bluuebunny/crossref_metadata_2025 huggingface dataset:
Social and health care integration: (1) The individual dimension
Authors: Brand Don
Published: November 2012

Purpose

This article begins a series of three about making a reality of integration policy in health and social care at individual, functional and cultural levels.

Design/methodology/approach

The paper outlines messages from policy debate and the Adult Social Care White Paper about the benefits to individuals and carers of improvements in integration. It follows the progress of a 91‐year‐old widow during a recent six‐week stay in hospital, and the difficulties she and her daughter encountered through professional and service faultlines and information blocks.

Findings

The paper questions the White Paper proposal for named professionals to coordinate care for people with complex needs, and argues that the benefits of integration will not be achieved without a significant change of culture. It outlines later papers exploring a functional model of integration, and examining the implications of culture change for the relationships between health and social care, between professionals and individuals, and between the Department of Health and the health and care system.

Originality/value

In “placing the individual at the centre”, the article grounds a series linking the newly‐published Care and Support White Paper and the emerging NHS reform programme to examine changes needed if integration is to benefit individuals and carers.
The problem with “skunk”
Authors: Potter Gary R. , Chatwin Caroline
Published: November 2012

Purpose

This article aims to discuss the use of the word “skunk” in contemporary discourse as short‐hand for premium quality, indoor‐grown cannabis. Skunk, as used in this way, is a contested term that many cannabis users reject. The purpose of the article is to draw attention to some practical implications of this semantic dispute for academic research and for policy development.

Design/methodology/approach

The authors draw on qualitative data generated during an online survey project examining UK cannabis markets. Findings discussed are contextualised by reference to use of the word skunk in public discourse through the media and policy documents.

Findings

The uncritical use of the word “skunk” by researchers, the media and others can pose problems, particularly where the use and implied meaning of the word is rejected (as it is amongst a segment of the cannabis using population). Attempts to acquire or disseminate knowledge, or to develop or enact policy about cannabis use and distribution in the UK may encounter significant problems if attention is not paid to this issue.

Originality/value

The article offers a view of the impact of the increased and uncritical public use of the word “skunk” on those who may be of particular concern to policy makers and academic researchers: those who are most involved with cannabis (e.g. heavier users, cannabis connoisseurs and cannabis growers).
Self‐care, plesio‐care, telecare and m‐care: a new assisted living model
Authors: Doughty Kevin , Godfrey David , Mulvihill Billy
Published: November 2012

Purpose

This paper critically reviews the motivations for introducing different connected healthcare to support Assisted Living in older and other vulnerable groups. The aim is to develop a new approach that will be sustainable in the future.

Design/methodology/approach

The methodology involves a consideration of assessment criteria currently being employed and the resulting costs and limitations in providing a person centred approach. The implications of introducing new technologies such as plesiocare and mCare are then considered.

Findings

It was found that one of the most cost‐effective applications of technology is in the support of informal carers but the telecare equipment that they are offered may not be the most appropriate.

Research limitations/implications

The findings are limited by a lack of formal risk assessments that are person centred. The implications include the need for improved training in assessment processes and access to a wider inventory of technologies.

Practical implications

Existing telecare services will need to change in order to adopt more plesiocare and self‐care approaches and to engage more actively in the development of models based on mcare.

Social implications

Governments and health ministries may achieve better and lower cost support for their ageing population by adopting a model that includes multiple layers of technology, including easier access to self‐care and mCare technologies.

Originality/value

This paper includes the first discussion on plesiocare and its relative advantages over telecare in supporting informal carers.
The need for cognitive profiles based on neuropsychological assessments to drive individual education plans (IEPs) in forensic settings
Authors: Lowings Graham , Wicks Beth
Published: November 2012

Purpose

Many people within secure forensic settings are expected to take part in psycho‐educational programmes as part of their treatment and rehabilitation. Many are hampered in their progress due to cognitive difficulties. This paper aims to outline the scale of the problem and to offer potential solutions.

