Atrial High-Rate Episodes in Patients with Devices Without a History of Atrial Fibrillation: a Systematic Review and Meta-analysis

Cardiovascular Drugs and Therapy - Atrial high-rate episodes (AHREs) recorded with cardiac implantable electronic devices (CIEDs) have been associated with the development of clinical atrial...     

Noninvasive risk factors for the prediction of inducibility on programmed ventricular stimulation in post‐myocardial infarction patients with an ejection fraction ≥40% at risk for sudden cardiac arrest: Insights from the PRESERVE‐EF study

BackgroundIn the PRESERVE‐EF study, a two‐step sudden cardiac death (SCD) risk stratification approach to detect post‐myocardial infarction (MI) patients with left ventricle ejection fraction (LVEF) ≥40% at risk for major arrhythmic events (MAEs) was used. Seven noninvasive risk factors (NIRFs) were extracted from a 24‐h ambulatory electrocardiography (AECG) and a 45‐min resting recording. Patients with at least one NIRF present were referred for invasive programmed ventricular stimulation (PVS) and inducible patients received an Implantable Cardioverter ‐ Defibrillator (ICD).MethodsIn the present study, we evaluated the performance of the NIRFs, as they were described in the PRESERVE‐EF study protocol, in predicting a positive PVS. In the PRESERVE‐EF study, 152 out of 575 patients underwent PVS and 41 of them were inducible. For the present analysis, data from these 152 patients were analyzed.ResultsAmong the NIRFs examined, the presence of signal averaged ECG‐late potentials (SAECG‐LPs) ≥ 2/3 and non‐sustained ventricular tachycardia (NSVT) ≥1 eposode/24 h cutoff points were important predictors of a positive PVS study, demonstrating in the logistic regression analysis odds ratios 2.285 (p = .027) and 2.867 (p = .006), respectively. A simple risk score based on the above cutoff points in combination with LVEF < 50% presented high sensitivity but low specificity for a positive PVS.ConclusionCutoff points of NSVT ≥ 1 episode/24 h and SAECG‐LPs ≥ 2/3 in combination with a LVEF < 50% were important predictors of inducibility. However, the final decision for an ICD implantation should be based on a positive PVS, which is irreplaceable in risk stratification.     

Electrophysiologic testing guided risk stratification approach for sudden cardiac death beyond the left ventricular ejection fraction

Sudden cardiac death threats ischaemic and dilated cardiomyopathy patients. Anti- arrhythmic protection may be provided to these patients with implanted cardiac defibrillators(ICD), after an efficient risk stratification approach. The proposed risk stratifier of an impaired left ventricular ejection fraction has limited sensitivity meaning that a significant number of victims will remain undetectable by this risk stratification approach because they have a preserved left ventricular systolic function. Current risk stratification strategies focus on combinations of non invasive methods like T wave alternans, late potentials, heart rate turbulence, deceleration capacity and others, with invasive methods like the electrophysiologic study. In the presence of an electrically impaired substrate with formed post myocardial infarction fibrotic zones, programmed ventricular stimulation provides important prognostic information for the selection of the patients expected to benefit from an ICD implantation, while due to its high negative predictive value, patients at low risk level may also be detected. Clustering evidence from different research groups and electrophysiologic labs support an electrophysiologic testing guided risk stratification approach for sudden cardiac death.     

Does previous protein feeding affect the response of sheep towards foods that differ in their rumen availability, but not content, of nitrogen?

The objective of the experiment was threefold: (1) to test whether an 'unlearned appetite' for dietary protein exists in sheep, (2) whether such an appetite and subsequent diet selection depend on the degree of previous protein deprivation, and (3) whether the N-source in the foods offered as choice influences diet selection. Differences in protein deprivation were achieved by feeding sheep with food either with high (HP) or low (LP) protein. Sheep were fed on Food LP, either for the same period of time as sheep on Food HP or until they reached the same live-weight (LW) as sheep on Food HP. Following the feeding regimes that induced differences in animal state, sheep were given a choice between a novel low-protein food (T) or Food T supplemented with isonitrogenous amounts with one of three nitrogen sources: urea (U), casein (C), or formaldehyde-treated casein (TFC). Diet selection measured in the short-term or over the first few days did not provide any evidence in support of an unlearned appetite for protein by sheep of different states. In fact, diet selection by all animals was characterized by an avoidance of the foods supplemented with the three nitrogen sources. This avoidance was strongest for the food supplemented with formaldehyde-treated casein. Selection of considerable amounts of supplemented foods was gradual and consistent only after animals gained experience of them, i.e. were allowed to consume a single supplemented food for a period of 7 days. Following this period, animals that had previously consumed Food LP for the same period of time as animals on Food HP selected a higher proportion of the supplemented food than the other sheep. The results support the view that there is no unlearned appetite for protein in sheep, and that control over diet selection is learned.     

Nursing staff shortage and in-hospital informal care in an oncology hospital in Greece: the nursing staff's perceptions

There is a broad variety of factors that are contributing to the nursing staff shortage. They include low wages, poor image of nursing, job satisfaction, ageing of the nursing workforce and cost reductions. In the Greek National Health System, there is a policy of open-visiting hours in hospitals. Family members stay with the patients for many hours and provide in-hospital informal care. The purpose of this study is to describe the perceptions of nursing staff about the nursing staff shortage and the in-hospital informal care in a Greek oncology hospital. For the data collection we used a 30-item questionnaire. The majority of the participants (82.9%) stated that most patients have a family member staying longer than the official visiting hours for assisting with care. A main reason according to the nurses' opinion (37.4%) is the nursing staff shortage. In addition, most nurses disagree with relatives providing some of the informal caregiving activities. The findings are consistent with the findings of other studies. They might be of interest to Greek health authorities, to nurses and to Greek citizens in order to implement possible solutions to improve the hospitalization in Greek hospitals.