Transseptal use of high-density grid catheter for VT mapping and retrograde hemodynamic support with Impella pump in presence of Mitraclips

Journal of Interventional Cardiac Electrophysiology - We sought to establish the technical feasibility of VT-mapping with high-density catheters in patients with Mitraclips, requiring a hemodynamic...     

Smokeless tobacco use in pregnancy: an integrative review of the literature

Objectives

To systematically critique and summarise the available evidence on the outcomes of smokeless tobacco use in pregnancy to inform the public health response.

Methods

In March 2013, a search was conducted of observational studies where the exposure to smokeless tobacco during pregnancy and maternal, placental and/or neonatal outcomes was assessed. Two reviewers extracted data and completed quality assessment of the literature utilizing the Agency for Healthcare Research and Quality criteria (West et al. 2002).

Results

The search resulted in 211 articles, 21 (10 %) of which met the final criteria for integrative review. Ten (10) of the studies are from India, seven (7) from Sweden, two (2) from Alaska and one (1) each from South Africa and Pakistan.

Conclusions

Many studies lacked sufficient power to estimate precise risks. Most reports were hindered by imprecise measures of exposure and lack of confounding variable control. However, there were indications that maternal smokeless tobacco use increases rates of stillbirth, low birth weight and alters the male:female live birth ratio. Maternal smokeless tobacco use may not be safe for mother or foetus.     

The Internet as a research site: establishment of a web-based longitudinal study of the nursing and midwifery workforce in three countries

Title.  The Internet as a research site: establishment of a web-based longitudinal study of the nursing and midwifery workforce in three countries.
Aim.  The aim of this paper is to describe the development of a web-based longitudinal research project, The Nurses and Midwives e-cohort Study.
Background.  The Internet has only recently been used for health research. However, web-based methodologies are increasingly discussed as significant and inevitable developments in research as Internet access and use rapidly increases worldwide.
Method.  In 2006, a longitudinal web-based study of nurses and midwives workforce participation patterns, health and wellbeing, and lifestyle choices was established. Participating countries are Australia, New Zealand and the United Kingdom. Data collection is handled through a dedicated website using a range of standardized tools combined into one comprehensive questionnaire. Internet-specific data collection and a range of recruitment and retention strategies have been developed for this study.
Discussion.  Internet-based technology can support the maintenance of cohorts across multiple countries and jurisdictions to explore factors influencing workforce participation. However, barriers to widespread adoption of web-based approaches include website development costs, the need for fast broadband connection for large data collection instruments, and varying degrees of Internet and computer literacy in the nursing and midwifery workforce.
Conclusion.  Many of the issues reported in this paper are transitional in nature at a time of rapid technological development. The development of on-line methods and tools is a major and exciting development in the world of research. Research via the world-wide web can support international collaborations across borders and cultures.     

Impact of prior therapy on the recovery and frequency of corneal pathogens

OBJECTIVE: To document the impact of prior antibiotic therapy on the recovery of corneal pathogens. METHODS: Medical records and laboratory reports of 334 consecutive microbial keratitis patients examined from January to December 2000 were reviewed. Comparisons of pathogens, culture positive rate, recovery time, antibiotic sensitivity profile, delay in presentation, and final visual acuity were analyzed for patients treated before presentation and those who were not. The chi square test was used to determine statistical significance. RESULTS: Of the 334 patients, 56% were exposed to at least one course of topical antimicrobials before culture. Patients on therapy were only slightly more likely to be culture negative (P = 0.317) but significantly more likely to have a delay in pathogen recovery (P = 0.002). Patients given prior antibiotics took significantly longer to heal (P = 0.003). Gram-negative organisms (47.5%) were the most frequent pathogens isolated from all culture-positive patients, followed by gram positives (28.7%), fungi (15.8%), and parasites (2%). An increase and significant difference in the frequency of fungi (P = 0.000) and acanthamoeba was reserved for the pretreated group. Gram negative organisms were more often isolated from patients who had not been pretreated (P = 0.002). Pretreated patients were more like to have a pathogen resistant to 1 or more of the commonly prescribed ocular antibiotics (P = 0.02). CONCLUSIONS: There is a delay in starting microbiologic-guided antibiotic treatment in patients who have received empiric therapy. Nonbacterial corneal pathogens may be associated more frequently with patients on prior therapy.     

A case series of paediatric high flow nasal cannula therapy

IntroductionHigh flow nasal cannula is an emerging treatment option in Paediatric Intensive Care Units for paediatric patients in acute respiratory distress. Yet there is a paucity of literature describing its clinical application in various presenting pathophysiologies.AimTo describe three cases with differing underlying pathophysiologies and their response to high flow nasal cannula oxygen therapy.MethodPatients admitted to the Paediatric Intensive Care Unit with bronchiolitis, asthma and cardiomyopathy, and treated with high flow nasal cannula therapy were searched in the Paediatric Intensive Care database. The most representative cases were chosen to review.ResultsOne infant and two children were reviewed. All were commenced on high flow nasal cannula therapy in the Paediatric Intensive Care Unit and all demonstrated an improvement in their work of breathing. There was also a substantial improvement in their haemodynamic status. No patient required escalation to other forms of respiratory therapy.ConclusionHigh flow nasal cannula therapy is a viable treatment option for a range of patients presenting to the Paediatric Intensive Care Unit with acute respiratory distress. More invasive methods of respiratory support may be avoided by the use of high flow nasal cannula therapy.     

Ventilator-associated events in children: A review of literature

Background

The complexity and variation in ventilator associated pneumonia (VAP) definitions in paediatrics may pose threats to the reliable identification of VAP. The revision of the surveillance definition to ventilator-associated event (VAE) has been mandated in adult populations, to overcome these issues. However, the evidence for application of the definition is unknown in children.

Prevalence,clinical correlates and treatment of permanent atrial fibrillation among the elderly: insights from the first prospective population-based study in rural Greece

To investigate the prevalence of permanent atrial fibrillation (AF), its clinical associated conditions and treatment status in the elderly population in rural Greece. 720 people (46.1% males) older than 65 years (mean age: 72.5 ± 5.7 years) living in four villages in rural Greece were screened with an electrocardiogram (response rate: 90.5%) for the presence of permanent AF. They underwent a physical examination, including blood pressure (BP) measurement, and body mass index (BMI) calculation, in addition to an interview about their medical history, physical activity, smoking habits, alcohol consumption and medication use. Subjects with AF for whom anticoagulants were contraindicated were identified and stroke risk stratification was performed using the CHADS2 algorithm. The prevalence of permanent AF was 5% (6.6% among men and 3.6% among women) and it increased with age. In the entire population, ECG evidence of myocardial ischaemia and ventricular premature beats were independently associated with the presence of permanent AF (OR 5.266; 95% CI 2.22–12.49, P = 0.0001 and OR 2.61; 95% CI 1.059–6.432, P = 0.037, respectively), while female sex was independently associated with the absence of the AF (OR 0.327; CI 0.147–0.729, P = 0.006). From those patients who were eligible for anticoagulation, 40.6% were treated with anticoagulants, 34.3% were given antiplatelets therapy and the rest received no antithrombotic treatment. This is the first prospective study demonstrating the prevalence, clinical correlates and treatment status of permanent AF in Greece. These results confirm the high prevalence of permanent AF among the elderly and underscore the issue regarding anticoagulants underutilization.