Design/methodology/approach

The numbers of people who are placed in secure settings with known neuropsychological difficulties and the range of their cognitive problems are explored. It is proposed that individual education plans based on neuropsychological profiles together with guidance on the preparation and delivery of educational materials could improve the efficacy of psycho‐educational programmes.

Findings

Many people within the secure forensic estate have neuropsychological deficits. Many have suffered traumatic or other acquired brain injury or have deficits associated with substance misuse or even childhood emotional trauma. Others have cognitive difficulties specific to their mental health and occasionally their prescribed medication. A significant number will have intellectual disability (IQ<70) or be within the borderline range (IQ between 70 and 79).

Originality/value

Understanding neuropsychological difficulties would mean that best use is made of the psycho‐educational materials presented, thus speeding up and improving the efficacy of the rehabilitation process and potentially reducing the risk that the person poses to themselves and others. There are resources, which offer guidance to teachers of children with neuropsychological difficulties but not for the adolescent and adult forensic population. This paper addresses this gap.
How does prison visiting affect female offenders' mental health? Implications for education and development
Authors: de Motte Claire , Bailey Di , Ward James
Published: November 2012

Purpose

The aims of this paper are to determine the state of visiting for women in the English prison system and to explore the relationship between women's mental health and visits in prison.

Design/methodology/approach

For the purpose of this paper the authors conducted a review of the literature. All literature published from 1983 onwards was included to coincide with the introduction of Pat Carlen's (1983) campaigning group Women in Prison (WIP). The review focused on all literature from England and Wales to reflect the National Criminal Justice System and used an inclusion criteria to achieve this.

Findings

The review revealed key themes including visit rejection, the importance of visits for maintaining identity and the contradicting emotions that women in prison experience when visited.

Originality/value

Social relationships and family ties are protective factors for prisoners' mental wellbeing, yet the number and frequency of visits to offenders in custody has declined. The potential role for prison visiting schemes to improve the mental wellbeing of women in custody is explored, including the implications for the education and training of staff and visitors involved in the visiting process.
Window tax
Authors: Gordon Peter J.
Published: November 2012

Purpose

The purpose of this paper is to discuss concerns that, despite recent campaigns, stigma has not been fully addressed by the psychiatric profession and that evidence suggests it may have unwittingly contributed to iatrogenic stigma.

Design/methodology/approach

The writer of this paper is a psychiatrist and considers the subject of stigma by employing the metaphor of bricked up windows. Arguments are supported through the evaluation of scientific research in addition to ideas from philosophy and literature.

Findings

The paper highlights areas of ongoing stigma and also identifies possible explanations for this in the current approach of the psychiatric profession.

Practical implications

It is hoped that this paper stimulates further discussion particularly within the psychiatric profession about the approach to tackling stigma.

Originality/value

This paper revisits the subject of Iatrogenic Stigma ten years on from an editorial in the British Medical Journal by Professor Norman Sartorius. The assumption of the psychiatric profession is that, by giving prominence to a biomedical view of mental illness, stigma will be lessened. This paper challenges this view and widens the discussion.
Employment – hope and reality
Authors: Williams Alex
Published: November 2012

Purpose

This article aims to explore what are likely to be key factors in a successful journey to employment for someone who has experienced long‐term mental distress.

Design/methodology/approach

The article is a personal account of entering and sustaining employment by someone who has experienced long‐term mental distress and use of secondary mental health services. The writer reflects on a hard fought journey to start paid work in the hope that readers may understand this process for themselves and others in similar positions.

Findings

Key factors in the transition to employment are hard work, workplace support, specialist vocational advice, individual determination and willing employers. Support needs to be flexible, personalised, ongoing and sometimes intensive. Time is measured in years rather than months.

Practical implications

The integration of specialist vocational advice within mental health teams may be an effective approach.

Research implications

Further research into the practical and psychological barriers to employment for mental health service users, which may extend far beyond the more commonly studied stigma and discrimination, would enhance existing knowledge of vocational rehabilitation.

