Background: Community-based cardiovascular screening has the opportunity to detect critical cardiovascular disease and positively affect public health outcomes. Disease deemed to be critical or severe at detection req...Background: Community-based cardiovascular screening has the opportunity to detect critical cardiovascular disease and positively affect public health outcomes. Disease deemed to be critical or severe at detection requires appropriate medical follow-up. This article examined the self-reported outcomes of individuals who had undergone community-based cardiovascular screening and had critical findings for abdominal aortic aneurysm (AAA) or carotid artery stenosis (CAS). Methods: Over 390,000 screening records for AAA and over 490,000 screening records for CAS were reviewed to identify individuals with critical screening findings. A critical AAA is defined as an aneurysm ≥ 5cm and critical CAS is defined as a hemodynamically significant stenosis with recorded peak systolic velocities of ≥300 cm/s, in this population. Identified individuals were then contacted via phone and surveyed about the medical care they received after their screening. Results: Review of the screening records found a prevalence of critical AAA findings of 0.037% (146 participants) and critical CAS findings of 0.12% (579 participants). 61% of participants with critical findings were reached for follow-up from both groups. Over 96% of participants with critical AAA and over 92% of participants with critical CAS had some forms of medical follow-up. Conclusions: Community-based cardiovascular screening has the ability to detect critical levels of disease. Findings of critical disease in the reviewed population are similar to the findings from previously published studies. Importantly, medical treatment received by those who seek follow-up appears to be consistent with recommended treatment guidelines. Identification and management of critical disease represent meaningful public and individual health benefits and the possibility of cost-savings.展开更多
Introduction: Community-based cardiovascular screening presents an opportunity to detect the presence of cardiovascular disease in individuals who report having no traditional risk factors, and also to identify the pr...Introduction: Community-based cardiovascular screening presents an opportunity to detect the presence of cardiovascular disease in individuals who report having no traditional risk factors, and also to identify the presence of those risk factors in those who are unaware of their health status. Identification of both disease and risk factors (e.g. high cholesterol, high blood pressure, diabetes, etc.) creates an opportunity for treatment and management to reduce and prevent cardiovascular events from occurring. Methods: Over 230,000 screening records for individuals who had undergone carotid artery stenosis (CAD), abdominal aortic aneurysm (AAA), or peripheral artery disease (PAD) screening were reviewed. Participants were stratified based on self-reported risk factors as having no risk factors, one risk factor, or two or more risk factors. Self-reported risk factors were also compared with results of screening for blood pressure, blood glucose, and lipid level status. Results: Abnormal findings of CAS, AAA, and PAD were all uncovered in individuals who self-reported as having no traditional risk factors. These abnormal findings included those defined as severe. The review of self-reported risk factors for accuracy demonstrated varying levels of inaccuracies in both under and over-reporting of risk factors. Conclusions: Community-based cardiovascular screening may result in the identification of cardiovascular disease in individuals with no established risk factors. While the underreporting of risk factors has also be demonstrated, it is clear that further research is warranted to better understand the presence of disease in the absence of risk factors.展开更多
Background: The indication and optimal duration of antiepileptic drug (AED) prophylaxis after aneurysmal subarachnoid hemorrhage (SAH) remains controversial. Our institution practices routine seizure prophylaxis for v...Background: The indication and optimal duration of antiepileptic drug (AED) prophylaxis after aneurysmal subarachnoid hemorrhage (SAH) remains controversial. Our institution practices routine seizure prophylaxis for variable durations at the discretion of the neurosurgeon and neuro-intensivist. Given the propensity of late onset seizures to progress to chronic epilepsy, we sought to investigate the efficacy of extended AED prophylaxis in reducing the risk of late seizures. Methods: This retrospective study analyzed 36 patients who were admitted to our neurosurgical intensive care unit (NICU) over a 2-year period (1st November 2015 to 31st October 2017). All hospital admissions records, electronic medication records as well as outpatient visits up to 1 year were reviewed. Late onset seizures were defined as seizures occurring more than 7 days post-intervention (or presentation if no intervention was performed) up to 1 year of follow-up. Results: Majority of the patients received Levetiracetam (94%) as seizure prophylaxis and late onset seizures occurred in 6 (17%) of the patients. Those patients who received a greater proportion of in-patient stay with AED prophylaxis had a statistically significant lower risk of developing late seizures (OR = 0.964, 95%, p = 0.02). Although the value tended towards benefit (OR = 0.382) for AED > 21 days in-hospital, the result was not statistically significant (p = 0.307). Conclusion: An extended duration of AED prophylaxis, in particular Levetiracetam, may confer some benefit in reducing risk of developing late seizures. However, the optimal duration of therapy is yet to be determined and further large multi-centered randomized studies are necessary.展开更多
