Same-Day Angiography, Cardiac Surgery Confirmed as Risk for Kidney Injury

Chicago Performing heart surgery on the same day as angiography is now confirmed as a risk factor for acute kidney injury (AKI), and hospital policy limiting the practice for elective cardiac surgery has significantly reduced the rate of AKI, according to a study published in the February 2013 issue of The Annals of Thoracic Surgery.

Although previous research has shown that performing diagnostic angiography and cardiac surgery on the same day is associated with increased risk of contrast-induced kidney injury, this study is the first to confirm causation and explore results following a change in hospital policy reducing this practice.

Researchers from Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato in Milan, Italy, examined data from 4,440 patients who underwent cardiac surgery and received a diagnostic angiography prior to surgery.

Both cardiac surgery and the use of contrast media are risk factors for AKI. It appears that the combination of these factors on the same day significantly increases the risk, said lead author Marco Ranucci, MD.

AKI after cardiac surgery is a severe complication that is associated with a high risk of mortality. AKI comprises three stages of increasing severity from stage 1 to stage 3.

The researchers observed a significantly higher rate of AKI stage 1 in patients operated on the same day as angiography versus patients operated on 3 days later (18.5% vs. 13.5%, respectively). Additionally, the incidence of AKI stage 2 or 3 was significantly higher (7.8%) in patients who were operated on the same day as angiography than in patients operated on 1 day or 3 days after angiography (4.4% and 3.9%, respectively).

Overall, surgery on the same day as angiography was significantly associated with AKI stage 2 or 3 and any AKI, and an institutional policy limiting the practice of surgery on the same day as angiography resulted in a significant decrease in AKI stage 1 (30%) and a significant decrease of any AKI (42%).

We recommend that angiography on the same day as surgery should be avoided or at least limited to low-risk cases. In patients at high risk for AKI, such as elderly patients or patients with pre-existing renal dysfunction, surgery should be planned at least 24 hours after angiography, Dr. Ranucci concludes. Since no randomized controlled trials are possible in this area, recently released guidelines offer the best possible level of evidence.

Hospital policy can reduce risk of kidney injury
In an invited commentary in the same issue, Jeremiah R. Brown, PhD, MS, an Assistant Professor at The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine in Hanover, NH, wrote that the results from Ranucci and colleagues presents a convincing case for setting hospital policy to limit the use of same-day cardiac catheterization for non-emergent cardiac surgery.

Dr. Brown said that Dr. Ranucci and his colleagues demonstrated great success in improving important patient outcomes and quality of care with a simple institutional policy change to eliminate the practice of same-day cardiac catheterization for non-emergent cardiac surgery.

In the meantime, Dr. Brown recommended that patients work with their physicians to reduce risk of kidney injury by planning to complete a cardiac catheterization ahead of time: Talk with your surgeon about having a diagnostic angiography at least 2 days ahead of planned cardiac surgery. There are rare circumstances for invasive diagnostic tests to be performed on the same day for non-emergent cardiac surgery. Hospital policies can be implemented to reduce the practice of same-day catheterization for cardiac surgery and minimize kidney injury, said Dr. Brown

For a copy of the study and invited commentary, contact Cassie Brasseur at 312-202-5865 or cbrasseur@sts.org.

Founded in 1964, STS is a not-for-profit organization representing more than 6,600 cardiothoracic surgeons, researchers, and allied health professionals worldwide who are dedicated to ensuring the best possible outcomes for surgeries of the heart, lung, and esophagus, as well as other surgical procedures within the chest. The Societys mission is to enhance the ability of cardiothoracic surgeons to provide the highest quality care through education, research and advocacy.

The Annals of Thoracic Surgery is the official journal of STS and the Southern Thoracic Surgical Association

News source: NewsWise

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Same-Day Angiography, Cardiac Surgery Confirmed as Risk for Kidney Injury

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Early Menopause May Occur In Women with BRCA Gene

Women with harmful mutations in the BRCA gene, which put them at higher risk of developing breast and ovarian cancer, tend to undergo menopause significantly sooner than other women, allowing them an even briefer reproductive window and possibly a higher risk of infertility, according to a study led by researchers at UC San Francisco.