Originality/value

Published testimonies from service users and survivors on their experiences of entering employment for the first time are few in number. More such testimonies would help understanding of this potentially complex process.
Care in the community?
Authors: Gray Susan
Published: November 2012

Purpose

This article aims to highlight how people with mental health problems are ostensibly in the community but can still “feel” excluded.

Design/methodology/approach

The author reflects on her own experiences and uses examples to demonstrate the above.

Findings

The article highlights the need for service users to be consulted and listened to by all in the community.

Originality/value

This article increases people's awareness of the real experience of service users, drawing upon the experience of someone with long experience of mental health services.
Intermittent breeding and the dynamics of resource allocation to reproduction, growth and survival
Authors: Baron Jean‐Pierre , Le Galliard Jean‐François , Ferrière Régis , Tully Thomas
Published: November 2012

In iteroparous organisms, the timing of reproduction varies greatly and reproduction may be intermittent. Here, we investigate the proximate determinants of intermittent breeding and their evolutionary significance in a viviparous snake, the meadow viper Vipera ursinii ursinii. We used individual life‐history data collected over a 28‐year capture–mark–recapture field study.

Among viviparous snakes, the meadow viper's almost exclusively insectivorous diet is remarkable. Breeding females maintain substantial foraging activity during gestation.

The life cycle is iteroparous, and female breeding frequency is essentially biennial. Breeding status is strongly associated with a threshold on female body condition prior to vitellogenesis.

Non‐breeding females grow and store fat reserves needed for future reproduction. Breeding females convert reserves into eggs, the number of which is determined by maternal size and body condition prior to vitellogenesis. During pregnancy, females stop growing.

Females survive breeding and non‐breeding years with equal probabilities. Our results suggest that income resources during pregnancy are used to fully cover the costs of gestation.

Integration of our data into a matrix population model allowed us to relate breeding pattern to fitness. According to the model, biennial breeding is strongly favoured by natural selection if consecutive breeding decreases maternal survival and/or fecundity. Growth cessation during breeding years generates weak selection pressures for intermittent breeding.
Coordination difficulties and self‐esteem: A review and findings from a New Zealand survey
Authors: Eggleston Matthew , Hanger Nicola , Frampton Christopher , Watkins William
Published: November 2012

Aims

Children and adolescents with significant coordination difficulties have consistently been found to have lower self‐esteem in relation to athletic competence and physical ability. However, findings in relation to global self‐esteem have been mixed. This study aimed to investigate the self‐esteem of children and adolescents with a diagnosis of dyspraxia in a large New Zealand sample.

Methods

A confidential postal questionnaire was sent to all members of the Dyspraxia Support Group of New Zealand. Children and adolescents aged seven to 18 years with a diagnosis of dyspraxia were asked to complete the Piers–Harris Children's Self‐Concept Scale 2nd edition (PHCSCS‐2), while parents were asked about a range of factors which might affect self‐esteem including possible coexisting conditions.

Results

There was a response rate of 20% with 75 valid responses. Coexisting conditions were common including 50.7% with a diagnosis of dyslexia or another learning disorder. Children and adolescents with dyspraxia scored significantly lower than PHCSCS‐2 norms on the physical appearance and attributes, intellectual and school status and popularity subscales and also the PHCSCS‐2 total score, indicating lower global self‐esteem.

Conclusions

This study strengthens the evidence that an association exists in children and adolescents between having significant coordination difficulties and lower global self‐esteem.
Effects of levonorgestrel‐quinestrol (EP‐1) treatment on Mongolian gerbil wild populations: a case study
Authors: FU Heping , ZHANG Jinwei , SHI Dazhao , WU Xiaodong
Published: November 2012

