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Clinical Communication, Cancer Patients &Considerations to Minimize the Challenges

Journal of Cancer Therapy 2016年第2期7卷 107-113页

作者： Irtiza Hasan tasnuva rashid Internal Medicine The University of Edinburgh Edinburgh UK Epidemiology Human Genetics & Environmental Sciences Department School of Public Health The University of Texas HSC at Houston Houston TX USA

Clinical communication is a multidimensional concept, which encompasses the core of effective clinical practice. Communication in cancer patients is particularly challenging and yet a less focused area in cancer care. Various barriers and challenges in communication may affect the management protocol of cancer patients. Challenges may arise in various dimensions of cancer care including breaking bad news to delivery of complex clinical information, determination of appropriate treatment strategies, dealing with uncertainties, end of life counseling as well as cultural and language barriers affecting the whole communication dynamics. Effective communication is the basic foundation for responsive treatment decisions, positive health outcome, patient driven compliance and overall high quality of care. Thus, there is a need for acknowledging and actively deciphering the challenges and developing and promoting various protocols of effective communication skills in cancer patients.

关键词： Physician-Patient Communication Communication with Cancer Patients Communication Challenges Patient-Centered Communication

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PCI in Post Thrombolysis Stable STEMI Patients: A Timeline in Question

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World Journal of Cardiovascular Diseases 2015年第12期5卷 335-342页

作者： Irtiza Hasan tasnuva rashid Md. Harun Ur rashid Bhuiyan Cardiology University of Canterbury Christ Church University Kent UK Internal Medicine The University of Edinburgh Edinburgh UK Department of Epidemiology The University of Texas HSC at Houston School of Public Health Texas USA Clinical & Interventional Cardiology Z.H. Sikder Cardiac Care & Research Centre Dhaka Bangladesh

ST elevation myocardial infarction (STEMI) occupies a significant portion of the cardiovascular disease spectrum and poses a continuing challenge on the health care delivery system worldwide. A dilemma exists in the clinical triage system for appropriate strategic modalities of treatment, based on underlying triad of patient-hospital-cardiac pathological factors as well as cut off timelines. Current European Society of Cardiology (ESC) guideline recommends percutaneous coronary intervention (PCI) within 3 to 24 hours in post thrombolysis stable patients. This review critically evaluated the evidences underlying the ESC recommendation. Trials included in this review are SIAM III, GRACIA 1, CAPITAL-AMI, CARESS-IN-AMI, NORDISTEMI, PRAGUE-1, WEST and LEIPZIG. Most of the evidences support the notion for immediate post thrombolysis PCI in stable patients within 1.9 to 2.7 hours, which contradicts the ESC timeline of up to 24 hours. Also, there is a reduced generalizability of the trial results due to differences in the design of the various trials, study population, composite endpoints, variations in drug dose & formulation, co-administration of pharmacotherapies and type of stents used. This warrants further research for standardization & optimization of the treatment protocol with respect to post thrombolysis PCI in stable STEMI patients.

关键词： ST-Elevation Myocardial Infarction (STEMI) Percutaneous Coronary Intervention (PCI) Thrombolysis European Society of Cardiology (ESC) Guideline

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A Critical Evaluation of the Role of Routine Uses of Statin as a Tool for Primary Prevention of Cardiovascular Diseases

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Open Journal of Preventive Medicine 2016年第4期6卷 133-142页

作者： Irtiza Hasan tasnuva rashid Md. Harun Ur rashid Bhuiyan Cardiology Canterbury Christ Church University Kent UK Internal Medicine The University of Edinburgh Edinburgh UK Department of Epidemiology School of Public Health The University of Texas HSC Houston TX USA Clinical & Interventional Cardiology Z. H. Sikder Cardiac Care & Research Centre Dhaka Bangladesh

Use of Statin is a cornerstone in modern day medical practice and an essential component for primary prevention of cardiovascular diseases (CVD). Various evidences exemplify and resonate the importance of Statins in reducing CVD mortality and improvement of survivability. However, there is a continental variation in recent guidelines directing lipid-lowering therapy in regards to aim, dose, timing as well as the protocol for initiation of therapy. Similar uncertainties exist with regards to the generalizability of the finding from available evidence, a variation of benefits of Statin with respect to age and gender, the validity of the research conducted and actual gain in survivability and mortality benefits. Thus, there is a need for looking at the actual indications, risk-benefit ratios and cost effectiveness before tediously prescribing Statin for the primary prevention of CVDs. This paper will attempt to critically review the evidence behind the uses of Statins in the primary prevention of CVDs.

关键词： Statin Cholesterol Cardiovascular Diseases Primary Prevention

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Routine Primary PCI;Whether and When Necessary for the Management of NSTEMI—An Evidence Based Evaluation

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World Journal of Cardiovascular Diseases 2015年第12期5卷 343-350页

Non ST elevated myocardial infarction (NSTEMI) accounts for a significant portion of the hospitalizations due to acute coronary syndromes worldwide and is posing a huge challenge towards the health care cost globally. This signifies the need for proper triage and management stratification for the best utilization of the health care resources. Primary Percutaneous Coronary Intervention (PCI) with early revascularization is a new emerging invasive technique and application of this technique is increasing tediously among the clinicians. However, the current body of evidences is divided between the efficacy, need and critical timing of PCI compared to conservative management in the treatment protocol for NSTEMI. A review of trials done comparing the early use of PCI versus conservative management indicates inconsistent finding with strong evidence towards early use of PCI in moderate to high-risk NSTEMI patients.

关键词： Non ST-Elevation Myocardial Infarction (NSTEMI) Percutaneous Coronary Intervention (PCI)

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