
Sheldon Singh
Irving Tiong
Atul Verma
Guy Amit
Alex Kiss
Florence Morriello
David Birnie
Jeff Healey
Ilan Lashevsky
David Newman
Eugene Crystal
Author Affiliation
Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Suite D-377, Toronto, ON, M4N 3M5, Canada.
Source
J Interv Card Electrophysiol. 2012 Nov;35(2):183-7
Date
Nov-2012
Language
English
Publication Type
Article
Keywords
Adult
Canada
Catheter Ablation - methods
Chi-Square Distribution
Humans
Internet
Physician's Practice Patterns - statistics & numerical data
Statistics, nonparametric
Tachycardia, Atrioventricular Nodal Reentry - surgery
Tachycardia, Supraventricular - surgery
Abstract
Dual atrioventricular nodal physiology (DAVNP) is a frequent finding in patients with suspected or documented supraventricular tachycardia (SVT). Empiric slow pathway ablation (ESPA) is sometimes performed in patients with DAVNP without inducible SVT at the time of electrophysiological study. Evidence to guide this practice in the adult population is limited. This study was aimed to assess the practice of ESPA by adult electrophysiologists in Canada.
All Canadian interventional electrophysiologists (n?=?81) were invited to complete a web-based questionnaire assessing their practice of ESPA in patients with suspected and documented SVT. Operator experience, reimbursement models, diagnostic, and treatment decisions regarding ESPA were assessed with case scenarios.
Forty-one responses (50 %) were obtained. Ninety-five percent of the responders stated that the evidence for ESPA is lacking or limited. Responders were more likely to perform ESPA in the setting of non-inducible SVT when there was documentation of the clinical arrhythmia (64 vs. 31 % (p?=?0.017)). The threshold to perform ESPA was highly variable. Longer time in practice (r?=?0.38, p?=?0.017) and less perceived complications with ESPA (r?=?0.31, p?=?0.05) were correlated with the practice of ESPA, whereas length of ablation waiting lists (r?=?-0.15, p?=?0.38), number of procedures performed per day (r?=?0.11, p?=?0.51) and type of reimbursement (p?=?0.24) were not associated with the practice of ESPA. The perceived complication rate with ESPA was
PubMed ID
22833011 View in PubMed
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Assessing the effectiveness of 'pulse radiofrequency treatment of dorsal root ganglion' in patients with chronic lumbar radicular pain: study protocol for a randomized control trial.

https://arctichealth.org/en/permalink/ahliterature124866
Source
Trials. 2012;13:52
Publication Type
Article
Date
2012
Author
Harsha Shanthanna
Philip Chan
James McChesney
James Paul
Lehana Thabane
Author Affiliation
Department of Anesthesia and Pain Medicine (D-149), St Joseph's Hospital, 50 Charlton Avenue East Hamilton, Ontario, L8N 4A6, Canada. harshamd@gmail.com
Source
Trials. 2012;13:52
Date
2012
Language
English
Publication Type
Article
Keywords
Catheter Ablation - methods
Chronic Pain - diagnosis - physiopathology - surgery
Ganglia, Spinal - physiopathology - surgery
Humans
Low Back Pain - diagnosis - physiopathology - surgery
Neuralgia - diagnosis - physiopathology - surgery
Ontario
Pain Measurement
Research Design
Time Factors
Treatment Outcome
Abstract
Chronic lumbar radicular pain can be described as neuropathic pain along the distribution of a particular nerve root. The dorsal root ganglion has been implicated in its pathogenesis by giving rise to abnormal impulse generation as a result of irritation, direct compression and sensitization. Chronic lumbar radicular pain is commonly treated with medications, physiotherapy and epidural steroid injections. Epidural steroid injections are associated with several common and rarer side effects such as spinal cord infarction and death. It is essential and advantageous to look for alternate interventions which could be effective with fewer side effects. Pulse radio frequency is a relatively new technique and is less destructive then conventional radiofrequency. Safety and effectiveness of pulse radio frequency in neuropathic pain has been demonstrated in animal and humans studies. Although its effects on dorsal root ganglion have been studied in animals there is only one randomized control trial in literature demonstrating its effectiveness in cervical radicular pain and none in lumbar radicular pain. Our primary objective is to study the feasibility of a larger trial in terms of recruitment and methodology. Secondary objectives are to compare the treatment effects and side effects.
This is a single-center, parallel, placebo-controlled, triple-blinded (patients, care-givers, and outcome assessors), randomized control trial. Participants will have a history of chronic lumbar radicular pain for at least 4 months in duration. Once randomized, all patients will have an intervention involving fluoroscopy guided needle placement to appropriate dorsal root ganglion. After test stimulation in both groups; the study group will have a pulse radio frequency treatment at 42°C for 120?s to the dorsal root ganglion, with the control group having only low intensity test stimulation for the same duration. Primary outcome is to recruit at least four patients every month with 80% of eligible patients being recruited. Secondary outcomes would be to assess success of intervention through change in the visual analogue scale measured at 4 weeks post intervention and side effects. Allocation to each group will be a 1:1 ratio with allocation block sizes of 2, 4, and 6.
ClinicalTrials.gov NCT01117870.
Notes
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PubMed ID
22540851 View in PubMed
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Assessment of Use vs Discontinuation of Oral Anticoagulation After Pulmonary Vein Isolation in Patients With Atrial Fibrillation.