Rodent pest population outbreaks occur frequently in grassland ecosystems in northern China. The Mongolian gerbil (Meriones unguiculatus) is a dominant pest rodent which is distributed across the semi‐desert grasslands of Inner Mongolia, China. In 2009, we studied the contraceptive effect of levonorgestrel‐quinestrol (EP‐1), concentration 50 ppm, on a wild Mongolian gerbil population. The one‐off contraceptive treatment was compared with a control group using a semi‐monthly live trapping method in the Ordos Semi‐desert Grassland Region of Inner Mongolia. The results show that juveniles were not recruited in spring in the treatment group. Ratios of juveniles in the control and treatment groups showed significant semi‐monthly differences from spring to summer (one‐way ANOVA, F2, 14= 7.53, P < 0.05). Between both groups, annual fluctuations of juvenile and total population densities were significantly different respectively (F2, 14= 4.64, P < 0.05; F2, 18= 7.72, P < 0.05). The contraceptive EP‐1 delayed the normal reproductive pattern of Mongolian gerbil populations. This suppressed birth rates of gerbil populations, reduced their densities, and changed their age structures. The period of EP‐1 baiting should be extended but it could be an ideal method for controlling Mongolian gerbil populations during each breeding season.
Observation of intra‐group and extra‐group copulation and reproductive characters in free ranging groups of western black crested gibbon (Nomascus concolor jingdongensis)
Authors: HUANG Bei , GUAN Zhenghua , NI Qingyong , ORKIN Joseph D. , FAN Pengfei , JIANG Xuelong
Published: November 2012

Black crested gibbons (Nomascus concolor) are 1 of only 3 gibbon species that have been observed in long‐term polygynous groups, but their mating behavior and reproductive characters have never been reported. Based on population monitoring over 7 years and direct observation for 26 months of the study groups in Wuliang Mountain, central Yunnan, we describe for the first time the copulation behavior and breeding pattern of free‐ranging western black crested gibbons. The gestation period of black crested gibbons is estimated to be between 6 and 7 months. The average breeding interval is 3.5 years, with infant independence at approximately 2.5 years. We observed 2 intra‐group copulations and 5 extra‐group copulations. Copulations were initiated when a female gave a ‘solicitation’ gesture. When a male made any mating attempt, the female might refuse it. These results demonstrate direct female mate choice. Both male and female gibbons dispersed from their natal groups and sometimes replaced paired adults in other groups. We observed no evidence of infanticide during inter‐group conflicts or after replacement of adults. Together with extra‐group copulations, these phenomena indicate a flexible social organization and complex mating system. We also observed a male‐biased sex ratio among offspring. More genetic work is necessary to describe the effects of inter‐group copulation and the genetic diversity of this population.
Antidepressant use, depression, and new‐onset diabetes among elderly Medicare beneficiaries (在老年医疗保险受益者中调查抗抑郁药的使用、抑郁症以及新发糖尿病)
Authors: Sambamoorthi Usha , Ma Yunsheng , Findley Patricia A. , Rust George
Published: November 2012

Background

The aim of the present study was to examine the association between antidepressant use, diagnosed depression, and new‐onset diabetes among elderly Medicare beneficiaries.

Methods

Longitudinal data from merged survey and claims from the nationally representative Medicare Current Beneficiary Survey(MCBS) from 1999 to 2005 were used. Diabetes incidence was extracted from claims and survey data over a 3‐year period. Data regarding depression and antidepressant use over time were obtained. Multivariate logistic regression analysis was used to examine associations between antidepressant use, depression, and new‐onset diabetes, adjusted for demographic, socioeconomic, and lifestyle risk factors. Analyses accounted for the complex design of the MCBS.

Results

The incident diabetes rate was 4.8% for those “without depression and without antidepressants” and 9.5% for those with any antidepressant use in all 3 years and diagnosed depression”. Compared with Medicare beneficiaries who did not report any antidepressant use, beneficiaries reporting antidepressant use in all 3 years were 50% more likely to have new‐onset diabetes. However, when diagnosed depression was entered in the model, there was no significant association between long‐term antidepressant use and new‐onset diabetes. Medicare beneficiaries with any depression were twice as likely as those without depression to develop diabetes (adjusted odds ratio 2.04; 95% confidence interval 1.51, 2.75).

