The competencies describe the implications of the study for current practice. The translational outlook places the work in a futuristic context, emphasizing directions for additional research. The ACCF has adopted this format for its competency and training statements, career milestones, lifelong learning, and educational programs.
Authors are asked to consider the clinical implications of their report and identify applications in one or more these competency domains that could be used by clinician-readers to enhance their competency as professional caregivers.
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This applies not only to physicians-in-training, but to the sustained commitment to education and continuous improvement across the span of their professional careers. Translational Outlook Translating biomedical research from the laboratory bench, clinical trials, or global observations to the care of individual patients can expedite discovery of new diagnostic tools and treatments through multidisciplinary collaboration.
Effective translational medicine facilitates implementation of evolving strategies for prevention and treatment of disease in the community. The Institute of Medicine identified 2 areas needing improvement: testing basic research findings in properly designed clinical trials and, once the safety and efficacy of an intervention has been confirmed, more efficiently promulgating its adoption into standard practice Sung NS, Crowley WF, Genel M.
The meaning of translational research and why it matters. JAMA ; Authors are asked to place their work in the context of the scientific continuum, by identifying impediments and challenges requiring further investigation and anticipating next steps and directions for future research. Competency in Patient Care: The diabetic patient with coronary symptomatology, prior to the diagnostic catheterization, should be made aware that if multivessel disease is identified and intervention is indicated, surgical consultation should be entertained.
Translational Outlook 1: Although this is a relatively short-term study median of 3. Translational Outlook 2: Compliance to medication is nonsatisfactory in patients with coronary artery disease. Comparing the compliance of FREEDOM patients taking a "polypill" approach including aspirin, statin, and an angiotensin-converting enzyme inhibitor with the compliance of patients treated conventionally with individual agents should be undertaken.
Positron emission tomography with Flabeled FDG has been employed for the identification of the macrophages in high-risk patients. Imaging with mannose, the isomer of glucose, may have an advantage because a subset of macrophages in high-risk plaques develop mannose receptors. Translational Outlook 1: Although circulating biomarkers of inflammation, such as hs-CRP, provide reliable information of systemic inflammation, detection of inflammation at the plaque level may allow identification of the high-risk plaques.
Translational Outlook 2: Plaque imaging with sugars, although feasible, must in a randomized fashion investigate whether treatment of individual high-risk plaques would favorably influence major adverse outcomes in atherosclerotic disease. Competency in Medical Knowledge 2: The oral direct thrombin inhibitor, dabigatran, and factor Xa inhibitors, rivaroxaban, apixaban, and edoxaban so-called novel oral anticoagulants or NOACs avoid the dietary restrictions and need for routine coagulation monitoring that are cumbersome aspects of anticoagulation with vitamin K antagonists such as warfarin.
Competency in Patient Care: All 3 NOACs currently approved for clinical use in the United States represent advances over warfarin because of their more predictable pharmacological profiles, fewer drug interactions, and considerably lower risk of intracranial bleeding than warfarin, but these advantages come at greater monetary cost, and there is presently no approved antidote or validated strategy rapid reversal of anticoagulation induced by any of the NOACs.
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Translational Outlook 1: The mechanism by which each of the NOACs evaluated to date cause less intracerebral hemorrhage than well-managed warfarin anticoagulation requires further investigation. Translational Outlook 2: Additional research is needed to understand the safety and efficacy of the NOACs, alone or in combination in patients with mechanical prosthetic heart valves to overcome the toxicity of this type of anticoagulation in the limited studies undertaken to date that contraindicate their use in patients who have undergone heart valve replacement with mechanical prostheses.
The reference list should be typed double-spaced on pages separate from the text; references must be numbered consecutively in the order in which they are mentioned in the text. Do not cite personal communications, manuscripts in preparation, or other unpublished data in the references; these may be cited in the text in parentheses. Do not cite abstracts that are older than 2 years.
Websites must be cited as references. It is important to note that when citing an article from the Journal of the American College of Cardiology , the correct citation format is J Am Coll Cardiol. Use the following style and punctuation for references: Periodical. Do not use periods after the authors' initials.
Glantz SA. It is all in the numbers. J Am Coll Cardiol ; Evidence for pre-procedural statin therapy: meta-analysis of randomized trials. Provide author s , chapter title, editor s , book title, publisher location, publisher name, year, and inclusive page numbers. Molecular biology of thrombolytic agents. In: Roberts R, editor. Molecular Basis of Cardiology. Provide a specific not inclusive page number. Cohn PF. Silent Myocardial Ischemia and Infarction.
Provide specific URL address and date information was accessed. Henkel J. FDA Consumer magazine [serial online]. January-February Accessed August 31, Provide authors, presentation title, full meeting title, meeting dates, and meeting location. Eisenberg J. Market forces and physician workforce reform: why they may not work.
