Alternating Current Electrocution Detection and Termination by an Implantable Cardioverter Defibrillator

A patient with an ICD accidentally grasped a power line and was electrocuted. He was unable to release the cable during electrocution though he remained conscious. After receiving a shock from his ICD. the powerline was released. ICD interrogation revealed inappropriate detection of alternating current and delivery of a shock.     

Twin Transfusion Syndrome

Twin transfusion syndrome (TTS) is a rare, yet frequently fatal, complication of twin gestations. Recently published data demonstrate a reduction in the perinatal mortality rate associated with TTS from nearly 100% to 20-40%. This article explains the pathophysiology of TTS, newly described treatments, complications, and specific aspects of nursing care for patients with this complication of multiple gestation.     

Offer of financial incentives for unprotected sex in the context of sex work

Introduction and Aims. Commercial sex workers (CSW) are often portrayed as vectors of disease transmission. However, the role clients play in sexual risk taking and related decision making has not been thoroughly characterised. Design and Methods. Participants were drawn from the Vancouver Injection Drug Users Study, a longitudinal cohort. Analyses were restricted to those who reported selling sex between June 2001 and December 2005. Using multivariate generalised estimating equation, we evaluated the prevalence of and factors associated with being offered money for sex without a condom. Results. A total of 232 CSW were included in the analyses, with 73.7% reporting being offered more money for condom non‐use, and 30.6% of these CSW accepting. Variables independently associated with being offered money for sex without a condom included daily speedball use [adjusted odds ratio (AOR) = 1.21, 95% confidence interval (CI): 0.23–0.62], daily crack smoking (AOR = 1.51, 95% CI: 1.04–2.19), daily heroin injection (AOR = 1.76, 95% CI: 1.27–2.43) and drug use with clients (AOR = 3.22, 95% CI: 2.37–4.37). Human immunodeficiency virus seropositivity was not significant (AOR = 0.98, 95% CI: 0.67–1.44). Discussion and Conclusions. Findings highlight the role clients play in contributing to unprotected sex through economic influence and exploitation of CSW drug use. HIV serostatus has no bearing on whether more money is offered for sex without a condom. Novel interventions should target both CSW and clients. [Johnston CL, Callon C, Li K, Wood E, Kerr T. Offer of financial incentives for unprotected sex in the context of sex work. Drug Alcohol Rev 2009]     

Modelling crack cocaine use trends over 10 years in a Canadian setting

Introduction and Aims. Crack cocaine use among illicit drug users is associated with a range of health and community harms. However, long‐term epidemiological data documenting patterns and risk factors for crack use initiation remain limited especially among injection drug users. We investigated longitudinal patterns of crack cocaine use among polydrug users in Vancouver, Canada. Design and Methods. We examined the rate of crack use among injection drug users enrolled in a prospective cohort study in Vancouver, Canada between 1996 and 2005. We also used a Cox proportional hazards regression analysis to identify independent predictors of crack use initiation among this population. Results. In total, 1603 injection drug users were recruited between May 1996 and December 2005. At baseline, 7.4% of participants reported ever using crack and this rate increased to 42.6% by the end of the study period (Mantel trend test P < 0.001). Independent predictors of crack use initiation during the study period included frequent cocaine injection, crystal methamphetamine injection, residency in the city's drug using epicenter and involvement in the sex trade (all P < 0.05). Discussion and Conclusions. These findings demonstrate a massive increase in crack use among injection drug users in a Canadian setting. Our findings also highlight the complex interactions that contribute to the initiation of crack use among injection drug users and suggest that evidence‐based interventions are urgently needed to address crack use initiation and to address harms associated with its ongoing use.[Werb D, DeBeck K, Kerr T, Li K, Montaner J, Wood E. Modelling crack cocaine use trends over 10 years in a Canadian setting. Drug Alcohol Rev 2010]     

Effect of the Implantable Atrial Defibrillator on the Natural History of Atrial Fibrillation