Conclusions

Depression independently increased the risk of developing diabetes in the MCBS population, although there is no evidence of an association between antidepressant use and new‐onset diabetes. If replicated, these results have significant clinical implications.
Defective ATM‐Kap‐1‐mediated chromatin remodeling impairs DNA repair and accelerates senescence in progeria mouse model
Authors: Liu Baohua , Wang Zimei , Ghosh Shrestha , Zhou Zhongjun
Published: November 2012

ATM‐mediated phosphorylation of KAP‐1 triggers chromatin remodeling and facilitates the loading and retention of repair proteins at DNA lesions. Mouse embryonic fibroblasts (MEFs) derived from Zmpste24−/− mice undergo early senescence, attributable to delayed recruitment of DNA repair proteins. Here, we show that ATM‐Kap‐1 signaling is compromised in Zmpste24−/− MEFs, leading to defective DNA damage‐induced chromatin remodeling. Knocking down Kap‐1 rescues impaired chromatin remodeling, defective DNA repair and early senescence in Zmpste24−/− MEFs. Thus, ATM‐Kap‐1‐mediated chromatin remodeling plays a critical role in premature aging, carrying significant implications for progeria therapy.
Electrocardiographic Predictors of Sudden Cardiac Death in Patients with Left Ventricular Hypertrophy
Authors: Panikkath Ragesh , Reinier Kyndaron , Uy‐Evanado Audrey , Teodorescu Carmen , Gunson Karen , Jui Jonathan , Chugh Sumeet S.
Published: November 2012

Background

Left ventricular hypertrophy (LVH) has been associated with increased risk of sudden cardiac death (SCD), and improvements in risk stratification methodology are warranted.

Methods

We evaluated electrocardiographic intervals as potential markers of SCD risk in LVH. Corrected QT, QRS, and JT intervals were evaluated in consecutive cases with SCD and LVH from the ongoing Oregon Sudden Unexpected Death study who underwent a 12‐lead electrocardiogram (EKG) and echocardiogram prior to and unrelated to the SCD event. Comparisons of age, gender, body mass index, LV ejection fraction, and EKG intervals together with clinical conditions (hypertension and diabetes) were conducted with geographically matched controls that had coronary artery disease but no history of ventricular arrhythmias or cardiac arrest. LVH was determined using the modified American Society of Echocardiography equation for LV mass. Independent samples t‐test, Pearson's chi‐square test, and multiple logistic regression were used for statistical comparisons.

Results

Of the 109 cases and 49 controls who met study criteria, age, gender, and comorbidities were similar among cases and controls. The mean LV mass index was not significantly different in cases compared to controls. However mean QTc (470.6 ± 53.6 ms vs 440.7 ± 38.7 ms; P < 0.0001) and QRS duration (113.6 ± 30.0 ms vs 104.9 ± 18.7 ms; P = 0.03) were significantly higher in cases than controls. In logistic regression analysis, prolonged QTc was the only EKG interval significantly associated with SCD (OR 1.72 [1.23–2.40]).

Conclusion

Prolonged QTc was independently associated with SCD among subjects with LVH and merits further evaluation as a predictor of SCD in LVH.
Prevention of Post–Coronary Artery Bypass Grafting (CABG) Atrial Fibrillation: Efficacy of Prophylactic Beta‐Blockers in the Modern Era
Authors: Khan Muhammad Fahad , Wendel Christopher S. , Movahed Mohammad Reza
Published: November 2012

Background

Atrial fibrillation/flutter (AF) is a common complication of open heart surgery and ACC/AHA guidelines strongly recommend the use of prophylactic beta‐blockers (BB) for its prevention. Several recent studies, however, have failed to show the desired protective effects of BB against post–coronary artery bypass grafting (CABG) AF. As the protocols of CABG, medical management of CAD (coronary artery disease) and demographic features of the patients undergoing open heart surgery have evolved significantly over the last two decades, we decided to perform a review of evidence from latest randomized controlled trials (RCTs) to confirm the efficacy of prophylactic BB.

