The Psychological Impact of Implantable Cardioverter-Defibrillator Recalls and the Durable Positive Effects of Counseling

Background: It is known that patients with lifesaving devices such as implantable cardioverter-defibrillators (ICDs) may be alarmed and worried by recalls or alerts related to their ICDs.
Objectives: This study aimed to determine whether counseling has any short- or long-term benefits, and to look for characteristics that identify those most worried and those most in need of counseling.
Methods: Among 100 patients with recall or alert ICDs, 14 were pacer dependent; 50 had ICDs for 1° prevention and 22 were women. Patients completed a survey indicating how worried they were on learning of the recall or alert (0–10 scale). After counseling and advice in accordance with manufacturer guidelines, patients were asked to indicate their level of worry, and were again asked after 6 months.
Results: For all patients, the "worry level" at the initial interview was 5.0 ± 3.7, falling to 2.2 ± 3.0 after counseling (P < 0.001) and 1.4 ± 2.3 after 6 months (P < 0.001 vs both earlier levels). There were no significant differences between those implanted for 1° versus 2° prevention or for pacer dependency. Women were initially more worried than men, but not for the long term. The 49 patients whose ICDs could be managed by reprogramming or software fix had significant reduction in worry after counseling and at 6 months compared to others. The 18 patients recommended for operative intervention remained more concerned after counseling (3.5 ± 3.3 vs 1.9 ± 2.9, P = 0.043).
Conclusions: Patients' concerns resulting from ICD recalls or alerts can be reduced by appropriate counseling. Those patients whose ICDs could be reprogrammed to safer parameters had the most reduction in worry levels.     

Quality of Life after Coronary Artery Surgery

Seventy-nine men were assessed using standard interview proceduresbefore and at three and 12 months after coronary artery surgery.At one year, the majority reported relief of angina and reduceddifficulty in performing everyday activities, but there wasconsiderable individual variation in changes in quality of life.Overall, there were improvements in mental state, leisure activity,satisfaction and family life, but few benefits for work andsexual relations. For a fifth of patients global quality oflife was no better or was worse than before surgery and thispoor outcome was not closely related to physical state. Patientswho described psychological symptoms or had a ‘passive’approach to their illness before operation were less likelyto have a good outcome. It is probable that the benefits ofsurgery could be substantially increased by provision of betterfacilities including simple individually planned preparationand rehabilitation. The study demonstrates that specific interviewbased ratings can be used to quantify changes in those aspectsof quality of life which are most important to patients andtheir families.     

A Life‐Threatening Flecainide Overdose Treated with Intravenous Fat Emulsion

Flecainide is a Vaughan Williams Class Ic antidysrhythmic associated with PR, QRS, and QTc prolongation on the electrocardiogram and development of life‐threatening cardiac toxicity in overdose. The cornerstone of treatment is fluid resuscitation and the administration of magnesium and sodium bicarbonate. We report a case of flecainide overdose associated with life‐threatening hemodynamic compromise successfully treated with intravenous fat emulsion (IFE) therapy. IFE should be considered as a novel adjunctive therapy in patients with life‐threatening toxicity following flecainide overdose.     

The Drug Dependence Syndrome and Related Disabilities

While the dependence syndrome has been extensively studied in alcohol patients, much less information is available about this syndrome in drugs other than alcohol. Since the core symptoms of the dependence syndrome have been defined as comprising a dimension of disability distinct from social, health and other consequences of substance abuse, we examined the relationships of dependence syndrome symptoms and related problems for drugs. We included cannabis, stimulants, barbiturates, tranquilizers, cocaine, opiates and hallucinogens in our analyses. Results showed high clustering of dependence symptoms with each other and with health, social and emotional problems attributed to drug use. This supports the syndrome concept for the core dependence symptoms, but not the concept that the symptoms form distinct dimensions from associated problems.     

Coccidiosis: localization of lymphoblasts in the infected small intestine

Summary Peripheral blood lymphocytes of chickens and thoracic duct lymphocytes and mesenteric lymph node cells of rats, were labelled with ¹²⁵-deoxyuridine and injected intravenously into chickens or rats respectively. Sixteen to 18 h later the intestines of coccidia infected animals contained more radioactivity than those of uninfected controls. This result was obtained with cell suspensions from both infected and normal donors indicating that, as with nematode infected rodents, the increased homing of the cells to parasitised gut was not antigen specific. In chickens the stimulus which causes the increased homing of cells to the intestine was induced within hours of parasite inoculation. This reflects the rapid response of this host, previously described with other parameters, and which may be characteristic of birds.