https://arctichealth.org/en/permalink/ahliterature300413
Source
JAMA Cardiol. 2017 02 01; 2(2):146-152
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Date
02-01-2017
Author
Sara Själander
Fredrik Holmqvist
J Gustav Smith
Pyotr G Platonov
Milos Kesek
Peter J Svensson
Carina Blomström-Lundqvist
Fariborz Tabrizi
Jari Tapanainen
Dritan Poci
Anders Jönsson
Anders Själander
Author Affiliation
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Source
JAMA Cardiol. 2017 02 01; 2(2):146-152
Date
02-01-2017
Language
English
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Keywords
Administration, Oral
Age Factors
Anticoagulants - administration & dosage
Atrial Fibrillation - complications - drug therapy - surgery
Brain Ischemia - epidemiology - etiology - prevention & control
Catheter Ablation - methods
Cause of Death - trends
Female
Follow-Up Studies
Humans
Incidence
Male
Middle Aged
Prognosis
Pulmonary Veins - surgery
Retrospective Studies
Risk Assessment - methods
Risk factors
Survival Rate - trends
Sweden - epidemiology
Time Factors
Warfarin - administration & dosage
Withholding Treatment
Abstract
Pulmonary vein isolation (PVI) is a recommended treatment for patients with atrial fibrillation, but it is unclear whether it results in a lower risk of stroke.
To investigate the proportion of patients discontinuing anticoagulation treatment after PVI in association with the CHA2DS2-VASc (congestive heart failure, hypertension, age =75 years [doubled], diabetes, stroke [doubled], vascular disease, age 65-74 years, sex category [female]) score, identify factors predicting stroke after PVI, and explore the risk of cardiovascular events after PVI in patients with and without guideline-recommended anticoagulation treatment.
A retrospective cohort study was conducted using Swedish national health registries from January 1, 2006, to December 31, 2012, with a mean-follow up of 2.6 years. A total of 1585 patients with atrial fibrillation undergoing PVI from the Swedish Catheter Ablation Register were included, with information about exposure to warfarin in the national quality register Auricula. Data analysis was performed from January 1, 2015, to April 30, 2016.
Warfarin treatment.
Ischemic stroke, intracranial hemorrhage, and death.
In this cohort of 1585 patients, 73.0% were male, the mean (SD) age was 59.0 (9.4) years, and the mean (SD) CHA2DS2-VASc score was 1.5 (1.4). Of the 1585 patients, 1175 were followed up for more than 1 year after PVI. Of these, 360 (30.6%) discontinued warfarin treatment during the first year. In patients with a CHA2DS2-VASc score of 2 or more, patients discontinuing warfarin treatment had a higher rate of ischemic stroke (5 events in 312 years at risk [1.6% per year]) compared with those continuing warfarin treatment (4 events in 1192 years at risk [0.3% per year]) (P?=?.046). Patients with a CHA2DS2-VASc score of 2 or more or those who had previously experienced an ischemic stroke displayed a higher risk of stroke if warfarin treatment was discontinued (hazard ratio, 4.6; 95% CI, 1.2-17.2; P?=?.02 and hazard ratio, 13.7; 95% CI, 2.0-91.9; P?=?.007, respectively).
These findings indicate that discontinuation of warfarin treatment after PVI is not safe in high-risk patients, especially those who have previously experienced an ischemic stroke.
Notes
CommentIn: JAMA Cardiol. 2017 Feb 1;2(2):152-154 PMID 27893050
PubMed ID
27893055 View in PubMed
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[Atrial fibrillation--towards non-inflammatory treatment? The Danish Society of Cardiology]

https://arctichealth.org/en/permalink/ahliterature82561
Source
Ugeskr Laeger. 2006 Mar 20;168(12):1212
Publication Type
Article
Date
Mar-20-2006
Author
Hagemann Arne
Brandes Axel
Author Affiliation
Kardiologisk Afdeling P, Amtssygehuset i Gentofte, DK-2900 Hellerup. arha@gentoftehosp.kbhamt.dk
Source
Ugeskr Laeger. 2006 Mar 20;168(12):1212
Date
Mar-20-2006
Language
Danish
Publication Type
Article
Keywords
Atrial Fibrillation - surgery
Catheter Ablation - methods - statistics & numerical data - trends
Denmark
Humans
PubMed ID
16571303 View in PubMed
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Best practice guide for cryoballoon ablation in atrial fibrillation: The compilation experience of more than 3000 procedures.

