Ectopy in Patients with Permanent Pacemakers and Implantable Cardioverter-Defibrillators Undergoing an MRI Scan

Background: Recent series suggest that magnetic resonance imaging (MRI) scanning can be performed safely in select patients with pacemakers or implantable cardioverter-defibrillators (ICDs). Limited data have been reported on ectopy during MRI scans in patients with pacemakers or ICDs. This study evaluated increased ectopy observed in patients with permanent pacemakers or ICDs undergoing MRI scanning of any landmark without peak specific absorption rate (SAR) limit.
Methods: Fifty-two patients with a total of 119 leads underwent a total of 59 MRI scans of any landmark using usual protocols with standard peak SAR settings for the scan. No patient was pacemaker dependent. All devices were programmed to single-chamber demand mode (VVI) or dual-chamber demand mode (DDI) with a lower rate of 40 bpm. Both telemetry and pulse oximetry plethysmographic waveform were observed continuously throughout the scans for ectopy.
Results: Increased ectopy was observed during seven scans. The ectopy in four scans was ventricular and had fixed coupling intervals of 1,500 and 3,000, and was likely due to device noise rejection behavior. The etiology of ectopy observed during the other three scans could not be determined. Ectopy could not be predicted by peak SAR, scan time duration, or landmark. No significant changes in pacing thresholds were seen postscan.
Conclusions: The current series suggests that a minority of patients with implanted pacemakers may have MRI-related ectopy. A significant proportion of this ectopy may arise from normal device behavior within the MRI environment.     

Nurse-led case management for community dwelling older people: an explorative study of models and costs

Aim To compare community matrons with other nurses carrying out case management for impact on service use and costs. Background In England, nurses working in general practice, as district nurses and disease-specific nurses, undertake use case management. Community matrons were introduced to case management to reduce unplanned hospitalizations of people with complex conditions. Methods Managers in three Primary Care Trusts (PCTs) identified four nurses/matrons engaged in case management. Nurses/matrons recruited five community-dwelling patients referred to them for case management. Patients reported use of health/social services for 9 months, 2008 to 2009. Nurses/matrons completed activity diaries. Results Service use data were available for 33 patients. Compared with other nurse case managers, community matrons had: smaller caseloads; more patient contact time (mean 364 vs. 80 minutes per patient per month); and older patients (mean age 81 vs. 75 years, P = 0.03) taking more medications (mean 8.9 vs. 5.6, P = 0.014). Monthly costs were significantly higher for patients managed by community matrons (add £861), and who lived alone (add £696). Hospitalizations were not associated with patient or service delivery factors. Conclusion Further research on cost-effectiveness of case management models is required. Implications for Nursing Management The case for continued investment in community matrons remains to be proven.     

United We Stand — Divided We Fall

ABSTRACT: In June, 1992, the NSW Health Department released their Discussion Paper on 'The Role and Function of Nurse Practitioners in NSW'. The paper recommends legislative changes to enable nurse practitioners to initiate certain diagnostic tests, prescribe from a limited list of drugs, refer directly to specialist medical officers in certain circumstances and be reimbursed for some of the services they provide. Strict criteria for accreditation and evaluation are also recommended. Overseas literature confirms that nurse practitioners provide a safe, competent and cost effective service, which is well accepted by consumers. Opponents of the nurse practitioner concept in Australia have argued that it would be 'dangerous practice' and a 'duplication of services' to implement the Discussion Paper's recommendations. These arguments can not be substantiated. Of more concern is the attempt to divide nurses and nursing on the issue. To suggest that it is acceptable for nurse practitioners to provide services where doctors don't choose to practice or to provide service to disadvantaged groups of people, with whom doctors don't choose to work is unacceptable to nursing. Nurses provide nursing care, they do not provide medical care. Wherever nurses happen to be located, nurses are nurses and do nursing. Whether or not there is a doctor available is not the issue. Nurses do not seek to be doctors. Nurses do not seek to practice medicine. Nursing as a profession stands alone. This paper discusses the nurse practitioner concept as it is proposed for NSW, the implications for urban, rural and remote area nurses, the deliberate attempts to create division amongst nurses on the issue and the need for nurses to stand together to protect, validate and legitimise nursing practice.     

Allergy to mice. II. Further characterization of two major mouse allergens (AG 1 and AG 3) and immunohistochemical investigations of their sources

Sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) and quantitative immunoelectrophoretic techniques have been used to characterize further the two major mouse allergens, antigen 1 (Ag 1) and antigen 3 (Ag 3). Gel filtration using Sephacryl S-200 showed Ag 1 to have a molecular weight of 18 kD and Ag 3 of 21 kD. SDS-PAGE followed by Western blotting onto nitrocellulose then incubation with individual antisera directed against each of the two major allergens, and an alkaline phosphatase enzyme system, was used to distinguish between the two allergens and indicated a molecular weight of 17 kD for Ag 1 and 16 kD for Ag 3. Ag 3 but not Ag 1 was shown to contain polysaccharide residues. Immunohistochemical staining of mouse skin sections demonstrated that antigens detected in whole dust extracts were present in the hair follicles, on the hair shafts and on the stratum corneum. Staining of similar sections using the rabbit anti-Ag 3 showed the presence of this major allergen in the hair follicles coating the hairs and extending along the skin surface. Serum from a pool of mouse-allergic subjects also demonstrated staining in the same areas when detected using a fluorescein-labelled anti-human IgE as second antibody. As both major allergens were present in extracts of fur this would appear to be most appropriate for use in diagnosis (i.e. skin test and RAST) and also possibly desensitization. However, dust from isolators (available in greater amounts) would be equally suitable.     

