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BACKGROUND: Radial artery access for coronary angiography or percutaneous coronary intervention (PCI) reduces the risk of death, bleeding, and vascular complications and is preferred over femoral artery access, leading to a class 1 indication by clinical practice guidelines. However, alternate upper extremity access such as distal radial and ulnar access are not mentioned in the guidelines despite randomized trials. We aimed to evaluate procedural outcomes with femoral, radial, distal radial, and ulnar access sites in patients undergoing coronary angiography or PCI. METHODS: PubMed, EMBASE, and clinicaltrials.gov databases were searched for randomized clinical trials that compared at least 2 of the 4 access sites in patients undergoing PCI or angiography. Primary outcomes were major bleeding and access site hematoma. Intention-to-treat mixed treatment comparison meta-analysis was performed. RESULTS: From 47 randomized clinical trials that randomized 38 924 patients undergoing coronary angiography or PCI, when compared with femoral access, there was a lower risk of major bleeding with radial access (odds ratio [OR], 0.46 [95% CI, 0.35--0.59]) and lower risk of access site hematoma with radial (OR, 0.34 [95% CI, 0.24--0.48]), distal radial (OR, 0.33 [95% CI, 0.20--0.56]), and ulnar (OR, 0.50 [95% CI, 0.31--0.83]) access. However, when compared with radial access, there was higher risk of hematoma with ulnar access (OR, 1.48 [95% CI, 1.03--2.14]). CONCLUSIONS: Data from randomized trials support guideline recommendation of class 1 for the preference of radial access over femoral access in patients undergoing coronary angiography or PCI. Moreover, distal radial and ulnar access can be considered as a default secondary access site before considering femoral access. REGISTRATION: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: 42024512365. GRAPHIC ABSTRACT: A graphic abstract is available for this article. [ABSTRACT FROM AUTHOR]

Background: Dizziness is a common condition that accounts for an estimated 5% of primary care clinic visits. The differential diagnosis is extensive, which may involve the inner ear, central and peripheral nervous system and the cardiovascular system among others. While routine cases can be diagnosed and treated with primary (general practitioner) or secondary (otolaryngologists (medicine in the community, there are many cases in which it is advisable to refer patients to a tertiary dizziness clinic. These cases include: unclear diagnosis, lack of improvement after medication or physiotherapy, medical comorbidities in which the central compensation process has been affected, chronic dizziness, bilateral vestibular disorder and more. Therefore, we established a multidisciplinary clinic (MDC) in a tertiary referral center at the Rambam Healthcare Campus., Objectives: To investigate the first year of the tertiary MDC neurotology clinic., Methods: Retrospective cohort of all patients examined at the tertiary MDC., Results: The first 123 consecutive patients (62% women) aged 56 years on average (19-85years, ±16) seen in the MDC from October 1, 2020 to October 31, 2021 are reported. Prior to assessment, 79 (64%) patients had been referred by an ENT doctor in the community with an unclear cause of dizziness; 49 (40%) patients experienced ongoing symptoms for years and 61 (50%) patients had dizziness on a daily basis. A total of 56 )46%) patients were found to have a peripheral vestibular cause for their dizziness and 67 (54%) patients had a central or other causes. More than one cause of dizziness and/or imbalance was noted in 20 (36%) of patients. Among the common peripheral vestibular causes were benign paroxysmal positional vertigo (BPPV) and Meniere's disease, and the central and functional disorders included vestibular migraine and persistent postural perceptual dizziness (PPPD). The frequency and intensity of symptoms were reduced in 29 patients of the 33 (88%) who underwent vestibular physiotherapy in the MDC as opposed to 8 (50%) patients in the community (p <0.05). Physiotherapy was found to be more effective in patients younger than 65 years old, and with less than six months of symptoms (p <0.05). However, patients with a medical history of neurological or cardiovascular problems are less likely to improve (p <0.05)., Conclusions: A tertiary neurotology clinic of a multidisciplinary team can provide proper care in persistent dizziness and/or unclear diagnosis. Vestibular physiotherapy plays a crucial role in the management of a dizzy patient, and hence it should be started as soon as possible.

Aim: The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use., Methods: A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered., Structure: Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests., (Copyright © 2022 The American College of Cardiology Foundation and the American Heart Association, Inc. Published by Elsevier Inc. All rights reserved.)