A report in the September issue of Archives of Internal Medicine (one of the JAMA/Archives journals) shows that older adults who maintain or begin any type of physical activity appear to live longer and have a lower risk of disability.

In the article, the authors write as background information: “Physical activity is a modifiable behavior associated with health, functional status and longevity, and encouraging a physically active lifestyle has become an accepted public health goal.” However, most of earlier research on the benefits of physical activity has only considered middle-aged populations.

The study including 1,861 individuals born between 1920 and 1921 was the work of Jochanan Stessman, M.D., and colleagues at Hebrew University Medical Center and Hebrew University Hadassah Medical School, Jerusalem. Participants underwent evaluations in their homes at ages 70, 78 and 85 years, during which they were asked about their physical activity levels. Those who performed less than four hours per week of physical activity were considered sedentary. Those who exercised about four hours weekly, performed vigorous activities such as jogging or swimming at least twice weekly or who engaged in regular physical activity, such as walking at least an hour daily, were considered physically active.

The proportion of participants who were physically active was:
• 53.4 percent at age 70
• 76.9 percent at age 77
• 64 percent at age 85

When compared with those who were sedentary, individuals who were physically active were:
• 12 percent less likely to die between ages 70 and 78
• 15 percent less likely to die between ages 78 and 85
• 17 percent less likely to die between ages 85 and 88

They were more likely to remain independent and experienced fewer declines in their ability to perform daily tasks. In addition, they reported a smaller number of new instances of loneliness:
• 12.2 percent vs. 22.6 percent from ages 70 to 78
• 26.5 percent vs. 44.1 percent from ages 78 to 85

There were also variations in poor self-rated health:
• 77.3 percent vs. 63.3 percent from ages 70 to 78
• 63.8 percent vs. 82.6 percent from ages 78 to 85

The benefits related with physical activity were observed not only in those who maintained an existing level of physical activity, but also in those who began exercising between ages 70 and 85.

The authors write: “Although the mechanism of the survival benefit is most likely multifactorial, one important finding was the sustained protective effect of physical activity against functional decline.” Physical activity may postpone the spiral of decline that begins with inability to perform daily activities and continues through illness and death. Exercise improves cardiovascular fitness, slows loss of muscle mass, reduces fat, improves immunity and suppresses inflammation.

“Despite the increasing likelihood of comorbidity, frailty, dependence and ever-shortening life expectancy, remaining and even starting to be physically active increases the likelihood of living longer and staying functionally independent,” the authors explain. “The clinical ramifications are far reaching. As this rapidly growing sector of the population assumes a prominent position in preventive and public health measures, our findings clearly support the continued encouragement of physical activity, even among the oldest old. Indeed, it seems that it is never too late to start.”

Arch Intern Med. 2009; 169[16]:1476-1483.

JAMA

Stephanie Brunner (B.A.)

UroToday – While erectile dysfunction has been described since ancient times, adequate treatment has only been available for the last three decades. Modern penile prosthetic devices were first developed in the early 1970s when Small et al. along with Scott et al. reported the implantation of penile prosthetic devices into the corpora cavernosa to fill the corpora cavernosa and provide a physiologically functional erection with good cosmetic results.

Semirigid rod and mechanical prostheses available today are the successors of the devices designed in the 1970s. These devices, while easier to implant, have few advantages over the newer inflatable devices because infection and mechanical malfunction rates are similar. The semirigid devices consist of a central metal core and a silicone elastomer rod while the mechanical Dura II implant is a series of disks held in position by a central cable. The latter design facilitates positioning of the implant between uses.

The three-piece inflatable penile prostheses vary in construction from three-layer silicon/Dacron/Lycra to a single layer of silicon or Bioflex . Options include girth expansion and/or length elongation. Design modifications over the past two decades have decreased mechanical malfunction rates from greater than 30% to less than 5% and antibiotic coating has reduced the infection rates from over 4% to fewer than 1%.

The three-piece inflatable penile prostheses continue to be the most satisfactory prostheses. These prosthetic devices produce the most natural appearing erection in girth, length, and with satisfactory rigidity and excellent flaccidity for optimal concealment. They also have advantages for many patients with complex penile implantations because the flaccid position removes pressure from the corporal cavernosa and decreases the possibility of erosion in these highly difficult implantations.

