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Query: EC:4.1.1.6 (CAD)
 4,420 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The nurse plays a major role in primary and secondary prevention of CAD. Nurses must be knowledgeable regarding the assessment of cardiac risk factors and interventions at each level of prevention. Patients have become more informed and desire more information regarding their disease and treatment. The nurse must remain updated on the current treatment modalities and risk factor prevention strategies to direct changes in behavior.
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PMID:Nursing interventions for risk factor reduction. 154 92

Nurses caring for the patient with CAD are most effective when they recognize that many factors affect psychosocial adjustment to heart disease, with age and gender as two prominent influences. Likewise, spouses of patients with CAD require special attention and assessment so that their caregiving and recovery from a cardiac-related event is successful. Caregiving spouses have been found to have more mood disturbance, less satisfaction with marriage and family, and lower levels of social support than patients, suggesting that attention to their concerns is paramount.
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PMID:Psychosocial adjustments of coronary artery disease patients and their spouses: nursing implications. 154 93

This study investigates the margin quality of four different tooth-coloured inlay systems using computer-aided quantitative margin analysis under scanning electron microscopy. Three types of restorations involved chairside procedures using a commercial CAD-CAM apparatus: one type of inlay restoration was milled from preformed glass ceramic blocks, the other two inlay types were milled from preformed porcelain blocks. The fourth system was based on an experimental indirect composite inlay system. Each inlay type was luted with its respective dual-curing luting composite, which was supplied with the system. After 6 months of clinical service, all four systems revealed a significant percentage of submargination indicating occlusal wear of the luting composite. The porcelain inlays and the composite inlays luted with their respective experimental luting composite showed the best marginal adaptation. Luted glass ceramic inlays, in particular, suffered from a significantly higher percentage of inlay margin fractures (9 per cent) and marginal openings (4 per cent) than the other systems. A possible explanation is that the glass ceramic subsurface structure at the inlay-lute interface was weakened by etching with ammonium bifluoride.
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PMID:Marginal adaptation of four tooth-coloured inlay systems in vivo. 154 81

Continuous ECG recording of ST segments can provide important insight into the effects of CAD in patients before, during, and after anesthesia and surgery. The stresses of anesthesia and surgery are particularly threatening to the patient with critical coronary disease and ischemia. ST-segment monitoring is a useful alternative to preoperative stress ECG in patients who are unable to exercise, particularly if radionuclide techniques are not readily available. Continuous ST-segment monitoring provides an additional and unique method of monitoring patients during and after surgery, and on-line analysis of such data provides the anesthesiologist with opportunities to recognize and promptly respond to ischemic episodes. Future studies will determine whether such aggressive strategies will alter the outcome for patients with perioperative myocardial ischemia.
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PMID:Perioperative myocardial ischemia and infarction. Detection of myocardial ischemia using continuous electrocardiography. 157 38

Although most of the published studies using DTS as a preoperative screening test show various shortcomings, the following conclusions can be drawn: 1. DTS should not be used as a routine preoperative test in vascular surgical patients. DTS possesses insufficient accuracy when used in patients without clinical findings suggestive of CAD. 2. DTS may prove more useful in stratifying patients with an intermediate probability of developing cardiac complications. In such a population the test will not offer an "all or nothing" linear results, but rather, when included with the clinical findings and the nature of the surgical procedure, a complex stratification. 3. Because of progress in the perioperative management of high-risk patients, positive findings on preoperative DTS may not correlate perfectly with perioperative cardiac occurrences. 4. Because several factors influence thallium uptake after dipyridamole, DTS does not have perfect specificity, which leads to the prescribing of an excessive number of coronary angiographies. Some patients will be seen as having a false-positive DTS test. 5. The use of DTS as a preoperative screening test leads to cardiac catheterization and hence to revascularization independent of symptomatology. Studies must be undertaken to determine whether this approach will improve short- and long-term patient survival.
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PMID:Dipyridamole-thallium-201 scintigraphy in the diagnosis and prognosis of coronary artery disease in patients undergoing noncardiac surgery. 157 42