Methods

We searched for RCTs comparing the efficacy of prophylactic BB versus placebo/control against post‐CABG AF. We limited our search to 1995 till present to reflect ongoing advancements in the protocols of CABG and the medical management of CAD. Initially, 34 trials were selected; however after certain exclusions only 10 RCTs were included in the final analysis.

Results

Prophylactic BB decreased the incidence of post‐CABG AF from 32.8% in the control group to 20% in the prophylactic group with risk ratio (RR) of 0.50 with 95% CI of 0.36–0.69, P value < 0.001. In a subgroup analysis, carvedilol appears to be superior to metoprolol for the prevention of postoperative AF.

Conclusions

Despite several limitations, this analysis confirms the efficacy of prophylactic BB against post‐CABG AF in this era. We recommend continuing perioperative BB in the open heart surgery patients in the absence of contraindications.
Indexes of Temporal Myocardial Repolarization Dispersion and Sudden Cardiac Death in Heart Failure: Any Difference?
Authors: Piccirillo Gianfranco , Rossi Pietro , Mitra Marilena , Quaglione Raffaele , Dell'Armi Annalaura , Di Barba Daniele , Maisto Damiana , Lizio Andrea , Barillà Francesco , Magrì Damiano
Published: November 2012

Background

The QT variability index, calculated between Q‐ and the T‐wave end (QTendVI), is an index of temporal myocardial repolarization lability associated with sudden cardiac death (SCD) in chronic heart failure (CHF). Little is known about temporal variability in the other two temporal myocardial repolarization descriptors obtained from Q–Tpeak and Tpeak–Tend intervals. We therefore investigated differences between these indexes in patients with CHF who died suddenly and in those who survived with a left ventricular ejection fraction (LVEF) ≤35% or >35%.

Methods and Results

We selected 127 ECG and systolic blood pressure (SPB) recordings from outpatients with CHF all of whom had been followed up for 30 months. We calculated RR and SPB variability by power spectral analysis and QTendVI, QTpeakVI, TpeakTendVI. We then subdivided data patients into three groups SCD, LVEF ≤ 35%, and LVEF > 35%. The LVEF was higher in the SCD than in the LVEF ≤ 35% group, whereas no difference was found between the SCD and LVEF > 35% groups. QTendVI, QTpeakVI, and TpeakTendVI were higher in the SCD and LVEF ≤ 35% groups than in the LVEF > 35% group. Multivariate analysis detected a negative relationship between all repolarization variability indexes, low frequency obtained from RR intervals and LVEF.

Conclusions

Our data show that variability in the first (QTpeakVI) and second halves of the QT interval (Tpeak–TendVI) significantly contributes to the QTendVI in patients with CHF. Further studies should investigate whether these indexes might help stratify the risk of SCD in patients with a moderately depressed LVEF.
Effectiveness of Cardiac Resynchronization Therapy with Defibrillator in At‐Risk Black and White Cardiac Patients
Authors: Elanchenny Meena , Moss Arthur J. , McNitt Scott , Aktas Mehmet , Polonsky Slava , Zareba Wojciech , Goldenberg Ilan
Published: November 2012

Background

There are limited data regarding racial differences in response to cardiac resynchronization therapy with defibrillator (CRT‐D).

Methods

We assessed the effectiveness of CRT‐D, as compared to implantable cardioverter defibrillator (ICD) therapy alone, in reducing the risk of heart failure (HF) or death and changes in cardiac volumes among 1638 (90%) white patients and 143 (8%) black patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT‐CRT).

Results

Enrolled black patients displayed a higher frequency of diabetes mellitus, treated hypertension, higher creatinine levels, and a lower distance walked in the baseline 6‐minute walk test. Kaplan‐Meier survival analysis showed that at 3 years of follow‐up the cumulative probability of HF or death was higher among blacks (29%) as compared with whites (22%; P = 0.05). Both black and white patients experienced similar and pronounced reductions in cardiac volumes with CRT‐D therapy (all P values for comparison between the two groups >0.10). Risk reduction conferred by CRT‐D therapy as not significantly different between blacks and whites (hazard ratio = 0.78 and 0.60, respectively; P for the difference = 0.44). However, possibly due to sample size limitations the CRT‐D versus ICD only adjusted risk for HF/death in blacks was not statistically significant.