Patients chosen for penile implantation therapy are usually those that have failed PDE5 inhibitors and less invasive therapy. Careful informed consent is critical in counselling patients before surgery. Post operatively patients should be counselled to cycle their devices daily and that satisfaction increases over 3 to 6 months after implantation. Multicenter studies have documented the long term satisfaction and normal mechanical function of penile implants and their satisfaction rates. Patients queried 5 years after surgery were using their implants an average of three times monthly.

Presented by: Culley C. Carson, MD, at the Masters in Urology Meeting – July 31, 2008 – August 2, 2008, Elbow Beach Resort, Bermuda

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To the many problems associated with lack of sleep —
moodiness, memory problems, difficulty concentrating — add the risk of
developing diabetes.

A study from the University at Buffalo shows that people who sleep less
than six hours a night during the work-week are 4.5 times more likely
to have elevated levels of blood sugar than those who slumber 6-8
hours.

The findings are being presented yesterday at the American Heart
Association’s 49th annual Conference on Cardiovascular Disease
Epidemiology and Prevention.

“Impaired fasting glucose — a reading higher than 100 — is known as
pre-diabetes, which is a precursor to type 2 diabetes,” said Lisa
Rafalson, Ph.D., a National Research Service Award (NRSA) Fellow in the
UB Department of Family Medicine and first author on the study.

“In fact, about 25 percent of people who have impaired fasting glucose
will at some point develop type 2 diabetes, which is associated with
many complications, including heart disease and premature death.”
Rafalson also is a research assistant professor is UB’s Department of
Social and Preventive Medicine.

Rafalson’s findings were based on data from an average six-year
follow-up of participants who initially took part in the Western New
York Health Study, conducted from 1996-2001. The 91 persons with
normal fasting glucose levels at baseline who developed pre-diabetes by
their follow-up exam were matched to persons from the study who had
maintained normal glucose levels who served as controls.

Participants were placed into three groups based on the average daily
amount of sleep they reported receiving from Sunday through Thursday:
short-sleepers — those who reported less than 6 hours of sleep
nightly; long-sleepers, who reported sleeping more than eight hours
nightly; and a reference group who slept 6-8 hours a night.

Results showed that “short-sleepers” had a significantly increased risk
of progressing from normal glucose levels to pre-diabetes, compared to
those who slept 6-8 hours nightly. Sleeping an average of more than 8
hours a night had no significant effect on glucose levels, results
showed.

“This study supports growing evidence of the association of inadequate
sleep with adverse health issues,” said Rafalson. She suggested that
during annual “well” visits, physicians should discuss sleep habits
with their patients, along with diet and exercise and other lifestyle
issues that are important to long-term health.

“Genetic susceptibility is always a possible explanation for this
finding,” Rafalson noted, “but it is more likely that pathways
involving hormones and the nervous system are involved in the
impaired-sleep/fasting glucose association.

“We hope our findings will generate more research into this complex
relationship between sleep and illness,” she said.

Additional authors on the study are Richard P. Donahue, Ph.D., M.P.H.;
Michael LaMonte, Ph.D., M.P.H.; Joan Dorn, Ph.D.; Maurizio Trevisan,
M.D., M.S.; Saverio Stranges, M.D., Ph.D.; and Jacek Dmochowski, Ph.D.
All authors are current or former members of the Department of Social
and Preventive Medicine, UB School of Public Health and Health
Professions.

Trevisan now heads the University of Nevada Health Sciences System;
Stranges is affiliated with the Clinical Sciences Research Institute,
Warwick Medical School, Coventry, UK, and Dmochowski is affiliated with
the University of North Carolina, Charlotte.

The study was funded by the National Institutes of Health.

The University at Buffalo is a premier research-intensive public
university, a flagship institution in the State University of New York
system and its largest and most comprehensive campus. UB’s more than
28,000 students pursue their academic interests through more than 300
undergraduate, graduate and professional degree programs. Founded in
1846, the University at Buffalo is a member of the Association of
American Universities.

University at Buffalo
What is Tiredness?
For more information on what tiredness is and how to beat it, please see:
What is Tiredness or Fatigue? How Can I Beat Tiredness? Why am I Tired?

