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Background: Despite a growing body of data demonstrating the benefits of multidisciplinary care in heart failure, persistently high rates of readmission, especially within the first month of discharge, continue to be documented. Aims: As Ž . Ž part of an ongoing randomized study on the value of multidisciplinary care in a high risk NYHA Class IV , elderly mean age . Ž . 69 years heart failure population, we examined the effects of this intervention on previously high 20% 1-month readmission Ž . Ž . rates. Methods: Unlike previous studies of this approach, both multidisciplinary MC and routine care RC populations were Ž . cared for by the cardiology service, complied with adherence to clinical stability criteria prior to discharge 100% of patients Ž . Ž and received at least target dose angiotensin-converting enzyme ACE inhibition with perindopril prior to discharge 94% of . indicated patients . We analysed death and unplanned readmission for heart failure at 1 month. Results: This early report Ž . from the first 70 patients 67% male, 71% systolic dysfunction with a mean ejection fraction of 31.0" 6.7% enrolled in this study demonstrates elimination of 1-month hospital readmission in both RC and MC groups. This unexpected result Ž represents a dramatic improvement both for this patient cohort 20% 30-day readmission rate prior to enrolment reduced to . 0% following the index admission in both care groups and in comparison with available data. Conclusions: Critical contributors to this improvement appear to be specialist cardiology care, adherence to clinical stability criteria prior to discharge and routine use of target or high-dose ACE inhibitor therapy prior to discharge. Widespread application of this approach may have a dramatic improvement in morbidity of CHF while limiting the escalating costs of this condition. ᮊ

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Abstract. This account of 58 spontaneous tumors involving bone in domestic cats compares and contrasts the pathological findings with previous surveys. Of the tumors described, only one was diagnosed as benign. Squamous cell carcinoma was the most common tumor of the series; osteosarcoma was the most common primary tumor. Only two tumors metastasized to the lungs (one hemangiosarcoma and one osteosarcoma), and only three metastasized to a regional node (two squamous cell carcinomas and one lymphosarcoma).This paper reviews 58 spontaneously occurring tumors involving bone in domestic cats. These tumors were seen over a 14-year period at the Blue Cross Animals' Hospital where an average of 2,000 cats are seen each year. The 58 reported tumors do not represent all those encountered during this period-only those submitted for pathological investigation have been included.The initial diagnoses had been made clinically-usually supported by radiological and sometimes by biopsy examination. All but two cats were destroyed eventually, and postmortem examinations were done. Surgical excision was possible in only four cats, and in two the lesion recurred soon afterwards; the remaining two cats recovered.Osteosarcoma has been reported as the most common primary bone tumor of the cat [5-7, 11, 18, 24, 31, 35, 431. There is a wide age range of affected cats [6, 7, 11, 24, 3 1, 381, with an average of 9 to 12 years. This is higher than in the dog [l I]. The sex incidence in two English surveys [6, 71 showed a preponderance of males, whereas a U.S. series [24] revealed a female to male ratio of 4: 1. Flat bones are affected more frequently than long bones [ 11, 24, 31, 331, again contrasting with the dog where the limb bones are the most common sites [ 111. The use of radiotherapy to successfully treat osteosarcoma of the nasal cavity in a cat has been described [25]. Giant cell tumors (osteoclastomas) are mentioned frequently [6, 8, 17, 26, 36, 39, 4 1-43]. Parosteal osteosarcoma, a slow-growing but malignant primary neoplasm of cortical bone, is documented fairly well [3,18,24,35, 421. Benign bone tumors reported are osteoma [18, 22, 24, 31, 34, 35, 381, and, less 670

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Background: Advances have been made in the medical management of congestive heart failure. However, there is concern that these changes may not be transmitted to the heart failure population in the community. Other impediments to improved prognosis, such as failure to apply non-pharmacological strategies and poor patient comprehension may also be prevalent in the community. Aims: The purpose of this study was to assess physician practice and patient knowledge in a heart failure population admitted to a University Hospital in Ireland. Methods: Patients admitted with a primary diagnosis of heart failure were studied. Estimation of ejection fraction was used to subdivide the population into heart failure with impaired and normal systolic function. Patients' course in hospital was noted with reference to management by cardiology or internal medicine, use of angiotensin-converting enzyme inhibition therapy and digoxin and application of dietary and rehabilitative services. Patient knowledge was assessed by questionnaire. Results: Eighty patients were included in this study. Two-thirds of the population had impaired systolic function. The majority of patients were managed by internal medicine physicians, and this population was older and more likely to have normal systolic function. Prescription of converting enzyme inhibitor therapy was more Ž . frequently used in cardiology-managed patients 96 vs. 70%, P -0.05 . Neither group applied dietary or rehabilitative advice to a significant level. Patient comprehension was poor, especially with regard to understanding of medicine and the value of weight measurement. Conclusion: The above data demonstrate a lack of use of rehabilitative and dietary services and poor patient knowledge. These deficiencies may play a role in determining outlook and may impede the expected improvement in prognosis that has been witnessed in large randomised studies. ᮊ

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To assess the risk and possible benefits of use of the percutaneous IABP in patients given thrombolytic therapy as treatment for acute myocardial infarction, we prospectively evaluated 810 consecutive patients entered into the TAMI trials. During hospitalization the 85 patients treated with the IABP had more cardiac risk factors, were slightly older (58 vs 56 years), and more often had anterior infarction (62% vs 38%). At acute cardiac catheterization, patients treated with the IABP also had more multivessel coronary disease (67% vs 43%), more frequent TIMI grade 0 or 1 flow (44% vs 28%), lower global ejection fraction (40% vs 52%), and worse regional infarct (-3.2 vs -2.5 SD/chord) and noninfarct (-0.67 vs +0.36 SD/chord) zone function. Although mortality rates (32% vs 4%) and in-hospital complications were greater in patients treated with the IABP, a greater improvement in global (delta ejection fraction: +1.9% vs +0.7%) and noninfarct zone (delta SD/chord: +0.11 vs -0.09) left ventricular function was observed in patients treated with the IABP at 1-week follow-up angiography. In addition, no reinfarction or reocclusion of the infarct-related artery occurred while patients were being treated with the IABP. These results suggest that the IABP may have a specific role after thrombolytic therapy in treating patients at high risk for reocclusion or at high risk for hemodynamic deterioration because of large infarction or critical stenoses in coronary vessels supplying the noninfarct zone.