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[Continuous practice and advanced training in interventional cardiology. Recommendations for the assessment and maintenance of proficiency in interventional cardiology. A statement for physicians and advanced training units from the Section of Hemodynamics and Interventional Cardiology of the Spanish Society of Cardiology].

This report reflects the interest of the Section of Hemodynamics and Interventional Cardiology of the Spanish Society of Cardiology in increasing quality, safety and applicability of percutaneous procedures, by giving scientific keys aimed at improving related functions of teaching or planning in this field and enhancing competence and prestige of Spanish interventional cardiologists. The purpose of the document is to describe the importance of current interventional cardiology, to identify quality references and to establish minimum acceptable requirements for assessing and maintaining the competence of practicing or providing advanced training in this discipline. To achieve this goal, a search for a gold standard of the different techniques of general interventional practice was carried out, and predictors of postprocedural outcome were analyzed, as well as their relation with different kinds of circumstances. This analysis identified coronary angioplasty as the standard on which recommendations regarding competence in overall interventional cardiology standards of quality and assessment and maintenance of proficiency must be based. On the other hand, the strong influence of experience and knowledge of results has been documented, especially in high-risk or high-complexity settings. On this basis, the report establishes specific recommendations about proficiency for practice and advanced training. It also suggests that interventional cardiology should be considered as a subspecialty, of cardiology requiring specific credentials.

Cardiology↗

[Indications for clinical applications of positron emission tomography in cardiology. Position report of the PET Cardiology Study Group of the German Society of Nuclear Medicine and the Nuclear Cardiology Study Circle of the German Society of Cardiology].

Positron emission tomography (PET) represents the most advanced scintigraphic technique which allows accurate qualitative and quantitative assessment of regional myocardial tracer distribution. Besides its well documented potential as a research tool, PET has gained increasing clinical acceptance in cardiology. At the current time, the two most important clinical indications are the detection of coronary artery disease using perfusion traces and the evaluation of patients with advanced coronary artery disease and impaired left ventricular function for identification of tissue viability using metabolic tracers. Direct comparison of PET and SPECT imaging has shown improved diagnostic accuracy of PET imaging for detection of CAD. However, the high cost and limited availability of this technique limit its widespread application as routine method for detection of CAD. Nevertheless, for determination of the functional significance of regional stenoses, PET is the most accurate non-invasive method available. Numerous studies using PET FDG-imaging have demonstrated the high diagnostic accuracy of metabolic imaging for the detection of tissue viability. Recovery of function following revascularization can be predicted with high positive and negative predictive value. Based on its documented diagnostic performance, PET is recommended for assessment of tissue viability especially in patients with severely impaired left ventricular function who are candidates for revascularization or cardiac transplantation. Promising new advances in imaging technology may reduce the costs of PET instrumentation and, therefore, widen the clinical application of this technique.

Coronary Disease↗

The ACC professional life survey: career decisions of women and men in cardiology. A report of the Committee on Women in Cardiology. American College of Cardiology.

OBJECTIVES: This survey was conducted to learn how the career decisions of women and men in cardiology influenced their professional and personal lives. BACKGROUND: Women represent only 5% of practicing adult cardiologists and 10% of trainees. Yet, women and men now enter medical school at nearly equal numbers. The factors that contribute to career satisfaction in cardiology should be identified to permit the development of future strategies to ensure that the best possible candidates are attracted to the profession. METHODS: A questionnaire developed by the Ad Hoc Committee on Women in Cardiology of the American College of Cardiology (ACC) was mailed in March 1996 to all 964 female ACC members and an age-matched sample of 1,199 male members who had completed cardiovascular training. RESULTS: Women were more likely to describe their primary or secondary role as a clinical/noninvasive than invasive cardiologist (p < 0.0001 women vs. men). Men and women both reported a high level of satisfaction with family life, but women were less satisfied with their work as cardiologists (88% vs. 92%, p < 0.01) and with their level of financial compensation. Compared with men, women expressed less overall satisfaction (69% vs. 84%) and more dissatisfaction with their ability to achieve professional goals (21% vs. 9%). These differences were most pronounced for women in academic practice. Women reported greater family responsibilities, which may limit their opportunities for career advancement. Women were more likely to alter training or practice focus to avoid radiation. A majority of women (71%) reported gender discrimination, whereas only 21% of men reported any discrimination, largely due to race, religion or foreign origin. CONCLUSIONS: Women cardiologists report overall lower satisfaction with work and advancement, particularly within academic practice. They report more discrimination, more concerns about radiation and more limitations due to family responsibilities, which may ultimately explain the low percentage of women in cardiology. Attention to these issues may result in programs to improve professional satisfaction and attract the best candidates into cardiology in the future.