INTRODUCTION: The purpose of our study was to evaluate the effect of repeated cardioversion with an implantable atrial defibrillator on the clinical outcome of patients with atrial fibrillation. METHODS AND RESULTS: The effects of the implantable atrial defibrillator on the total duration of atrial fibrillation, number of atrial fibrillation recurrences, and left atrial size were evaluated prospectively in 16 patients with atrial fibrillation (13 men and 3 women; mean age 58 +/- 11 years). Seven patients had no cardiovascular disease, 5 patients had hypertension, 3 patients had coronary heart disease, and 1 patient had congenital heart disease. Eight patients had paroxysmal atrial fibrillation for a mean duration of 80 +/- 61 months, and eight patients had persistent atrial fibrillation for a mean duration of 68 +/- 119 months. Except for one patient who received digoxin throughout the study, all patients received the same Class I or III antiarrhythmic agent throughout the study. The implantable atrial defibrillator successfully converted 50 (93%) of 54 spontaneous episodes of atrial fibrillation in 12 patients. During the initial 3 months of clinical follow-up, the atrial defibrillator documented 261 +/- 270 hours of atrial fibrillation compared with 126 +/- 172 hours (P = 0.01) during the subsequent 3 months. The left atrial size decreased from 4.4 +/- 0.7 cm at the time of atrial defibrillator implantation to 4.1 +/- 0.6 cm (P = 0.02) 6 months later. The number of atrial fibrillation recurrences did not change. These findings were observed in the absence of changes in drug therapy. No complications were observed. CONCLUSION: Restoration and maintenance of sinus rhythm in patients with atrial fibrillation by repeated cardioversion with an implantable atrial defibrillator was associated with a reduction in the total arrhythmia duration and a reduction in left atrial size. These results suggest that maintenance of sinus rhythm with the atrial defibrillator may reverse the remodeling process associated with atrial fibrillation.     

Assessing health needs in people with severe learning disabilities: a qualitative approach

Summary

• ? The nursing assessment, and the contribution it makes to the identification of an individual's health needs, is often a complex and multidimensional process. This is always true when the individual concerned has a severe learning disability.
• ? The nurse should develop the assessment in partnership with individuals who may experience major communication difficulties, or have unappreciated levels of perceptual or cognitive dysfunction. They may also live with the ongoing possibility that their affective or behavioural responses may be misinterpreted as ‘challenging behaviour’.
• ? This case study focuses upon one particular young man with a severe learning disability living in a community home. Drawing upon the principles of qualitative research methods, especially those of ‘grounded theory’, this study aims to demonstrate how these can be used to develop a uniquely person-centred assessment.
• ? A systematic process of observation, analysis and reflection produces a detailed picture of the individual and his or her particular health states.
• ? The strength of this approach is threefold. Firstly, the person is considered as an active participant and remains the central focus. Secondly, in contrast to many other forms of assessment, the person is viewed as dynamic with ever changing needs. Thirdly, the process of nursing judgement is made explicit and integrated into the assessment process.

     

Central line infection: a review

• ? There is increasing and widespread use of central line catheterization in clinical practice. Nevertheless, there is a growing awareness and concern about the escalating rate of infection related to central lines, especially in those patients receiving total parenteral nutrition.
• ? This paper reviews selected studies which have identified factors contributing to central line infection.
• ? Factors relating to all areas of catheter management, including insertion, maintenance and removal have been implicated in central line infections.
• ? Nurses who are involved to varying degrees in all phases of central line management, play an important role in infection control.
• ? An understanding of infection-related factors is the first step needed to effect changes in procedures and protocols in the care of patients with central lines.

     

The Short- and Long-Term Outcome of Left Internal Mammary Artery Angioplasty

Failure of internal mammary artery (IMA) bypass grafts is uncommon. However, as their use continues to increase, this complication will be encountered more frequently by interventional cardiologists. The purpose of this article is to describe the short- and long-term outcome of patients undergoing IMA angioplasty through a retrospective review of patients undergoing internal mammary angioplasty at two centers from January 1988 to June 1995. Percutaneous recanalization was attempted on 82 lesions either within an IMA or in the ongoing native left anterior descending artery during 74 procedures in 67 patients. The mean time from bypass surgery was 23 months. The lesion success rate was 84%. Dissection of the IMA occurred in 18% of procedures and was the most common cause for procedural failure and unfavorable outcome. Long-term follow-up was available in 82% of patients at a mean follow-up of 45 months postprocedure. Clinical events occurred in 23 patients (34%) with 4 deaths (1 of which occurred during the initial hospitalization and after emergency bypass surgery), 2 repeat coronary bypass operations, and 17 patients with repeat coronary angioplasties. Despite the high repeat revascularization rate, 80% of patients were asymptomatic or had only infrequent angina at follow-up. We conclude that angioplasty of or through an IMA bypass graft can be performed with a satisfactory procedural success rate and long-term symptomatic benefit.     

Decreased cerebral 5-HT1A receptors during ageing: reversal by Ginkgo biloba extract (EGb 761)

Abstract— Investigation of [³H]8-hydroxy-2(di-n-propylamino)tetralin binding to 5-HT_1A receptors in cerebral cortex membranes of Wistar rats showed that the maximal number of binding sites (B_max) was reduced significantly (22%) in aged (24-month-old) as compared with young (4-month-old) animals. Chronic treatment with Ginkgo biloba extract did not alter binding in young rats but increased binding density significantly (33%) in aged rats. These results confirm previously described age-related 5-hydroxytryptaminergic alterations. Together with data in the literature, they also suggest a restorative effect in aged rats, associated with decreased receptor density resulting from the protective action of Ginkgo biloba extract treatment on neuronal membrane.