文摘Background: Community-based cardiovascular screening has the opportunity to detect critical cardiovascular disease and positively affect public health outcomes. Disease deemed to be critical or severe at detection requires appropriate medical follow-up. This article examined the self-reported outcomes of individuals who had undergone community-based cardiovascular screening and had critical findings for abdominal aortic aneurysm (AAA) or carotid artery stenosis (CAS). Methods: Over 390,000 screening records for AAA and over 490,000 screening records for CAS were reviewed to identify individuals with critical screening findings. A critical AAA is defined as an aneurysm ≥ 5cm and critical CAS is defined as a hemodynamically significant stenosis with recorded peak systolic velocities of ≥300 cm/s, in this population. Identified individuals were then contacted via phone and surveyed about the medical care they received after their screening. Results: Review of the screening records found a prevalence of critical AAA findings of 0.037% (146 participants) and critical CAS findings of 0.12% (579 participants). 61% of participants with critical findings were reached for follow-up from both groups. Over 96% of participants with critical AAA and over 92% of participants with critical CAS had some forms of medical follow-up. Conclusions: Community-based cardiovascular screening has the ability to detect critical levels of disease. Findings of critical disease in the reviewed population are similar to the findings from previously published studies. Importantly, medical treatment received by those who seek follow-up appears to be consistent with recommended treatment guidelines. Identification and management of critical disease represent meaningful public and individual health benefits and the possibility of cost-savings.
文摘Introduction: Community-based cardiovascular screening presents an opportunity to detect the presence of cardiovascular disease in individuals who report having no traditional risk factors, and also to identify the presence of those risk factors in those who are unaware of their health status. Identification of both disease and risk factors (e.g. high cholesterol, high blood pressure, diabetes, etc.) creates an opportunity for treatment and management to reduce and prevent cardiovascular events from occurring. Methods: Over 230,000 screening records for individuals who had undergone carotid artery stenosis (CAD), abdominal aortic aneurysm (AAA), or peripheral artery disease (PAD) screening were reviewed. Participants were stratified based on self-reported risk factors as having no risk factors, one risk factor, or two or more risk factors. Self-reported risk factors were also compared with results of screening for blood pressure, blood glucose, and lipid level status. Results: Abnormal findings of CAS, AAA, and PAD were all uncovered in individuals who self-reported as having no traditional risk factors. These abnormal findings included those defined as severe. The review of self-reported risk factors for accuracy demonstrated varying levels of inaccuracies in both under and over-reporting of risk factors. Conclusions: Community-based cardiovascular screening may result in the identification of cardiovascular disease in individuals with no established risk factors. While the underreporting of risk factors has also be demonstrated, it is clear that further research is warranted to better understand the presence of disease in the absence of risk factors.
文摘Background: The indication and optimal duration of antiepileptic drug (AED) prophylaxis after aneurysmal subarachnoid hemorrhage (SAH) remains controversial. Our institution practices routine seizure prophylaxis for variable durations at the discretion of the neurosurgeon and neuro-intensivist. Given the propensity of late onset seizures to progress to chronic epilepsy, we sought to investigate the efficacy of extended AED prophylaxis in reducing the risk of late seizures. Methods: This retrospective study analyzed 36 patients who were admitted to our neurosurgical intensive care unit (NICU) over a 2-year period (1st November 2015 to 31st October 2017). All hospital admissions records, electronic medication records as well as outpatient visits up to 1 year were reviewed. Late onset seizures were defined as seizures occurring more than 7 days post-intervention (or presentation if no intervention was performed) up to 1 year of follow-up. Results: Majority of the patients received Levetiracetam (94%) as seizure prophylaxis and late onset seizures occurred in 6 (17%) of the patients. Those patients who received a greater proportion of in-patient stay with AED prophylaxis had a statistically significant lower risk of developing late seizures (OR = 0.964, 95%, p = 0.02). Although the value tended towards benefit (OR = 0.382) for AED > 21 days in-hospital, the result was not statistically significant (p = 0.307). Conclusion: An extended duration of AED prophylaxis, in particular Levetiracetam, may confer some benefit in reducing risk of developing late seizures. However, the optimal duration of therapy is yet to be determined and further large multi-centered randomized studies are necessary.
