End-of-treatment self-efficacy: a predictor of abstinence

Results of previous studies suggest that end-of-treatment self-efficacy in problem drinkers has limited predictive validity. One explanation for this finding has been the postulated existence of a ceiling effect, i.e. the possibility that subjects who rate themselves highly in terms of self-efficacy form a heterogeneous group with some subjects making inflated self-efficacy judgements based on an over-optimistic perception of their coping abilities. In the present study, end-of-treatment self-efficacy in 63 problem drinkers, as measured by the Situational Confidence Questionnaire and a newly designed Self-Efficacy Questionnaire (SEQ), was predictive of abstinence status at 3 month follow-up. In those patients who on the SEQ had expressed great confidence in their ability to remain abstinent over the follow-up period, the additional consideration of keyworkers' confidence in their patients' ability to remain abstinent as well as patients' anticipated need for future help improved the prediction of abstinence status. These results are discussed with respect to the postulated ceiling effect. A prognostic tree using just three baseline variables predicted abstinence status correctly in 88% of all cases.     

Sensing Lead Insulation Defect Resulting in a Damage of the ICD Pulse Generator Case

Eight months after ICD implantation with an electrically active case the patient presented with ICD system sensing failure. Upon re-operation, we found an insulation defect of the proximal sensing lead and the generator case showed arc marks suggesting a short circuit between the sensing lead and case. the generator was replaced, the original sensing lead insulated, and a new sensing lead inserted. Bench testing of the explanted generator showed a damaged internal circuitry. Proximal lead insulation defects combined with electrically active cases may result in damage of the case. The potential damage of internal circuitry warrants generator replacement.     

Impact of Occluder Device Type on Success of Percutaneous Closure of Atrial Septal Defects–A Medium‐Term Follow‐up Study

Objective: To identify differences between various occluder types regarding thromboembolic event rates and existence of residual shunts during medium‐term follow‐up. Methods: Three hundred nine consecutive patients with presumed paradoxical embolism and scheduled for percutaneous closure of patent foramen ovale or atrial septal defect between 1997 and 2006 were considered for this study. Device implantation failed in seven patients (nonstable device position), so 302 patients (46 ± 12 years, 190 males) formed the study group using Amplatzer? (n = 208), Starflex? (n = 61), and Cardiastar? (n = 33) occluders. Follow‐up transesophageal echocardiography was performed 1, 3, and 6 months after implantation. Results: Periinterventional complications occurred in two patients (cardiac arrhythmias). There were more residual shunts in the Starflex? and Cardiastar? group than in the Amplatzer? group at 6‐month follow‐up (8/61 vs. 7/33 vs. 8/208, P = 0.0005). Performing logistic regression, the type of occluder device was a significant risk factor for the presence of residual shunt 6 months after implantation (P = 0.0033; Cardiastar? vs. Amplatzer? OR 6.346, 95% CI 1.998 – 20.156; Starflex? vs. Amplatzer? OR 4.369, 95% CI 1.444 – 13.222). During mean follow‐up of 31 ± 8 months 16 recurrent thromboembolic events occurred; the annual recurrence was 2.1% for combined end‐point stroke, TIA, and peripheral embolism (Amplatzer?: 1.3%, Starflex?: 3.9%, and Cardiastar?: 3.6%, P = 0.0467). The presence of an atrial septal aneurysm was the only significant risk factor (P = 0.0168, OR 3.664, 95% CI 1.263 – 10.630) for the occurrence of thromboembolic events. Conclusions: Percutaneous closure of patent foramen ovale or atrial septal defect is a safe procedure with little incidence of peri‐ and postprocedural complications. There is a significant difference between the Amplatzer?, Cardiastar?, and Starflex? occluders in regard to complete closure of the defects and annual recurrence of thromboembolic events.     

After antagonization of acute opiate overdose: a survey at hospitals in Vienna

This study describes the clinical management and characteristics of people who, following acute opioid overdose, are taken to hospital after efficient antagonization by the pre-hospital emergency service. In addition, it defines areas of interest for further research. Over a 4-month period (September-December 1993) we collected data by a structured protocol sheet on patients' characteristics, anamnestic data on abuse and emergencies, clinical presentation, treatment by specific antidote and routine laboratory investigations. Outcome leas verified by retrospective review of prehospital and forensic data. We studied 77 subjects, predominantly young males, who were involved in 83 emergencies, mostly occurring at weekends. In more than 60% of cases a single administration of specific antidote sufficed to stabilize the patients; 64% of patients left hospital against medical advice after an average stay of less than 6 hours; 46% denied daily opioid abuse and half the subjects, especially younger drug-users, seemed interested in counselling. This hospital-based study did not provide reliable data on the epidemiology of opioid overdose. Clinical management is determined by experience, pragmatism and beliefs. Efforts towards secondary prevention of drug problems at emergency departments might be warranted, and further research on pattern and management of opioid overdose is needed.     