Moreover, the study showed that carriers of the mutation who are heavy smokers enter menopause at an even earlier age than non-smoking women with the mutation.

While the authors note that further research is needed, given the size and demographics of the study, women with the abnormal gene mutation should consider earlier childbearing, and their doctors should encourage them to initiate fertility counseling along with other medical treatments, the scientists said.

The study will be published online in Cancer on January 29, 2013.

This is the first controlled study to explore the association between BRCA1 and BRCA 2 and the age at onset of menopause, the authors said.

Our findings show that mutation of these genes has been linked to early menopause, which may lead to a higher incidence of infertility, said senior author Mitchell Rosen, MD, director of the UCSF Fertility Preservation Center and associate professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences. This can add to the significant psychological implications of being a BRCA1/2 carrier, and will likely have an impact on reproductive decision-making, Rosen said.

Mutations in either of the genes BRCA 1 or BRCA 2 can produce a hereditary, lifetime risk of developing breast cancer and ovarian cancer. Some women decide to reduce their risk by undergoing prophylactic surgery to remove at-risk tissue, including their breasts and ovaries. The abnormal genes are the most identified inherited cause of breast cancer carriers are five times more likely to develop breast cancer than those without the mutations, according to the National Cancer Institute.

The new study was designed to determine whether women with the BRCA1 or BRCA2 mutation have an earlier onset of menopause compared with unaffected women.

The researchers looked at nearly 400 female carriers of mutations in the BRCA gene in northern California and compared their onset of menopause to that of 765 women in the same geographic area without the mutation. Most of the women in the study were white because almost all of the BRCA1/2 carriers within the UCSF cancer risk registry are white.

The scientists found that women with the harmful mutation experienced menopause at a significantly younger age 50 years -- compared to age 53 for the other midlife women.

Heavy smokers (more than 20 cigarettes a day) with the abnormal gene had an even earlier onset of menopause -- 46 years. By comparison, only seven percent of white women in northern California had undergone menopause by that age, said the authors. Smoking has been shown to alter menstrual cycles and estrogen status, among other impacts.

The authors point out that while their study shows a possible increased risk of infertility for the mutation carriers, further study is needed. They also said that data regarding the age of natural menopause is limited because most women with the mutation are recommended to undergo risk-reducing surgery after they complete childbearing.

Women with the mutation are faced with challenges in reproductive choices, said study co-author Lee-may Chen, MD, a professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Services. These data may help women understand that their childbearing years may be even more limited by earlier menopause, so that they can make decisions about their reproductive choices and cancer risk-reducing surgery.

The first author of the study is Wayne T. Lin, MD, MPH, who at the time of the research was a resident at UCSF and is now a fellow at the Brigham and Womens Hospital at Harvard Medical School. Other authors include Marcelle Cedars, MD, a UCSF professor and director of the Division of Reproductive Endocrinology in the Department of Obstetrics, Gynecology and Reproductive Services ; and Mary Beattie, MD, clinical professor in the UCSF Department of Medicine. Study data was collected from the Cancer Risk Program at UCSF and the northern California site of the Study of Womens Health Across the Nation, a project of the University of California Davis and Kaiser Permanente.

Funding for the study was provided by National Institutes of Health grants NR004061, AG012505, AG012535, AG012531, AG012539, AG012546, AG012553, AG012554, and AG012495. Support was also provided by the UCSF Cancer Risk Program Patient Registry, which is supported by the UCSF Helen Diller Family Comprehensive Cancer Center. The Study of Womens Health Across the Nation has grant support from the NIH, Department of Health and Human Services through the National Institute on Aging, the National Institute of Nursing Research, and the NIH Office of Research on Womens Health.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.