The central aim of this review was to examine the application of intervention therapy for CAD in the elderly population. The data reviewed indicates that it is no longer appropriate to use age 70 or 75 as the upper limit of eligibility for thrombolytic intervention in patients with acute myocardial infarction. Elderly who are physiologically active without contraindications to thrombolytic therapy should be considered eligible. Additional controlled trials specifically targeted at the elderly population are needed to better define the precise dosing regimen and the magnitude and extent of bleeding complications in this group. Nevertheless, it appears appropriate to recommend thrombolytic intervention for most eligible elderly patients presenting with acute myocardial infarction. This recommendation is based on the fact that the higher mortality in the elderly results in more lives saved per patient treated than for younger patients. It is important to reemphasize that this recommendation is for treating elderly patients with acute infarction as suggested by ST-segment elevation and/or Q waves, without contraindications to thrombolytic therapy. Those with non-Q-wave infarctions, hypertension, recent stroke, history of bleeding, or other contraindications are not candidates. Regarding intervention therapy in other elderly patients with acute and chronic manifestations of coronary disease, results also appear very encouraging. Elderly patients appearing to tolerate PTCA include those with all forms of angina from chronic stable angina to unstable angina. Although only observational data are on hand at present, our review suggests these elderly patients tolerate PTCA well and indeed may benefit. The elderly patients who have co-morbid factors that adversely influence the application of CABG for revascularization may be the best candidates for PTCA. At present, the challenge for the physician is to carefully assess each elderly patient on an individual basis for intervention therapy. This evaluation should be aimed at identifying factors that may permit application of intervention treatment to the elderly patients who are most likely to receive the greatest benefit.
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PMID:Intervention therapy for coronary artery disease in the elderly. 158 17

The relationship between hostility and coronary artery disease may be partially mediated by unhealthy lifestyle behaviors. This study examined the relationship between hostility, lifestyle behaviors, and physical risk factors in 138 adult men and women. Subjects completed the Cook and Medley Hostility Scale (Ho scale) and self-reports of their dietary habits, consumption of alcohol and cigarettes, and physical activity. Recent findings indicated that a composite hostility score from three rationally derived subscales of the Ho scale tapping the dimensions of cynicism, hostile affect, and aggressiveness was a better predictor of mortality than the total Ho score. Thus, this composite measure of hostility and the total Ho score were used in data analyses. Measures of resting blood pressure, height, weight, and adiposity were also obtained. In men and women, both measures of hostility were positively associated with cholesterol intake and vigorous physical activity. Among women, both hostility measures were positively related to animal fat intake and negatively related to fiber intake. The composite measure was positively related to their resting systolic pressures. Among men, both hostility measures were positively related to cigarette smoking and sugar intake and negatively associated with systolic blood pressure and calcium intake. Findings are discussed in terms of previous research linking hostility to lifestyle behaviors and CAD.
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PMID:Hostility: relationship to lifestyle behaviors and physical risk factors. 159 41

What can we look forward too? Lots of fun with new CAD/CAM systems that will enhance dentistry, providing quality restorations quickly. The evolution of an array of new versions of already available systems as well as altogether new systems will provide improved quality, expanded capabilities, and increasing user friendliness. And new materials will be more esthetic, wear more nearly like enamel, and strong enough for full crowns and bridges. We can also look forward to lots of change. Because of the cost of CAD/CAM systems, many clinicians are likely to collaborate by sharing a single system. Laboratories and clinicians may collaborate as well, with data being gathered in the operatory and sent to a laboratory via modem. The fabrication would then be done by the laboratory. Other changes that we cannot even predict are likely to occur in dentistry. Exciting times are here. Automation through dental CAD/CAM systems will, most certainly, change the profession. The impact of that change will only be known in the future. But as the future approaches, the systems and materials available to us will continue to evolve, improve, and enhance dentistry.
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PMID:CAD/CAM in dentistry: a historical perspective and view of the future. 159 43

With a new CAD-CAM technique, we restored and provided esthetic treatment for both natural teeth and fixed prostheses with worn or broken surfaces.
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PMID:Porcelain CAD-CAM veneers. Some new uses explored. 159 28

The aim of this study was to evaluate the anatomo-clinical correlations and the prognostic significance of silent myocardial ischaemia (SI) during exercise testing (ET). Four hundred and six patients with angiographically proven CAD and positive ET were studied. Patients were divided into two groups: 309 patients (Group A) with positive ET for both electrocardiographical findings and angina, and 97 patients (Group B) with positive ET for electrocardiographical findings but not for angina (SI). In Group A the following clinical characteristics differed significantly from Group B: incidence of diabetes mellitus (15.8% vs 27.8%, P less than 0.04); duration of disease (less than 1 month from its first manifestation) (30.4% vs 54.6%, P less than 0.001) and a positive ET at low work-load (41.7% vs 50.5%, P less than 0.05). Mortality during follow-up (mean 72 +/- 11 months) was 8.6% in Group A and 8.2% in Group B (NS). Incidence of sudden death was similar in the two groups (2.9% vs 2.06%; NS). The multivariate analysis shown as independent variables, related significantly with a poor prognosis in both groups: left ventricular function (P less than 0.0001); prior myocardial infarction (P less than 0.0001); and multivessel disease (P less than 0.001). In conclusion, patients with a recent onset of symptoms, a positive ET at low workload and diabetes mellitus are more likely to present SI during ET. The long-term prognosis and the incidence of sudden death are similar in patients with painful and painless myocardial ischaemia during ET.
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PMID:Characterization and long-term prognosis of patients with effort-induced silent myocardial ischaemia. 160 Sep 82


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