https://arctichealth.org/en/permalink/ahliterature272310
Source
Heart Rhythm. 2015 Jul;12(7):1658-66
Publication Type
Article
Date
Jul-2015
Author
Wilber Su
Robert Kowal
Marcin Kowalski
Andreas Metzner
J Thomas Svinarich
Kevin Wheelan
Paul Wang
Source
Heart Rhythm. 2015 Jul;12(7):1658-66
Date
Jul-2015
Language
English
Publication Type
Article
Keywords
Atrial Fibrillation - surgery
Cardiac Imaging Techniques - methods
Catheter Ablation - methods
Cryosurgery - methods
Humans
Practice Guidelines as Topic
Pulmonary Veins - surgery
Treatment Outcome
Abstract
Since the release of the second-generation cryoballoon (CB2; Arctic Front Advance(TM), Medtronic Inc) and its design modifications with improved cooling characteristics, the technique, dosing, and complication profile is significantly different from that of the first-generation cryoballoon. A comprehensive report of CB2 procedural recommendations has not been reported.
The purpose of this study was to review the current best practices from a group of experienced centers to create a user's consensus guide for CB2 ablation.
High-volume operators with a combined experience of more than 3000 CB2 cases were interviewed, and consensus for technical and procedural best practice was established.
Comprehensive review of the CB2 ablation best practice guide will provide a detailed technique for achieving safer and more effective outcomes for CB2 atrial fibrillation ablation.
PubMed ID
25778428 View in PubMed
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Cardiac rehabilitation versus usual care for patients treated with catheter ablation for atrial fibrillation: Results of the randomized CopenHeartRFA trial.

https://arctichealth.org/en/permalink/ahliterature282780
Source
Am Heart J. 2016 Nov;181:120-129
Publication Type
Article
Date
Nov-2016
Author
Signe S Risom
Ann-Dorthe Zwisler
Trine B Rasmussen
Kirstine Lærum Sibilitz
Trine L S Madsen
Jesper Hastrup Svendsen
Christian Gluud
Jane Lindschou
Per Winkel
Selina Kikkenborg Berg
Source
Am Heart J. 2016 Nov;181:120-129
Date
Nov-2016
Language
English
Publication Type
Article
Keywords
Aftercare
Aged
Atrial Fibrillation - psychology - rehabilitation - surgery
Cardiac Rehabilitation - methods
Catheter Ablation - methods
Denmark
Exercise Test
Exercise Therapy
Exercise Tolerance
Female
Humans
Male
Mental health
Middle Aged
Oxygen consumption
Patient Education as Topic
Quality of Life
Surveys and Questionnaires
Treatment Outcome
Abstract
To assess the effects of comprehensive cardiac rehabilitation compared with usual care on physical activity and mental health for patients treated with catheter ablation for atrial fibrillation.
The patients were randomized 1:1 stratified by paroxysmal or persistent atrial fibrillation and sex to cardiac rehabilitation consisting of 12 weeks physical exercise and four psycho-educational consultations plus usual care (cardiac rehabilitation group) versus usual care. The primary outcome was Vo2 peak. The secondary outcome was self-rated mental health measured by the Short Form-36 questionnaire. Exploratory outcomes were collected.
210 patients were included (mean age: 59 years, 74% men), 72% had paroxysmal atrial fibrillation prior to ablation. Compared with usual care, the cardiac rehabilitation group had a beneficial effect on Vo2 peak at four months (24.3mL kg(-1) min(-1) versus 20.7mL kg(-1) min(-1), p of main effect=0.003, p of interaction between time and intervention=0.020). No significant difference between groups on Short Form-36 was found (53.8 versus 51.9 points, P=.20). Two serious adverse events (atrial fibrillation in relation to physical exercise and death unrelated to rehabilitation) occurred in the cardiac rehabilitation group versus one in the usual care group (death unrelated to intervention) (P=.56). In the cardiac rehabilitation group 16 patients versus 7 in the usual care group reported non-serious adverse events (P=.047).
Comprehensive cardiac rehabilitation had a positive effect on physical capacity compared with usual care, but not on mental health. Cardiac rehabilitation caused more non-serious adverse events.
PubMed ID
27823683 View in PubMed
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[Catheter ablation--more effective than drugs].

https://arctichealth.org/en/permalink/ahliterature273174
Source
Lakartidningen. 2015;112
Publication Type
Article
Date
2015

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