A web-based approach for electrocardiogram monitoring in the home

A Web-based electrocardiogram (ECG) monitoring service in which a longitudinal clinical record is used for management of patients, is described. The Web application is used to collect clinical data from the patient's home. A database on the server acts as a central repository where this clinical information is stored. A Web browser provides access to the patient's records and ECG data. We discuss the technologies used to automate the retrieval and storage of clinical data from a patient database, and the recording and reviewing of clinical measurement data. On the client's Web browser, ActiveX controls embedded in the Web pages provide a link between the various components including the Web server, Web page, the specialised client side ECG review and acquisition software, and the local file system. The ActiveX controls also implement FTP functions to retrieve and submit clinical data to and from the server. An intelligent software agent on the server is activated whenever new ECG data is sent from the home. The agent compares historical data with newly acquired data. Using this method, an optimum patient care strategy can be evaluated, a summarised report along with reminders and suggestions for action is sent to the doctor and patient by email.     

Access and closure of the left ventricular apex: state of play

Calcific aortic stenosis is the most frequent manifestation of valvular heart disease. The preferred treatment for patients of all age groups is surgical aortic valve replacement. Recently, transcatheter aortic valve implantation (TAVI) has become the standard of care for patients that are deemed to be at high risk for open heart surgery. The most common access route for TAVI is the retrograde transfemoral (TF) approach, followed by the antegrade transapical (TA) approach. Both access routes have distinct indications. While the TF route is least invasive and the access of choice at most centers, the apical route is used complementary in patients with poor femoral access. In addition, the TA approach holds various benefits such as a short distance from the operator to the annulus facilitating exact positioning of the valve and the possibility to accommodate larger sheaths. Furthermore, the TA approach not only provides direct access to the aortic valve but also the mitral valve allowing for a wide range of interventions. Various apical closure devices are currently being developed under the premise of increasing overall safety of the TA-TAVI approach by further standardizing the procedure, alleviating left ventricular access and minimizing the risk of complications, such as apical bleeding. The aim of this article is to give an overview of current devices for apical closure. The ideal apical closure device should be easy to put in place, leave a minimum of foreign material, provide complete hemostasis and have a minimal risk of displacement. So far the range of commercially available devices in Europe is very limited with only one CE-certified device on the market and one device that is expected to receive CE-certification soon. Off-the-shelf closure devices could help flatten the initial operator learning curve and facilitate a safe apical access, ultimately leading to an entirely percutaneous TA-TAVI approach.     

Morphometric analysis of postoperative corneal neovascularization after high-risk keratoplasty: herpetic versus non-herpetic disease

Background

Postoperative complications after high-risk corneal grafting are decisively associated with corneal neovascularization (CNV). This study aimed to identify the incidence, extent, speed, localization, and influence of surgery-related factors on CNV after high-risk penetrating keratoplasty (PK) and to evaluate the effect of removing the angiogenic stimulus, i.e., residual components of herpes simplex virus (HSV) on postkeratoplasty CNV in patients with herpetic stromal keratitis (HSK).

Methods

All primary high-risk PK performed for HSK and non-herpetic keratitis (controls) between 1 January 1998 and 31 December 2003 at our department with available standardized corneal photographs taken preoperatively as well as 6?weeks, 3, 6 and 12?months postoperatively were evaluated (n _herpes?=?19, n _controls?=?5 patients). Maximal extension of CNV, limbus suture distance (LSD), limbus graft distance (LGD) and graft size in digitalized pictures were measured in each of the 16 sectors of the cornea at every visit.

Results

One hundred percent of the prevascularized corneas (n?=?24) showed further CNV outgrowth within 1?year after keratoplasty, while 58?% of these patients featured high-grade CNV reaching the host–graft junction or invading the donor tissue. Overall, CNV outgrowth was fastest during the first 6?weeks after PK, with a mean speed of 48?μm/week. Mean CNV growth speed within 6?months post-PK was significantly lower in the herpes group (13?μm/week) than in the non-herpes group (25?μm/week, p?=?0.017). Corneal location around the 12 o'clock position showed the most intense vessel outgrowth, which proved to be an independent risk factor for high-grade CNV (p?=?0.025). Inverse correlation was evident between CNV growth speed and LSD (p?=?0.032).

Conclusions

Additional intense CNV outgrowth is a common phenomenon after high-risk keratoplasty, strongly marked in the early postoperative period. The removal of residual HSV components representing a potential angiogenic stimulus leads to a reduction in corneal angiogenesis not in the short term, but in the long term after PK in patients with HSK. In addition to preferable atraumatic operation techniques, modern antiviral prophylaxis and anti-angiogenic therapy should be applied early, possibly even prior to transplantation. Short LSD seems to be an intraoperative adjustable risk factor for CNV in high-risk setting. Attention should also be paid to the superior site around the 12 o'clock position.     

New ferrocene-containing copolyesters

We have synthesized four new ferrocene monomers (three diols and one diester). The redox potential of these ferrocene derivatives varies between 0 mV and 230 mV due to different degrees of ring alkylation. Amorphous and liquid crystalline copolyesters were prepared with these monomers in the polymer main chain. Cyclovoltammetric measurements show that the redox potential of the ferrocene units is increased by about 40 mV upon polymer formation (esterification). Since the ester group is 4 to 6 σ-bonds away from the ferrocene unit this increase is probably caused by some charge-transfer interaction through space. First rheological measurements show an unusual rubber-like behaviour of the ferrocene-containing copolyesters.     

Perceived unfairness in working conditions: The case of public health services in Tanzania

Background  

The focus on the determinants of the quality of health services in low-income countries is increasing. Health workers' motivation has emerged as a topic of substantial interest in this context. The main objective of this article is to explore health workers' experience of working conditions, linked to motivation to work. Working conditions have been pointed out as a key factor in ensuring a motivated and well performing staff. The empirical focus is on rural public health services in Tanzania. The study aims to situate the results in a broader historical context in order to enhance our understanding of the health worker discourse on working conditions.     

Morbidity in elderly women undergoing gynaecological pelvic floor surgery

Purpose  

We investigated the morbidity in elderly patients undergoing surgery due to pelvic organ prolapse.