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Jafna L Cox

Publications and source records attributed to Jafna L Cox.

25 records · Page 2Linked to original sources
PubMed2003

Use of complementary and alternative medical therapies in patients with cardiovascular disease.

BACKGROUND: Complementary and alternative medical (CAM) therapies are becoming increasingly popular, yet little information is available about the prevalence and patterns of CAM therapy use by patients with cardiovascular disease (CVD). METHODS: Interviewers administered telephone questionnaires to 107 patients randomly selected from a stratified cohort of 2487 eligible patients participating in a registry of patients with CVD. RESULTS: The current use of CAM therapies was reported by 64% of the patients surveyed. Nutritional supplements (40%) and megadose vitamins (35%) were the most frequently used preparations. Most CAM therapy users (65%) cited their underlying cardiac condition as the reason for taking such therapy. The most common sources of information about CAM were a friend or relative (43%) or the respondent's usual physician. However, although 80% of respondents claimed that they had discussed their use of CAM therapies with their physician, 58% of respondents taking a potentially toxic cardiovascular medication (digoxin, warfarin, sotalol, or amiodarone) were simultaneously taking an oral supplement. CONCLUSION: The use of CAM therapies was high in the cohort of patients surveyed. Physicians caring for patients with CVD need to inquire about CAM therapy use. Further scientific study should be performed to evaluate the potential benefits and risks of CAM therapies in this patient population.

Aged↗
PubMed2003

Diabetes control among patients presenting with acute myocardial infarction in a Canadian tertiary health care setting.

BACKGROUND: The use of an insulin infusion following myocardial infarction, and its consequent lowering of glucose, significantly improves mortality. OBJECTIVE: To explore whether this knowledge was being applied in clinical practice. METHODS: The authors conducted a chart audit of all subjects with an acute myocardial infarction admitted to the coronary care unit of a tertiary health care centre in Nova Scotia between January 1, 2000 and December 31, 2000. Information was obtained from a computerized database as well as individual chart review. Treatment of patients with and without diabetes was specifically compared. RESULTS: There were 447 total admissions. One hundred and twenty-eight had diabetes mellitus and the majority of these (93%) had type 2 diabetes. Most patients (54%) sustained a non-Q wave infarction and 77% had either thrombolytic therapy or cardiac catheterization. Mean glucose on admission and discharge was 11.32 mmol/L and 9.86 mmol/L, respectively. Diabetes was managed conservatively among 98%, and only 2% received insulin infusion therapy. Only 16.3% of diabetic patients had their glycated hemoglobin A1c checked (mean value 9.12%). In-hospital mortality was 21% among patients with diabetes and 10.4% among those without. CONCLUSIONS: The present study highlights the poor outcome of patients with diabetes presenting with acute myocardial infarction. Despite clinical trial evidence suggesting that use of insulin infusion would confer significant benefit in this population, it was markedly underused even in a setting where other evidence-based therapies were well prescribed. These findings raise questions about the need for national clinical practice guidelines incorporating the use of insulin infusion in standard care.

Aged↗
PubMed2002

Is blood glucose an independent predictor of mortality in acute myocardial infarction in the thrombolytic era?

OBJECTIVES: This study was designed to assess the prognostic significance of hyperglycemia in acute myocardial infarction (AMI) in the thrombolytic era using contemporary criteria for hyperglycemia. BACKGROUND: Most studies that have examined this issue were performed before the widespread use of disease-modifying therapies and varied in their definition of hyperglycemia, assessment of risk factors, and reported outcomes. METHODS: There were 1,664 consecutively hospitalized patients with AMI between October 1997 and October 1998 from a disease-specific, population-based registry. Patients were stratified according to history of diabetes mellitus and, further, according to whether they had a blood glucose >198 mg/dl (11 mmol/l). The influences of cardiac risk factors, medications, and interventions were analyzed, and multivariate logistic regression was used to determine the influence of blood glucose on mortality. RESULTS: In patients without a history of diabetes, glucose levels were < or =198 mg/dl in 1,078 patients (Group 1) and >198 mg/dl in 135 (Group 2). Of those with diabetes, glucose levels were < or =198 mg/dl in 169 patients (Group 3) and >198 mg/dl in 282 (Group 4). Compared with Group 1 patients, the odds ratios (95% confidence interval) for in-hospital mortality among those in Groups 2, 3, and 4 were 2.44 (1.42 to 4.20; p = 0.001), 1.87 (1.05 to 3.34; p = 0.035), and 1.91 (1.16 to 3.14; p = 0.011), respectively. These groups also had greater 12-month mortality. CONCLUSIONS: Hyperglycemia in AMI is associated with poor outcome even among patients without known diabetes. This finding underlines the need for aggressive glucose management in this setting and may support a more vigorous screening strategy for early recognition of diabetes.

Aged↗
PubMed2002

A qualitative study of evidence in primary care: what the practitioners are saying.

BACKGROUND: Little is known about the impact of evidence-based medicine in primary care. Our objective was to explore the influence of evidence on day-to-day family practice, with specific reference to cardiovascular disease. METHODS: A total of 9 focus groups were conducted in rural, semi-urban and urban settings in Nova Scotia. The participants were 50 family physicians who had practised in their communities for more than 1 year and who were treating patients with cardiovascular disease. FINDINGS: Two major themes emerged: evidence in the clinical encounter and the culture of evidence. The family physicians reported thinking about evidence during the clinical encounter but still situated that evidence within the specific context of their patients and their communities. They appreciated evidence that had been appraised, summarized and published as a guideline by an independent national organization. Evidence remained in the forefront of consciousness for a limited time frame. Local specialists, trusted because of their previous successes with shared patient care, were important sources and interpreters of evidence. INTERPRETATION: Day-to-day family practice offers both obstacles and opportunities for the application of evidence. Although evidence is an important part of clinical practice, it is not absolute and is considered along with many other factors.

Cardiovascular Diseases↗
PubMed2002

New use of antiarrhythmia drugs in Saskatchewan.

BACKGROUND: Cardiac dysrhythmias are a diverse group of disorders and many are associated with significant morbidity and mortality. Because their recent therapeutic management has not been adequately described, this study details the antiarrhythmia drugs that were dispensed to patients who had not received therapy in the preceding two years, and it evaluates the potential indications for the drugs as well as whether the therapy is consistent with the recommended procedures. METHODS: Patients who were dispensed a [Vaughn Williams?] class I or class III antiarrhythmia drug in 1993 or 1994, but not during the two previous years, were identified from the Saskatchewan prescription drug datafile. The drug data were linked with other information that was obtained from the provincial administrative health care utilization datafiles. Further clinical data were obtained from hospital charts and, to a limited extent, from physicians' records. RESULTS: Most patients were elderly (median age of 70 years) and were men (58.0%), although sotalol was prescribed more frequently to women (53.0%). A potential indication was identified for 63.8% of the patients and, of these, the most common was atrial fibrillation (65.3%). Almost half of the patients had a history of myocardial infarction, congestive heart failure or cardiomyopathy, and one-quarter of those were treated with amiodarone. CONCLUSIONS: While it is not possible to prove a direct link, the results of the present study are broadly consistent with the 'evidence-based' lessons of the Cardiac Arrhythmia Suppression Trial and other studies. The increasing use of propafenone, however, may indicate a lack of appreciation for the fact that, as a class IC drug, there is at least the potential for an adverse outcome when propafenone is used in patients with structural heart disease.

Adult↗