The University of Pittsburgh School of Medicine has received a four-year, $4.7 million grant from the Pennsylvania Department of Health to find new ways to stop deadly hospital-acquired infections that often are resistant to treatment. The grant, funded by Pennsylvania’s share of the national 2008-2009 tobacco settlement, will focus on C. difficile, A. baumanniiand the drug-resistant bacteria known as MRSA, which cause tens of thousands of deaths in the U.S. every year.

“Infections that are resistant to antibiotics are becoming increasingly problematic not only in the United States, but around the world,” said Lee Harrison, M.D., principal investigator of the grant and professor of medicine and epidemiology, University of Pittsburgh. “We not only need to develop new drugs, but also to improve infection surveillance and focus on targeted interventions.”

The grant will enable investigators to establish a Center of Excellence in Prevention and Control of Antibiotic-Resistant Bacterial Infections at the University of Pittsburgh, and will include partnerships with several UPMC hospitals, Carnegie Mellon University and Kane Regional Centers of Allegheny County.

The project will assess the medical and economic impacts of new strategies to prevent and control hospital-acquired infections, which were diagnosed in 27,000 patients in Pennsylvania in 2007. Patients with these infections were hospitalized three times longer and their admissions were four times as expensive as non-infected patients.

Most bacterial infections can be effectively controlled with existing antibiotic drugs, but microbial pathogens like C. difficile, A. baumannii and MRSA have an inherent ability to develop drug resistance through many genetic mechanisms, making them particularly difficult to treat.

Co-investigators on the grant include Scott Curry, M.D., Jo-anne Burge, M.D., Yohei Doi, M.D., Bruce Lee, M.D., and Paula Davis, all with the University of Pittsburgh School of Medicine.

The grant was awarded as part of the Commonwealth Universal Research Enhancement Program (CURE), which supports clinical, health services and biomedical research, and was one of only four awarded to address 2008-2009 Health Research Advisory Committee priorities.

University of Pittsburgh Medical Center, U.S. Steel Tower, 600 Grant St., 57th Floor, Pittsburgh, PA 15213 United States

Source
University of Pittsburgh Medical Center

The World Congress of Nephrology (April 21-25, 2007, Rio de Janeiro, Brazil) represents a unique opportunity for the global nephrology community to come together, share and exchange ideas, and collectively address current and future challenges faced by renal clinicians and scientists.

Updating on all aspects of basic and clinical research and care of renal patients, one of the many highlights for each day’s program will be the keynote lectures to be given by a series of five outstanding scientists and clinicians covering several of the hottest topics in renal science and medicine.

Timely exchange and debate will surround the future applications of medical genetics to kidney disease, systems biology and the promise of personalized medicine, and hypoxia and hypoxia-inducible factors. Three clinical topics of particular interest will cover the connection between the kidney and cardiovascular disease, the current status of halting progression in diabetic nephropathy, and the often controversial issue of organ donation and allocation.

The core scientific program for WCN 2007 is divided into eight themes with over 70 individual symposia and some 300 invited speakers that will present topics of key interest to both clinicians and investigators. The themes (Molecular and Cell Biology and Physiology, Vascular Biology, Inflammation and Immunology and Pathology, Developmental Genetics and Pediatrics, General Clinical Nephrology, Acute Renal Failure, Chronic Kidney Disease, Diabetes and Hypertension, ESRD-dialysis, and Transplantation) will deliver the very latest advances in both clinical and basic research as well as updates on clinical care.

Interactive case discussions are part of several themes as well as sessions devoted to exciting abstracts of new research findings. Throughout the meeting over 2000 poster presentations will also take place .

###

Contact: Amanda Wren

International Society of Nephrology

London Fertility Centre commends the decision by the Human Fertilisation and
Embryology Authority to hold public consultation into the regulation of hybrid and
chimera embryos since it is aware that members of the general public may not agree
with this area of research, considering it as science stepping into science fiction.
However, the use of such embryos may have scientific and later clinical benefits that
far outweigh these initial concerns.

London Fertility Centre considers that there would not be any need to entertain the
idea of chimera and hybrid embryos if HFEA initiatives were promoted to give
realistic financial compensation for more egg and sperm donors to come forward and
donate their gametes specifically for research projects, including the isolation of stem
cell lines.