Adult↗

Recommendations of the European Board for the Specialty Cardiology (EBSC) for education and training in basic cardiology in Europe. The Executive Committee of the European Board for the Specialty Cardiology.

The Cardiology Monosection of the UEMS and the European Society of Cardiology have created a European Board for the Specialty of Cardiology whose task is to prove guidelines for training and training institutions. The recommendations are presented here and in summary require at least 3 years education and training in basic cardiology (after at least 2 years of a common trunk of general internal medicine) at an approved institution with adequate exposure to all aspects of adult cardiological practice.

Adult↗

Recommendations of the European Board for the Specialty Cardiology (EBSC) for education and training in basic cardiology in Europe. The Executive Committee of the European Board for the Specialty Cardiology.

The Cardiology Monosection of the UEMS and the European Society of Cardiology have created a European Board for the Specialty of Cardiology whose task is to prove guidelines for training and training institutions. The recommendations are presented here and in summary require at least 3 years education and training in basic cardiology (after at least 2 years of a common trunk of general internal medicine) at an approved institution with adequate exposure to all aspects of adult cardiological practice.

Cardiology↗

[A resources-activities analysis in cardiology: a report on Piemonte experience. The Cardiology Network of the Piemonte Section of the Associazione Nazionale Medici Cardiologi Ospedalieri].

We are living in an era characterized by cost-containment. Thus, expenditure for the health system represents one of the most important items of the national balance. Nowadays, the optimal management of health organization is essential. In addition, patients expect hospitals to provide more and more effective and efficient cures. With respect to this need, in order to achieve high standard of health cure, the identification of work and the time that the medical departments dedicate to a specific therapeutic and/or diagnostic procedure represent a fundamental tool for the optimal management of patients. However, to provide reliable results, these data should be collected in the largest number of structures possible. For this purpose, 17 departments of cardiology have organized a network with the goal of creating the most important data base on this matter available in Italy. The evaluation of the data obtained (more than 8000 medical procedures) allows us to identify the resources normally used for curing patients admitted to cardiological departments. These provide an extensive view of the work load in the Public Health Services fundamental to implementing a health service in accordance with the criteria of Total Quality Management. The present paper illustrates the scope of this study and the methods used to create the data base. In addition, it discusses some cultural aspects related to the introduction of managerial criteria in the medical arena. The detailed results, regarding the items analyzed, will be presented in a special paper.

Cardiology↗

Nuclear cardiology in the UK: British Nuclear Cardiology Society survey 1994.

This study surveyed practice in nuclear cardiology in the UK in 1994. A questionnaire was sent to 219 centres performing nuclear imaging asking for details of current practice in nuclear cardiology. Replies were received from 192 centres (88%). Activity in performance of myocardial perfusion imaging (MPI) and radionuclide ventriculography (RNV), anticipated changes in activity, differences between regional and district general hospitals, technical imaging parameters and referral sources were surveyed. Of the responding centres, 125 (65%) performed nuclear cardiology. More regional centres (85 vs 55%, P < 0.0003) performed a higher proportion (62 vs 24%, P < 0.001) of nuclear cardiology activity compared with district general hospitals. Nuclear medicine activity was estimated at 9.3 scans/1000/year, of which 8.9% was cardiology (0.82/1000/year; MPI, 0.56/1000/year; RNV, 0.26/1000/year). A comparison with previous surveys showed a significant increase of 24% in nuclear cardiology since 1988, with a strong rise in MPI (350%); however, RNV has fallen by 47%. Myocardial perfusion activity in the UK remains very low (25 and 5% for MPI and RNV respectively) when compared with the average of 2.2/1000/year for Europe and 10.8/1000/year for the USA. In conclusion, MPI has increased on average by 23% per annum (compound rate) since 1988, but in 1994 was still only 32% of the British Cardiac Society target of 2.6 scans/1000/year. Proper resourcing for capital expenditure on new equipment and new staff will be important to maintain momentum in closing the gap. Also important is clinical understanding, as already implemented by including nuclear cardiology in guidelines for specialist cardiology training.