All abbreviations used in the figure should be identified either after their first mention in the legend or in alphabetical order at the end of each legend. All symbols used arrows, circles, etc. Target length should be words per figure. All figures must have a number, title, and caption. Figures should be cited in numerical order in the text. Figure titles should be short and followed by a 2 to 3 sentence caption.
Your Central Illustration, if not an existing figure, should be listed first. If the figure has been previously published, cite the figure source in the legend. All abbreviations used in the figure should be identified in alphabetical order at the end of each legend see also Figures. TABLES Each table should be on a separate page, with the table number and title centered above the table and explanatory notes below the table. Use Arabic numbers. Table numbers must correspond with the order cited in the text. Tables should be self-explanatory, and the data presented in them should not be duplicated in the text or figures.
All tables must have a title. Abbreviations should be listed in a footnote under the table in alphabetical order.
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Cite the source of the table in the footnote. Our in-house medical illustrators will create the final printable versions of these figures in consultation with the authors and the editors. The purpose of these illustrations is to provide a snapshot of your paper in a single visual, conceptual manner. This illustration must be accompanied by a legend title and caption. The Central Illustration legend should be listed first in your list of figure legends, unless it is an existing figure. Color images must be at least DPI. Gray scale images should be at least DPI. All abbreviations used in the figure should be identified in an alphabetical order at the end of each legend.
Figure legends should be typed double-spaced on pages separate from the text. Figure numbers must correspond with the order in which they are mentioned in the text. If previously published figures are used, written permission from the original publisher is required.
Video submissions for viewing online should be one of the following formats: AudioVideo Interleave. Videos should be brief whenever possible less than 5 minutes. Longer videos will require longer download times and may have difficulty playing online.
Videos should be restricted to the most critical aspects of your research. A longer procedure can be restructured as several shorter videos and submitted in that form. It is advisable to compress files to use as little bandwidth as possible and to avoid overly long download times. Video files should be no larger than 5 megabytes. A video legends page giving a brief description of the video content should be provided for each video. By submitting an article to the journal, all authors of the submission agree to receive emails from all the American College of Cardiology's JACC Journals regarding yourmanuscript, including editorialquerieswhile themanuscript is under review and emails fromthe publisher should the paper be accepted for publication.
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The contact information provided by the corresponding author will be included in the galley proofs, the published PDF version of the manuscript, and the online version of the manuscript. Studies should be in compliance with human studies committees and animal welfare regulations of the authors' institutions and the U.
enter Food and Drug Administration guidelines. Human studies must be performed with the subjects' written informed consent. Authors must provide the details of this procedure and indicate that the institutional committee on human research has approved the study protocol. If radiation is used in a research procedure, the radiation exposure must be specified in the Methods.
Studies on patients or volunteers require ethics committee approval and informed consent, which should be documented in your paper. Patients have a right to privacy. These same 5 components were used in the interventions incorporated into the HBCR studies we reviewed Supplemental Table 2. We believe it is critical for both providers and patients to design HBCR programs to include important and effective risk-modifying health behaviors that patients can directly control physical activity, healthy eating, medication adherence, smoking, and stress management.
Figure 2. Structure, process, and outcome metrics for home-based cardiac rehabilitation. All studies we reviewed included an initial baseline evaluation of participants. The medical history encompasses cardiovascular events, procedures and surgery, left ventricular function, comorbid conditions eg, mental health and substance abuse , current symptoms eg, chest pain, shortness of breath, lower extremity edema , and lifestyle habits dietary, physical activity, tobacco and alcohol habits. The physical examination includes a full cardiovascular-focused examination.
Testing includes the assessment of physical fitness usually measured by maximal exercise capacity or distance on a 6-minute walk test and other components that help to assess cardiovascular health, including a lead ECG, blood pressure, resting heart rate, lipid levels, body mass index, waist circumference, waist-to-hip ratio, blood glucose, glycosylated hemoglobin, psychosocial factors eg, marital status, social support, anxiety, and depressive symptoms , frailty eg, neuromuscular status, balance, and cognition function , sleep-related health, and patient-reported quality of life.
In some cases, intensity or modality was not reported. The majority of HBCR exercise protocols involved walking with variable support via telephone calls or home visits from a physical therapist, exercise physiologist, or nurse. One HBCR program provided 4 weeks 12 sessions of supervised CBCR exercise sessions with electrocardiographic monitoring, 35 and another provided 12 onsite visits or telephone calls, depending on patient preference. The provision of home exercise equipment is a potentially important component of HBCR that has not been thoroughly evaluated by the existing studies.