This is especially so now that the HFEA have given permission for one centre to
allow women to donate half of their eggs to research at the same time as benefiting
from IVF from the remaining half of the eggs that are not given away thereby
receiving an indirect financial benefit.

London Fertility Centre predicts that in general there would be fewer concerns if
research was to be undertaken on human embryos from donors who have given
informed consent to their specific use rather than research being undertaken on
embryos created in part with animal eggs.

London Fertility Centre (LFC) is one of the most comprehensive and long standing
providers of assisted conception treatments in the UK. LFC offers a broad scope of
services for both male and female factor infertility as well as a caring approach.

LFC has an impressive track record in comprehensive fertility treatments and
pioneered many of the new developments now used routinely in assisted conception
worldwide.

lfc

Researchers affiliated with Boston University School of Medicine (BUSM) have found that risk factors for post-traumatic stress symptomatology (PTSS) among Operation Enduring Freedom (OEF)/Operational Iraqi Freedom (OIF) male veterans were relatively similar to what was observed in a prior group of Vietnam veterans. The findings, which currently appear online in the Journal of Abnormal Psychology, suggest there are key pathways through which risk factors contribute to PTSS across different male veteran cohorts. In addition, the researchers also identified a number of novel mechanisms of risk for OEF/OIF female veterans.

A growing body of research indicates that certain individuals are at higher risk for mental health problems following exposure to traumatic events. Prior research on risk factors for PTSS in war-exposed Veterans has revealed both direct and indirect mechanisms of risk that span pre-deployment, deployment and post-deployment timeframes.

According to the researchers the goal of this study was to identify the mechanisms through which previously documented risk factors contribute to PTSS in a national sample of 579 female and male Veterans deployed for OEF and OIF, as well as to examine the extent to which results mirrored findings among Vietnam Veterans.

Consistent with the conservation of resources (COR) theory, their findings indicated that PTSS was accounted for by multiple chains of risk, many originating in pre-deployment experiences that placed both female and male Veterans at risk for additional stress exposure. In addition, the researchers observed that family relationships during deployment appeared to play a more prominent role in explaining female veterans’ compared to male veterans’ post-deployment readjustment.

“These findings provide support for the generalizability of mechanisms of risk for PTSS across Veteran groups, and suggest that there may be some key pathways through which risk factors contribute to PTSS that generalize across different Veteran populations,” explained lead author Dawne Vogt, PhD, an associate professor of psychiatry at BUSM and researcher at the National Center for Posttraumatic Stress Disorder in the VA Boston Healthcare System.

“While risk factors for PTSS were fairly similar to what was observed among Vietnam veterans for male OEF/OIF veterans, Mechanisms of risk for female OEF/OIF Veterans were more similar to that observed for male OEF/OIF Veterans than for female Vietnam Veterans, underscoring women’s expanding roles in the military and their increased exposure to combat-related stressors.

With respect to difference in specific mechanisms of risk, Vogt added that “concerns about relationship disruptions demonstrated a significant impact on PTSS through its effect on post-deployment stressors and post-deployment social support for women only, suggesting two additional avenues through which family concerns set the stage for PTSS in this group.” Particularly noteworthy according to Vogt was the finding that women who reported experiencing more concerns about relationship disruptions also reported less post- deployment social support, as this finding indicates that relationship problems experienced during deployment may erode the support available to them when they return.

Future research efforts would benefit from examining whether these documented pathways are observed in other trauma populations. The researchers believe the identification of key mechanisms of risk that transcend the particular sample and trauma type under study can provide an important contribution to the literature.

This research was supported, in part, by a Department of Veterans Affairs Health Sciences Research and Development Service grant (PI: Susan Eisen, PhD) and the National Center for Post-traumatic Stress Disorder.

Source:
Gina DiGravio

Boston University Medical Center

For the first time, researchers using magnetic resonance imaging (MRI) have found both structural and functional abnormalities in specific brain regions of schizophrenic patients who experience chronic auditory hallucinations, according to a study published in the August issue of Radiology.

“The results showed abnormalities in specific areas of the brain associated with the capacity to process human voices,” said lead author, Luis Mart’-Bonmat’, M.D., Ph.D., chief of magnetic resonance in the Department of Radiology at Dr. Peset University Hospital in Valencia, Spain.