Influence of Left Ventricular Lead Location on Outcomes in the COMPANION Study

Introduction: There are no randomized controlled trial data that evaluate mortality and hospitalization rates in cardiac resynchronization therapy (CRT) recipients based on left ventricular (LV) lead location. We analyzed the event-driven outcomes of mortality and hospitalization as well as functional outcomes including Functional Class, Quality-of-Life, and 6-minute walk distance in 1,520 patients enrolled in the COMPANION study of CRT versus optimal medical therapy.
Methods and Results: Over a mean follow-up after implantation of 16.2 months, patients randomized to CRT, regardless of lead location, experienced benefit compared with optimized pharmacologic therapy (OPT), with respect to all-cause mortality or heart failure hospitalization. All but a posterior location showed benefit with respect to the all-cause mortality or all-cause hospitalization outcome. Mortality benefit in CRT-D patients was indifferent to LV lead position. All functional outcomes including 6-minute walk distance, Quality-of-Life (QOL) and Functional Class improved with CRT, regardless of LV lead location.
Conclusion: LV lead location was not a major determinant of multiple measures of response to CRT therapy in the COMPANION Trial. While acute data indicate that a left lateral LV lead location results in the most favorable hemodynamic response, these chronic data suggest that positioning an LV lead in an anterior rather than a lateral or posterior LV location has similar benefit.     

PRELIMINARY EVIDENCE FOR GUT INVOLVEMENT IN THE PATHOGENESIS OF RHEUMATOID ARTHRITIS?

¹¹¹Indium leucocyte scans were performed on 26 patients withactive rheumatoid arthritis. An abnormal localization of radioactivitywas observed in the gut of 12 of these patients, generally inthe region of the terminal ileum, caecum and ascending colon.No difference was found in the intake of nonsteroidal anti-inflammatorydrugs between those with positive and negative scans. Two patientswith positive scans were on no medication. These observationssuggest the possibility of a primary role for a gastrointestinallesion in the aetiology of rheumatoid arthritis, although theseabnormalities could be secondary or unrelated. KEY WORDS: Gut, Rheumatoid arthritis, Indium leucocyte scan     

Effects of therapeutic suggestion in children undergoing general anesthesia: a randomized controlled trial

Objectives and aim: The goal of this randomized controlled trial was to examine the effect of intraoperative positive therapeutic suggestion on postoperative nausea and vomiting (PONV) in children undergoing general anesthesia and otolaryngological surgery. Background: Because of the high incidence of PONV following otolaryngological surgery and its negative impact on recovery, researchers have examined various nonpharmacological interventions to target this phenomenon. To date, the effectiveness of therapeutic suggestion has not been studied in children. Methods: Participants were 67 children undergoing tonsillectomy and adenoidectomy and their mothers. Children received a standardized anesthetic procedure and were randomly assigned to one of three interventions administered under general anesthesia: therapeutic suggestion, story (prosody control), or standard operating room noise. Children, parents, and healthcare personnel were blinded to group assignment. Nausea and vomiting were recorded in the postanesthesia care unit (PACU) and for the first 3 days at home. Results: Results demonstrated a decrease in nausea severity across the first 3 days, F_2,49 = 10.37, P < 0.001, but no group differences in nausea severity in the PACU (F_2,49 = 0.87, P = 0.43) or at home (F_2,49 = 0.80, P = 0.46). There were also no group differences in vomiting episodes in the PACU (χ² (2) = 1.25, P > 0.05) or at home (F_2,49 = 1.59, P = 0.21). Conclusions: In this blinded controlled trial, therapeutic suggestion delivered intraoperatively did not impact children’s PONV. However, because this is the first study of this kind, replication may be needed.     

EFFECT OF ORAL GLUCOSE ON THE RATE OF METABOLISM OF ETHANOL IN HUMANS

We have tested whether the effect of carbohydrate on the rateof alcohol metabolism can be reproduced by glucose alone. Tenmale subjects were given ethanol by intravenous infusion untila steady state was established and 100 g glucose in solutionwas then taken orally. The rate of alcohol metabolism, measuredas the rate of infusion required to maintain a constant breathalcohol reading, increased significantly after glucose but therewere differences between the subjects. The presence or absenceof a change in the rate of alcohol metabolism after glucosewas associated with the subject's fasting rate and with theirglucose tolerance.     

THE AGE OF MENARCHE IN MELBOURNE SCHOOLGIRLS *

The age of menarche has been determined in Melbourne girls of British ancestry born between 1927 and 1947. The mean and normal limits of age at menarche have been calculated. Statistical assessments have also been made of secular and seasonal trends. The results could be useful to paediatricians in assessing maturity clinically. The same statistical methods could be used to compare the present data with corresponding data derived from other groups of Australian girls.