Complications of Third-Generation Implantable Cardioverter Defibrillator Therapy

To determine the incidence of complications of third-generation implantable cardioverter defibrillator (ICD) therapy, 144 patients were prospectively studied who underwent first implant of third-generation devices (i.e., ICD systems with biphasic shocks, ECC storage capability, and nonthoracotomy lead systems). During 21 ± 15 months of follow-up, 41 (28%) patients had one or more complications. No patient died perioperatively (30 days) and no ICD infection was observed during follow-up. Complications included bleeding or pocket hematoma (hemoglobin drop > 2 g/dL) in 5 (3%) patients, prolonged reversible ischemic neurological deficit in 1 (1%) patient, postoperative deep venous thrombosis of leg in 1 (1%) patient, pneumothorax in 2 (1%) patients, difficulty to defibrillate ventricular fibrillation intraoperatively in 2 (1%) patients, generator malfunction in 1 (1%) patient, arthritis of the shoulder in 3 (2%) patients, and allergic reaction to prophylactic antibiotics in 2 (1%) patients. A total of seven lead related complications were observed in six (4%) patients including endocardial lead migration in four (3%) patients. Twenty-three (16%) patients received inappropriate shocks for supraventricular tachyarrhythmias (n = 13), non-sustained ventricular tachycardia (VT) (n = 7), or myopotential oversensing (n = 3). We conclude that serious complications such as perioperative death or ICD infection are rare in patients with third-generation ICDs. Lead-related problems and inappropriate shocks during follow-up are the most frequent complications of third-generation ICD therapy. Recognition of these complications should promote advances in ICD technology and management strategies to avoid their recurrence.     

Interference with Cardiac Pacemakers by Magnetic Resonance Imaging: Are There Irreversible Changes at 0.5 Tesla?

VAHLHAUS, C., et al. : Interference with Cardiac Pacemakers by Magnetic Resonance Imaging: Are There Irreversible Changes at 0.5 Tesla? The safety and feasibility of magnetic resonance imaging (MRI) in patients with cardiac pacemakers is an issue of gaining significance. The effect of MRI on patients' pacemaker systems has only been analyzed retrospectively in some case reports. Therefore, this study prospectively investigated if MRI causes irreversible changes in patients' pacemaker systems. The effect of MRI at 0.5 Tesla on sensing and stimulation thresholds, lead impedance and battery voltage, current, and impedance was estimated during 34 MRI examinations in 32 patients with implanted pacemakers. After measurements at baseline and with documentation of intrinsic rhythm and modification of the pacing mode, patients underwent MRI. The rest of the function time of the pacemaker was calculated. Measurements were again performed after 99.5 ± 29.6 minutes (mean ± SD), immediately after MRI examination, and 3 months later. Lead impedance and sensing and stimulation thresholds did not change after MRI. Battery voltage decreased immediately after MRI and recovered 3 months later. Battery current and impedance tended to increase. The calculated rest of function time did not change immediately after MRI. MRI affected neither pacemaker programmed data, nor the ability to interrogate, program, or use telemetry. Surprisingly, in the gantry of the scanner, temporary deactivation of the reed switch occurred in 12 of 32 patients when positioned in the center of the magnetic field. Missing activation of the reed switch through the static magnetic field at 0.5 Tesla is not unusual. MRI at 0.5 Tesla does not cause irreversible changes in patients' pacemaker systems.     

Influence of rubber dam on objective and subjective parameters of stress during dental treatment of children and adolescents – a randomized controlled clinical pilot study

International Journal of Paediatric Dentistry 2013; 23: 110–115 Background. Rubber dam is recommended for isolating the working field during adhesive dentistry procedures; however, dentists often omit rubber dam, particularly in paediatric dentistry, supposing that it would stress the patient. Aim. The aim of this study was to evaluate stress parameters during a standardized dental treatment procedure performed with or without rubber dam. The treatment time was measured as a secondary outcome variable. Design. This study was designed as a randomized, controlled, clinical study with 72 patients (6–16 years; mean age, 11.1). During standardized fissure sealing procedures, objective parameters of stress (e.g., skin resistance, breath rate) were recorded. The operator’s stress level was measured by pulse rate. Subjective pain (patients) and stress perception (operator) were evaluated by an interview. Results. The breath rate was significantly (P < 0.05) lower and the skin resistance level was significantly higher during treatment with rubber dam compared to the control group. Subjective pain perception was significantly lower for the test group. The treatment time needed for the fissure sealing procedure was 12.4% less in the test group. Conclusion. Isolation with rubber dam caused less stress in children and adolescents compared to relative isolation with cotton rolls if applied by an experienced dentist.