Schizophrenia is a chronic, severe and disabling brain disorder that affects approximately 1 percent of the global population, according to the National Institute of Mental Health. People with schizophrenia often experience hallucinations, delusional thoughts, paranoia, disorganized thinking and other cognitive difficulties. Although the cause of schizophrenia has not been determined, it is believed to result from a combination of environmental and genetic factors. The condition is treatable, but there is no cure.

“Developing a clear understanding of the pathological abnormalities associated with schizophrenia is one of the greatest challenges in psychiatry,” Dr. Mart’-Bonmat’ said. “Using MRI to mark brain regions that are affected in both structure and function will help pinpoint specific abnormalities associated with the disease and ultimately enable more effective treatment.”

The researchers studied 31 right-handed men, 21 with schizophrenia who suffered from persistent auditory hallucinations and 10 healthy controls. Morphological MR images were acquired to show abnormalities in brain structure while functional MRI was used to gauge brain response to various emotional and neutral stimuli.

Among the schizophrenic patients, the results showed functional abnormalities and corresponding gray matter deficits in several brain regions associated with regulating emotion and processing human voices.

“We hope that by evaluating combined structural and functional abnormalities in the brains of these patients, we may uncover biological markers to find candidates for specific treatments and better monitor patient response to those treatments,” Dr. Mart’-Bonmat’ said.

###

Radiology is a monthly scientific journal devoted to clinical radiology and allied sciences. The journal is edited by Anthony V. Proto, M.D., School of Medicine, Virginia Commonwealth University, Richmond, Va. Radiology is owned and published by the Radiological Society of North America, Inc. (rsna/radiologyjnl)

The Radiological Society of North America (RSNA) is an association of more than 40,000 radiologists, radiation oncologists, medical physicists and related scientists committed to excellence in patient care through education and research. The Society is based in Oak Brook, Ill. (rsna/)

“Chronic Auditory Hallucinations in Schizophrenic Patients: MR Analysis of the Coincidence between Functional and Morphologic Abnormalities.” Collaborating on this paper with Dr. Mart’-Bonmat’ were Juan Jose Lull, MSc., Graci’n Garc’a-Mart’, MSc., Eduardo J. Aguilar, M.D., David Moratal-P’rez, Ph.D., Cecilio Poyatos, M.D., Montserrat Robles, PhD., and Julio Sanju’n, M.D., Ph.D.

Source: Linda Brooks

Radiological Society of North America

Female veterans do not receive the same quality of outpatient care as male veterans at about one-third of the 139 Department of Veterans Affairs facilities that offer it, according to a report released on Friday by VA, the AP/Philadelphia Inquirer reports. Women account for about 14% of the U.S. Armed Forces and about 5% of VA’s population, but that number is expected to nearly double in the next two years. The VA’s review found the health care disparity even as women are serving on the front lines at historic levels.

The review found a need for more physicians trained to address the health care needs of women, as well as more equipment for women’s health. The report noted that other studies had found better surgical outcomes and decreased mortality for women at VA hospitals compared with women enrolled in Medicare Advantage plans or those receiving private care. Other studies also have shown better performance of breast and cervical cancer screenings among women receiving care through VA than those enrolled in private or other government-sponsored health plans.

William Duncan, associate deputy undersecretary at VA, said the disparity between men and women’s health is unacceptable and the department is working to address the issue. He said, “We’re striving to understand the reason for these health disparities in veterans health care based on personal characteristics.” The report states that VA has made some progress, such as creating on-site mammography services and women’s clinics at most VA facilities. VA also is trying to recruit more clinicians with training in women’s care, according to the report (Hefling, AP/Philadelphia Inquirer, 6/16).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

More than a quarter of ischemic stroke patients with documented symptom start time arrived at Get With The Guidelines®-Stroke hospitals within the first hour of stroke onset – allowing the opportunity for quicker treatment with clot-busting drugs that can reduce stroke damage, according to a study in Stroke: Journal of the American Heart Association.

“The ‘golden hour’ refers to the first 60 minutes after stroke onset, when there is the greatest chance to restore blood flow and save threatened tissue,” said Jeffrey L. Saver, M.D., study lead author and professor of neurology at the UCLA Stroke Center in Los Angeles, Calif. “With this study, we have characterized, for the first time, the frequency with which acute stroke patients present in this first hour, when the opportunity to save threatened brain tissue by reperfusion is greatest.”

