Pulmonary hypertension is an uncommon disease that carries a significant morbidity and mortality. Pulmonary arterial hypertension is a subtype of pulmonary hypertension that describes a group of disease entities that lead to an elevation in precapillary pulmonary artery pressure. Despite advances in the diagnosis and treatment of pulmonary arterial hypertension, it remains a difficult disease to recognize and manage. In this review article, we will discuss the definition and diagnosis of pulmonary arterial hypertension. Additionally, we will discuss the ever-expanding management options, their mechanisms and strategies, including combination therapy and the most recent advances and future directions.
Objective: Natural disasters, domestic terrorism and other forms of catastrophe, though rare, pose a significant public health challenge when they do occur. Hospital personnel must have the appropriate training to identify, treat, and possibly even oversee local disaster preparedness initiatives. Insufficient resources have been placed on the education received by healthcare providers in tertiary medical institutions. We intended to assess the current state of knowledge and interest in disaster preparedness among different tiers of hospital staff and training levels in order to identify potential barriers and areas for further training. Design: A cross-sectional online survey was given to hospital attending physicians, subspecialty fellows, residents, nurses, physician assistants, and their respective students. The survey questions were disseminated throughout the Society of Critical Care Medicine (SCCM) Members and the North Shore Long Island Jewish (NSLIJ) hospital system via e-mail newsletters. Main results: A total of 572 individuals participated between October 2013 and May 2014. 85% of respondents expected to be dealing with a disaster during their career. 61.5% of respondents noted they would not feel comfortable leading and directing a local disaster management initiative. Yet 51.9% of respondents treated victims of natural disasters, 56.5% of transportation disasters and 34.8% of a structural collapse. When asked about level of formal disaster management training: 27.5% noted that no training was provided and 33% noted that they received 12 hours of training and only a quarter had more than 48 hours of formal training. 86.6% of respondents noted an interest in participating in a disaster management training workshop. Conclusions: Many of our respondents had low level of disaster management training, did not feel comfortable leading a disaster initiative, however many have had to take care of victims of disasters. Based on our findings, hospital professionals feel under prepared for disaster management, and disaster preparedness should be considered an integral part of medical training.
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