Remote Monitoring of Cardiovascular Implantable Devices in the Pediatric Population Improves Detection of Adverse Events

With the exponential growth of cardiovascular implantable electronic devices (CIEDs) in pediatric patients, a new method of long-term surveillance, remote monitoring (RM), has become the standard of care. The purpose of this study was to determine the usefulness of RM as a monitoring tool in the pediatric population. A retrospective review was performed of 198 patients at the University of Iowa Children’s Hospital who had CIEDs. Data transmitted by RM were analyzed. The following data were examined: patient demographics; median interval between transmissions; detection of adverse events requiring corrective measures, including detection of lead failure; detection of arrhythmias and device malfunctions independent of symptoms; time gained in the detection of events using RM versus standard practice; the validity of RM; and the impact of RM on data management. Of 198 patients, 162 submitted 615 RM transmissions. The median time between remote transmissions was 91 days. Of 615 total transmissions, 16 % had true adverse events with 11 % prompting clinical intervention. Of those events requiring clinical response, 61 % of patients reported symptoms. The median interval between last follow-up and occurrence of events detected by RM was 46 days, representing a gain of 134 days for patients followed-up at 6-month intervals and 44 days for patients followed-up at 3 month-intervals. The sensitivity and specificity of RM were found to be 99 and 72 %, respectively. The positive and negative predictive values were found to be 41 and 99 %, respectively. RM allows for early identification of arrhythmias and device malfunctions, thus prompting earlier corrective measures and improving care and safety in pediatric patients.     

Improved population level survival in younger Hodgkin lymphoma patients in Germany in the early 21st century

Treatment for Hodgkin lymphoma (HL) is more aggressive in Germany than in the United States (US) and differences in treatment may lead to differences in population level survival. Patients diagnosed with HL in 11 German states in 1997–2006 were included in the analyses and were compared to similar analyses from patients in the Surveillance, Epidemiology, and End Results database in the US. Period analysis was used to calculate 5‐year relative survival for the time period of 2002–2006 overall and by gender, age and histology. Overall 5‐year relative survival for patients with HL in Germany was 84·3%, compared to 80·6% for the US. Survival was highest in patients aged 15–29 years at 97·9% and decreased with age to 57·5% at age 60 +  Survival for men and women, respectively, was 84·7% and 84·1% in Germany and 78·2% and 83·6% in the US. 5‐year relative survival for patients diagnosed with HL in Germany was close to 100% for younger patients. Survival of HL patients in the US was lower than in Germany overall, but was comparable in older patients and in women. Population‐based studies with longer follow‐up are still needed to examine effects of late toxicity on long term survival.     

Variations in physician recommendations for surgery after diagnosis of a high-risk lesion on breast core needle biopsy

OBJECTIVE: This article focuses on four high-risk lesions: lobular neoplasia, benign papilloma, radial scar, and flat epithelial atypia. Controversies exist in the management after core biopsy of each of these lesions--whether to perform immediate surgical excision so as not to miss an associated malignancy or imaging follow-up because concomitant malignancy is low. This review is staged in two parts per lesion. The first is from data gathered during the last two American Roentgen Ray Society annual meetings from the audience response system querying practice management styles per diagnostic lesion. The second part is a brief review of selected articles recommending either follow-up or surgery. The strengths and weaknesses of each article are discussed. CONCLUSION: Our opinion is that neither recommendation, surgical excision or follow-up, is well substantiated in the literature and that our ignorance is not serving the needs of women worldwide. The time is now for a prospective trial.     

Plaque complement activation and cognitive loss in Alzheimer's disease

Background  

Complement activation is increased in Alzheimer's disease (AD), but its significance is unclear. The objective of this study was to determine the relationship between complement activation and cognition during the development of AD.     

Trying to improve compliance with prophylactic penicillin therapy in children with sickle cell disease

Aims To evaluate compliance with prophylactic penicillin therapy in sickle cell disease (SCD) in children.
Methods Forty-five children aged 37±19 (9–84) months [mean±s.d; range] with homozygous SCD were recruited. After a baseline period of 2 months the patients were randomized to either the intervention or non-intervention group. The intervention consisted of a slide show explaining the pathogenesis of sickle cell disease and its complications; weekly phone calls by the clinic social worker; and a calendar. Compliance was again evaluated after the 2 month intervention period and after a further 2 month monitoring period without intervention. Compliance was monitored using the Medication Event Monitoring System. At the end of the 6 months, parents in both groups completed a questionnaire the aims of which were to determine knowledge and understanding of sickle cell disease and previous experience with infection. Patient admissions to the hospital during the study were recorded.
Results Compliance during the 2 month baseline assessment was 66.0±32.5 (1.3–98.2)% and 69.3±25.4 (19.8–96.5)% in the intervention ( n =13) and non-intervention ( n =10) groups respectively ( P =0.79). During the next 2 months, compliance in the intervention group ( n =11) was 79.0±31.4 (11.0–100.0)% and in the non-intervention group ( n =9) was 66.0±20.2 (42.2–96.8)% ( P =0.297). In the final 2 month monitoring period compliance was 82.0±34.7 (3.8–100.0)% and 65.8±25.3 (25.0–98.2)% in the intervention ( n =7) and the non-intervention ( n =6) groups respectively ( P =0.366). No statistically significant differences were found when comparing compliance between the groups.
Conclusions Compliance with prophylactic antibiotic therapy in children with sickle cell disease is highly variable and its evaluation is problematic.     

Long-term survival in chronic myelocytic leukemia after a first primary malignancy

Within the past 10–15 years, major advances in therapy have strongly improved prognosis of patients with chronic myelocytic leukaemia (CML). We estimated trends in 5- and 10-year relative survival of patients developing CML after a previous malignancy in the United States from 1990–1994 to 2000–2004. Period analysis was employed to disclose recent developments with minimum delay. Overall, 5- and 10-year relative survival increased from 17.6% to 37.7% (p < 0.0001) and from 7.6% to 23.8% (p < 0.0001), respectively. Improvements were particularly strong in younger age groups. Prognosis of CML patients with previous malignancy no longer lags behind prognosis of patients with primary CML.