Changes in paced signals may predict in‐hospital cardiac arrest

1 Background

An increasing number of patients with chronic illnesses have implanted cardiac rhythm devices such as pacemakers and implantable cardioverter‐defibrillators (ICDs). This study was conducted to identify potentially useful predictors of in‐hospital cardiac arrest (I‐HCA) within paced electrocardiogram (ECG) signals from cardiovascular patients with implanted medical devices.

2 Methods

In this retrospective study of 17 subjects, full‐disclosure ECG traces prior to the time of documented I‐HCA were analyzed to determine R‐R intervals and QRS durations (QRSd).

3 Results

Ventricular paced QRSd prolongation was observed prior to I‐HCA in 10/16 (63%) subjects. QRSd was significantly greater immediately preceding cardiac arrest than during each of the 8 hours prior to cardiac arrest (P < 0.05). Heart rate changes (measured using standard deviation) within 15 minutes of cardiac arrest were significantly greater in subjects with pulseless electrical activity (PEA)/asystolic arrest compared to those with cardiac arrests due to ventricular tachycardia/ventricular fibrillation (VT/VF) (10.13 vs 3.31; P  =  0.024). Significant differences over the 8 hours preceding cardiac arrest in heart rate (74 vs 86 beats/min; P  =  0.002) and QRS duration (172 ms vs 137 ms; P < 0.001) were observed between subjects with initial rhythms of VT/VF and those with initial rhythms of PEA/asystole.

4 Conclusions

Patterns of diagnostic ECG features can be extracted from the telemetry data of patients with implanted medical devices prior to adverse events including I‐HCA. The detection of these significant changes might have an immediate prognostic impact on the timely treatment of some patients at risk of adverse events.     

Elderly Veterans Receiving Care at a Veterans Affairs Medical Center While Enrolled in Medicare-Financed HMOs : Is the Taxpayer Paying Twice?

Elderly veterans who visit our Veterans Affairs (VA) Medical Center primary care clinic often mention they are enrolled in HMOs. Approximately 20% of patients hospitalized at our facility report health insurance coverage. Of 1,000 hospitalizations during a 6-month period in which veterans reported insurance coverage, 337 involved elderly veterans. Of these 337 hospitalizations, 218 (65%) were for 174 veterans who stated they were enrolled in a Medicare-financed HMO. The VA's Medical Care Cost Recovery Program deemed only 46 (21%) of the hospitalizations billable and received reimbursement for 20 (9%). Thus, the VA is providing costly services already paid for by the Health Care Financing Administration under prepaid capitation contracts, and recovers minimal reimbursement from the HMOs.
KEY WORDS: veterans; elderly; Medicare; HMOs; health care financing.     

Factors associated with nutritional status in children aged 5–24 months in the Republic of Cameroon

This study was conducted to clarify nutritional status and associated factors in 5–24 month old children in the district of Batouri, Republic of Cameroon. Mothers were interviewed using a semistructured questionnaire, and the child's weight, length, head circumference, and mid‐upper arm circumference was collected. The data were compared with child growth standards proposed by the World Health Organization using Z‐scores; χ²‐test, Fisher's exact test, and Wilcoxon rank sum test were used to determine variables associated with malnutrition. A total of 100 mother–child pairs participated in this study; valid data from 100 pairs were subjected to analysis. The percentages of children with malnutrition indicators were wasting (6%), stunting (31%), underweight (14%), and low mid‐upper arm circumference (16%). Five factors were found to be statistically significant in their association with the children's malnutrition: mother's age, child's age, mother's educational level, mothers who had family planning information, and the source of tap water. A high percentage of stunting was positively associated with a high percentage of chronic malnutrition. We speculate that insufficient nutrition was more likely to begin after weaning.     

Critical consciousness of public health nurses: A descriptive,comparative survey

Background

Public Health Nurses (PHN) caring for vulnerable populations amid systemic inequality must navigate complex situations, and consequently they may experience serious moral distress known to be detrimental to PHN wellbeing.

Objective

Given PHN awareness of social inequities, the study aimed to determine if PHNs were motivated to enact social change and engage in social and political action to address inequality.

Design and sample

A survey of 173 PHNs was conducted in fall 2022. The convenience sample was mainly female (96.5%), White (85%), had associate/bachelor's degrees (71.7%), and worked in governmental public health settings (70.7%).

Measure

The study employed the Short Critical Consciousness Scales’ subscales: Critical Reflection, Critical Motivation, and Critical Action.

Results

PHNs were highly motivated to address inequities (Critical Motivation = 20.83; SD = 3.16), with similarly high awareness (Critical Reflection = 17.89; SD = 5.18). However, social and political action scores were much lower (Critical Action = 7.13; SD = 2.63). A subgroup of PHNs with strong agreement regarding the impact of poverty were more likely to be younger (p = .039) and work in a community setting (p = .003); with higher scores across subscales (p < .001).

Conclusions

High critical reflection and motivation among PHNs aligned with literature. Lower Critical Action scores warrant investigation into validity for PHNs, and possible role constraints.