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Travel Risk Management Safety and Security Tips Video Series Released

Business and leisure travel can be filled with excitement and opportunity but unfortunately, bad things happen to good people everyday. Therefore, all travel should be considered hazardous, until proven otherwise according to Travel Risk Management Solutions.

To help travellers and travel managers understand the processes, threats and hazards, the online information and advisory service run by Travel Risk Management Solutions has released 70 Travel Risk Management Safety and Security Tips on video.

Each of the unique, 2-5 minute videos focuses on routine travel health, safety and security issues and provides professional advice on how to make travel more profitable, efficient and safer. This first series, is part of a larger 200+ video series to follow in 2013. Also in the series is a 200+ travel risk management safety and security tips image sequence with specific travel images accompanied by short, professional advisory tips and recommendations.

Awareness of travel threats and hazards ranging from flight cancellations, bad weather conditions, natural disasters, civil unrest and localized crime is at and all time high commented Tony Ridley, Editor-in-Chief of www.travelriskmanagementsolutions.com . As an experienced and internationally recognized travel risk management professional Tony went on to say It is no longer good enough, both from a legal perspective and that of public opinion, not to make informed decisions about business or leisure travel. In order to make an informed decision, travellers, travel managers and risk managers all need to understand the whole-of-journey health, safety and security aspects; and that is what this series of complimentary video and image tutorials is designed to do concluded Tony Ridley.

This unique offering of Travel Risk Management Safety and Security Tips can be found at www.travelriskmanagementsolutions.com along with a wide range of business and leisure travel risk management content on areas such as duty of care, negligence, due diligence, health and safety legislation, risk assessments and travel management solutions.The series contains:

About Travel Risk Management Solutions
www.travelriskmanagementsolutions.com is a professional services information and advisory channel for those responsible for business and leisure travel. It also acts as a reference resource for travellers. It is managed and maintained by a professional network of subject matter experts on travel, travel management, risk management, health and safety, travel security, aviation, corporate security and other associated business and leisure fields of expertise.

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The best business ideas for 2013 are those that enable aspiring entrepreneurs to make a decent income without having to risk too much of their savings as capital. The rule of thumb is that people should only invest money that they can afford to lose. For most people, this does not amount to much, if anything. This is why there are so many people who are looking for low cost business ideas for the year ahead. EmpoweredEzine.com recently reviewed some of these business opportunities in blog post.

Making the jump from conventional employment to becoming a personal business owner can be a scary and risky venture. But many people have decided to take that risk, as staying where they are and having to depend on a company or business that could decide to downsize and cut their jobs at any time is also quite a risk, and one that does not carry the same potential for reward as starting a personal business.

There are a lot of business ideas that are particularly appealing because they can be started off small and can then grow as the business owners confidence and skill and the business profits grows. Starting off small would help to decrease the risk of jumping feet first into a business, only to have that business fold underneath them.

By starting small, a new business owner can work on the new business without completely cutting ties with their 9 to 5 jobs. This way they still have that monthly support to keep them going as the business starts off and things start moving.

However, there are others that suggest that the best way to start a new business is to go all in. They reason that if the person still has the safety net of a conventional job, that they will never take the kind of risks that would make a so-so personal business into a major success. This could be true in some cases, however intense research into the business and the market should be conducted and everything possible should be done to protect the investment and ensure that if things do not pan out, the damages will not be too much to recover from.

The main thing that aspiring entrepreneurs should keep in mind before investing in any of the trending business ideas in 2013, is that there is no perfect investment opportunity. There are certain businesses that are perfect for certain people, however they may not be the best for others. The persons interests, talents, and the amount of time they are willing or able to invest in the business should all be taken into account, as these factors can be just as important as the amount of capital the person has to invest.

Doing enough research, seeking advice from experts in the field, and really weighing the pros and cons of each business opportunity are a must in order to find the best business ideas for each individual. For more information on some of the popular business ideas that are gaining momentum as the year begins, please visit the Empowered Ezine website for a full Top Business Ideas For 2013 Review.

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