Cardiology↗

[10 years of nuclear cardiology. (I). Clinical development and technological progress in nuclear medicine at the Ignacio Chávez National Cardiological Institute].

The department of nuclear medicine of the Instituto Nacional de Cardiología started at the right moment (June 2, 1977), when the first cardiological procedures were developed. Unfortunately, it coincided in time with the beginning of the financial crisis. The higher costs of nuclear medicine instruments and operationsdid not allow the evolution of the department according to the original project, as nuclear cardiology demands special tracers and instrumentation, which are expensive and only available abroad. To solve these problems, we planned the creation of our own technology. We created a laboratory for radiopharmacy to elaborate lyophylized ingredients for the "cold" kits for instant labeling with 99Tcm of several tracers. With this, we achieved a substantial decrease in the operating costs, with total independence of commercial firms, and the future of the department was assured. In the field of instrumentation, a new system for tomodensitometric imaging of the thorax has been created by using two external gamma sources 99Tcm, and a digital system for image display and analysis was designed, built and programmed. This system, allowed the development of the quantitative technique of nuclear cardiology. We expect the software menu to be finished within this year. The transit from general nuclear medicine to nuclear cardiology has been slow in this Institute. During the first 8 years, the cardiological studies represented 10.8% of all in vivo studies; this figure increased to 37.8% in 1986. However, the increasing demand of cardiological studies tends to displace other in vivo studies due to oversaturation of the gamma-camera and the digital system. It can be concluded that the evolution of nuclear cardiology has been slow in this Institute, but represents a factual progress based on the creation of a technological substructure with internal resources.

Angiocardiography↗

Staffing in cardiology in the United Kingdom 1990. Sixth biennial survey: with data on facilities in cardiology in England and Wales 1989.

The Sixth Biennial Survey of Staffing in Cardiology was conducted in July 1990. This report summarises the data that were collected, together with the results of a survey of facilities in cardiology made in 1989. The total number of cardiologists in the United Kingdom, defined as individuals trained in the specialty and spending at least 40% of their time working in it, is now 323. Six individuals work part time only, making 320 whole time posts. This number has increased over the two years from 1988 to 1990 by 32, of which 23 work only in the specialty and nine as general physicians with a major interest in cardiology. The rate of increase in numbers over the past decade has been reasonably consistent with an average of approximately 4.4% per year. Thirty one districts in England and Wales still have no cardiologist and 13 other districts have little provision with an average of three (visiting) sessions each per week. The population in these 44 districts is 8.3 million. Scotland also has an inadequate distribution of service in the specialty. If recommendations for cardiac surgery and angioplasty made in the Fourth Report of a Joint Cardiology Committee of the Royal College of Physicians of London and the Royal College of Surgeons of England are to be met, we calculate that we need 63 more cardiologists in our major centres. To provide one cardiologist in every district hospital and two for larger districts would require 94 more specialists, making a total shortfall of 157 individuals. We have no excess of senior registrars to provide for a major expansion at consultant level. Time spent within the senior registrar (or academic equivalent) grade has tended steadily to decline and very few now reach the end of their contracts. The need for more individuals to pass through the senior registrar grade will be met in part by a planned reduction in the training period to three years. This will be inadequate, however, because projected retirements show that the number of consultant vacancies will increase sharply from 1997. We believe that additional senior registrar posts must be created if a serious shortfall in service provision by consultants is to be avoided. The provision of non-invasive facilities in cardiology is reasonable. The need for additional equipment for invasive cardiology has not been assessed. The number of physiological measurement technicians varies considerably between regions and is generally inadequate.

Allied Health Personnel↗