He said people who arrive within the first hour are more likely to receive tissue plasminogen activator (tPA) – a clot-busting drug that’s the only proven treatment for acute ischemic stroke – than are those who arrive between one and three hours after onset. Researchers studied data on 106,924 acute ischemic stroke patients with a known stroke onset time presenting to 905 hospitals participating in the American Heart Association/American Stroke Association’s Get With The Guidelines-Stroke quality improvement program between April 2003 and December 2007.

Besides determining how often patients reached the hospital within the first hour, researchers identified features that distinguish “golden hour” patients from patients who present later. They also examined the treatments those patients receive.

The researchers, who presented preliminary study findings at the International Stroke Conference 2009, found that:

- 28.3 percent of patients arrived in less than 60 minutes from stroke onset.
- 31.7 percent arrived between one to three hours after stroke onset.
- 40.1 percent arrived more than three hours after stroke onset.

People arriving within the “golden hour” tended to have more severe stroke deficits and more frequently arrived by ambulances than those arriving later. Once they got to the hospital, these patients more frequently received tPA.

More than one in four patients arriving in the “golden hour” were treated with tPA, compared with only one in eight patients arriving one to three hours after onset and virtually no patients arriving later, Saver said.

However, hospitals did not treat early arriving patients as promptly as would be ideal, the researchers said.

“The national guideline goal is to treat patients with intravenous tPA within 60 minutes of their arriving at the emergency department, also called ‘door-to-needle’ time,” Saver said. “Only about one in five of the ‘golden hour’ patients were treated within this target timeframe.”

He said patients and families should know the warning signs of a possible acute stroke and to call 9-1-1 immediately if any of these symptoms appear:

- sudden weakness on one side of the body
- sudden loss of vision
- sudden speech problems
- sudden severe dizziness
- sudden severe headache

Furthermore, nurses and physicians must be prepared when patients arrive, in part by setting up stroke teams that can respond to acute stroke patients rapidly and reliably, Saver said.

“Results of the study confirm that stroke providers need to do more to ensure rapid delivery of intravenous tPA to all eligible patients – especially those arriving in the first hour of their stroke symptoms when the benefits of early treatment are even greater,” said Lee H. Schwamm, M.D., study coauthor, chair of the Get With The Guidelines National Steering Committee and professor of neurology at Harvard Medical School in Boston, Mass. “Based on this data, we at the AHA/ASA recognized that we needed to do more to help hospitals shorten their door-to-needle times.”

Ralph L. Sacco, M.S., M.D., president-elect of the American Heart Association, said quality improvement efforts such as Get With The Guidelines merge the best science with how providers treat stroke in the community.

“They are the cornerstone of how we are making huge strides in the way we research, diagnose and treat stroke,” said Sacco, professor and chairman of the department of neurology at Miller School of Medicine at the University of Miami in Florida. “But we’re only just beginning to improve stroke care at the nation’s hospitals.”

He said the next-step quality performance initiative by the American Heart Association/ American Stroke Association is the newly launched Target: Stroke quality improvement program, which will equip providers with tools and strategies to improve the time and rate in which patients get life-saving drugs.

“This is a highly focused initiative with an explicit goal of doubling the percentage of acute stroke patients who receive their tPA with a door-to-needle time of less than 60 minutes,” Sacco said. “It can make a difference in markedly improving outcomes for our patients.”
Other co-authors are Eric E. Smith, M.D., M.P.H.; Gregg C. Fonarow, M.D.; Mathew J. Reeves, Ph.D.; Xin Zhao, M.S.; and DaiWai M. Olson, Ph.D., R.N.

Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available here.

Note: The American Heart Association’s Get With The Guidelines® quality improvement program is designed to help hospitals treat patients with evidenced-based medicine known to improve health outcomes. For more information, visit this page.

The Get With The Guidelines®-Stroke (GWTG-Stroke) program is provided by the American Heart Association/American Stroke Association. The GWTG-Stroke program is currently supported in part by a charitable contribution from Bristol-Myers Squib/Sanofi Pharmaceutical Partnership and the American Heart Association Pharmaceutical Roundtable. GWTG-Stroke has been funded in the past through support from Boeringher-Ingelheim and Merck.

Source
American Heart Association