In an era of healthcare reform and a push to meet appropriate use guidelines for tests, imaging and therapy amid declining reimbursements, there has been much discussion about implementation of clinical decision support software (CDS). There is apprehension by some physicians who view CDS as technology telling doctors how to practice medicine. There are others in healthcare who are concerned about adding cost with the implementation of this software and how it will be updated based on the most current clinical data and practice guidelines. However, if implemented in a way where it is integrated with workflow and accepted by the physicians and hospital leadership, CDS has helped some hospitals meet appropriate use criteria and reduce unnecessary tests, which in turn helped reduce healthcare costs.

Over the past decade in the United States, there has been growing interest in transradial artery percutaneous access as a way to significantly reduce bleeding rates and access site complications. However, adoption in the United States has been slow compared to other parts of the world, partly due to lack of training in interventional programs until recently. In articles and sessions at various cardiology conferences, I have heard varying U.S. adoption rate percentages.

Time is critical for the thousands of patients that suffer from an ST-elevation myocardial infarction (STEMI) each year. Current American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend that a hospital’s door-to-balloon (D2B) times for STEMI patients be 90 minutes or less, starting from the moment patients enter the emergency department (ED) to the second a percutaneous coronary intervention (PCI) is performed. Hospitals with catherization laboratories are using a range of methods, varying from the use of advanced technologies to the implementation of certain protocols, to meet this target and shave off their D2B times.

Researchers at The Johns Hopkins University and Yale University have discovered that a specialized receptor, normally found in the nose, is also in blood vessels throughout the body, sensing small molecules created by microbes that line mammalian intestines, and responding to these molecules by increasing blood pressure. The finding suggests that gut bacteria are an integral part of the body’s complex system for maintaining a stable blood pressure.