First inappropriate implantable cardioverter defibrillator therapy is often due to inaccurate device programming: analysis of the French OPERA registry

AIMS: Inappropriate therapy delivered by implantable cardioverter defibrillators (ICDs) remains a challenge. The OPERA registry measured the times to, and studied the determinants of, first appropriate (FAT) and inappropriate (FIT) therapies delivered by single-, dual- and triple-chamber [cardiac resynchronization therapy defibrillator (CRT-D)] ICD. METHODS AND RESULTS: We entered 636 patients (mean age = 62.0 ± 13.5 years; 88% men) in the registry, of whom 251 received single-, 238 dual-, and 147 triple-chamber ICD, for primary (30.5%) or secondary (69.5%) indications. We measured times to FAT and FIT as a function of multiple clinical characteristics, examined the effects of various algorithm components on the likelihood of FAT and FIT delivery, and searched for predictors of FAT and FIT. Over 22.8 ± 8.8 months of observation, 184 patients (28.9%) received FAT and 70 (11.0%) received FIT. Ventricular tachycardia (VT) was the trigger of 88% of FAT, and supraventricular tachycardia was the trigger of 91% of FIT. The median times to FIT (90 days; range 49-258) and FAT (171 days; 50-363) were similar. The rate of FAT was higher (P <0.001) in patients treated for secondary than primary indications, while that of FIT were similar in both groups. Out of 57 analysable FIT, 27 (47.4%) could have been prevented by fine tuning the device programming like the sustained rate duration or the VT discrimination algorithm. CONCLUSIONS: First inappropriate therapy occurred in 11% of 636 ICD recipients followed for ～2 years. Nearly 50% of FIT could have been prevented by improving device programming.     

Living on the Edge of Being Overstretched—A Norwegian Qualitative Study of Employed Pregnant Women

In this study, our aim was to explore female employees’ experiences of work during pregnancy and their expectations of becoming a mother for the first time. We conducted 10 interviews and analyzed the data using qualitative content analysis. The main finding, living on the edge of being overstretched, contained two themes: being exhausted by adapting to professional life and being prepared for becoming a mother. In order to increase the well-being of pregnant employees, women should be provided with information from their supervisors and health care services about pregnancy-related life changes.     

Real-world comorbidities and treatment patterns of patients with acromegaly in two large US health plan databases

Acromegaly is a rare, chronic, and debilitating disease that results from excessive growth hormone production. Clinically, this disease is associated with enlargement of soft tissue, excessive skeletal growth, and increased risk of cardiovascular disease. Acromegaly is often diagnosed late, when a wide range of comorbidities may already be present. First-line therapy for acromegaly is typically surgery; but a number of highly-specific pharmacological agents have recently enabled a more aggressive medical management of acromegaly. Since surgical cure of acromegaly is low for macroadenomas, medical control of active acromegaly is an important component of treatment. There are no published US data currently available regarding real-world rates of comorbidities and treatment patterns among patients with acromegaly. This retrospective study examined the comorbidities and treatment patterns of 949 health plan enrollees, who had acromegaly diagnosis and/or procedure codes in an administrative claims database from July 1, 2002 through June 30, 2010. Acromegaly was associated with high rates of hypertension and diabetes along with a number of other comorbidities. The incidence of comorbidities was highest among patients with acromegaly-related treatment, which may have resulted, in part, from inadequate disease management and/or poor disease control. Unexpectedly, 55 % of patients identified with acromegaly received no treatment for acromegaly (i.e., surgery, radiotherapy, and medication) and only 28 % received a medication treatment during the observation period. However, some patients may have received a curative surgery prior to the observation period, which may have reduced the use of other acromegaly-related treatments during the study period. Of those treated with medications, the most common first medications were octreotide, cabergoline, and bromocriptine. Given the high incidence of serious comorbidities associated with active acromegaly, earlier diagnosis and treatment, along with appropriate follow-up care, may potentially avoid the life-long consequences of uncontrolled disease.     

Subject Index to Volume 3

By monodimensional thin-layer electrophoresis on 5 X 10-cm cellulose layers o-aminolevulinic acid (oAL) is rapidly separated from interfering substances. Detection with a cupric nitrate-Ninhydrin sequence adds specificity and permits detection of as little as 10 ng/lLl of urine. Confirmation can be obtained on two-dimensional chromatograms (5 X 5 em) with the use of either Ninhydrin or a modified MauzeraUasGranick reagent for detection. The quantity of (’)Al can be estimated by visual or densitometric comparison with standards. The method is rapid and inexpensive and is suggested for use in conjunction with the more expensive column chromatographic technique.     

Swedish Norms for the Harvard Group Scale of Hypnotic Susceptibility,Form A

This article examines the norms for a Swedish adaptation of the Harvard Group Scale of Hypnotic Susceptibility, Form A (HGSHS:A) (Shor & Orne, 1962). In total, 291 subjects (199 females and 92 males) participated in the study. Comparisons are made between the Swedish sample and reference samples,which include English versions of the HGSHS:A from the United States and Australia, as well as 5 translated versions from Italy, Finland, Denmark, Spain, and Germany. In the Swedish sample, females scored significantly higher than males. Generally, however, the normative data from the Swedish sample are congruent with the reference samples and therefore can be used as a tool for initial screening of hypnotic susceptibility in Sweden.     

Changes in sense of coherence in old age – a 5‐year follow‐up of the Umeå 85+ study

Scand J Caring Sci; 2013; 27; 13–19 Changes in sense of coherence in old age – a 5‐year follow‐up of the Umeå 85+ study Objective: This study aims to describe the changes in sense of coherence (SOC) over time and relate these changes to negative life events among very old people. Design: Prospective and longitudinal study. Subjects: 190 old women and men participated, of whom 56 could be included in the 5‐year follow‐up. Methods: The mean SOC score from the first and second data collection were compared using a paired sample t‐test. The relationship between the index of negative life events and the changes on SOC score between the two data collections was investigate using linear regression. Main outcome measures: Antonovsky’s SOC scale and an index of negative life events including severe physical and mental diseases, various losses as losses of spouses, cognitive and functional ability. Result: For the whole group of subjects (n = 56), the SOC scores was higher (70.1 vs. 73.7, p = 0.029) at the second point measure. The most common negative life events at follow‐up were loss of independence in activities in daily living and decrease in cognitive function. A significant correlation between the index of negative life events and changes in SOC over 5 years was found (p = 0.025). The more negative life events, the more decrease in SOC. Conclusion: We concluded that there is a risk of decreased SOC and thereby quality of life when negative life events accumulate among very old people. Nursing interventions might play an important role for maintaining and perhaps strengthening SOC among old people exposed to negative life events.