Conclusions

Black patients in MADIT‐CRT experienced increased risk of HF or death as compared with whites, but displayed a similar magnitude echocardiographic response to CRT‐D. These findings suggest that cardiac resynchronization therapy may be an effective therapeutic modality in black patients. However, further studies are needed to assess the clinical response to CRT‐D in this high‐risk population.
The Prognostic Value of Electrocardiographic Estimation of Left Ventricular Hypertrophy in Dialysis Patients
Authors: Covic Adrian C. , Buimistriuc Laura‐Dumitriţa , Green Darren , Stefan Alina , Badarau Silvia , Kalra Philip A.
Published: November 2012

Background

Left ventricular hypertrophy (LVH) is associated with poor cardiovascular outcome in CKD. Electrocardiogram (ECG) is low‐cost but infrequently used to assess presence of LVH in dialysis patients. The aim of this study was to establish which ECG‐determined LVH method is most sensitive in dialysis patients, and also most predictive of death.

Methods

This was a longitudinal observational study in dialysis patients from a single center, undergoing interval ECGs. Fourteen methods of ECG LVH assessment were compared. Survival was also compared between four LVH evolutionary categories: persistent LVH; new LVH; LVH regression; and no LVH.

Results

The study included 418 dialysis patients (46.3% women, mean age 51 years, mean follow up 67 months, 76 deaths, 37 cardiovascular deaths). LVH prevalence varied according to method (range 13.4–41.9%).

No measurement predicted all‐cause mortality. After Cox regression, there was an independent association between LVH and cardiovascular mortality using Novacode (HR = 3.04; 95% [CI] = 1.11–8.28, P < 0.05), but not with other methods. Patients with persistent ECG changes of LVH had increased risk of cardiovascular mortality compared to other LVH evolutionary categories (P < 0.044).

Conclusions

ECG scoring of LVH can be predictive of cardiovascular mortality. The Novacode method, based on repolarization abnormalities, is a better predictor than standard ECG techniques that are based on voltage criteria. Novacode LVH estimation at dialysis initiation may prove to be a noninvasive and cost‐effective bedside tool for cardiovascular risk stratification in patients receiving dialysis.
The Prognostic Significance of Frequency and Morphology of Premature Ventricular Complexes during Ambulatory Holter Monitoring
Authors: Ephrem Georges , Levine Michael , Friedmann Patricia , Schweitzer Paul
Published: November 2012

Background

Multiform premature ventricular complexes (PVCs) are associated with an adverse prognosis in patients with structural heart disease. Very frequent PVCs are associated with ventricular dysfunction. Our hypothesis is that multiform PVCs confer an adverse prognosis in the general population.

Methods

We performed a retrospective cohort study of patients ≥18 years old referred to our institution for 24‐hour ambulatory Holter monitoring between July 1, 2008 and December 31, 2009. Holters without PVCs or with more frequent ectopy (couplets, triplets, or nonsustained ventricular tachycardia) were excluded. Clinical and adverse event (AE) data (“major adverse cardiovascular event” or new/worsening heart failure) were gathered from chart review. Data was analyzed by PVC frequency (rare, occasional, or frequent) and pattern (uniform or multiform).

Results

A total of 222 patients (43% male, mean age: 55 ± 16 years) were evaluated (median follow‐up 2.3 years [IQR: 2.0–2.6]). Median frequency was 2 PVCs per hour (IQR: 1–13). Multiform PVCs were noted in 48%. Patients with multiform PVCs were older, and had a higher prevalence of comorbidities. Thirty‐nine AE were noted. Patients with an AE were younger, had a higher prevalence of HTN, diabetes, CAD, CHF, and previous MI. The multiform group had a higher incidence of AE (28%) compared to the uniform group (8%) (P < 0.001). Increasing PVC frequency was associated with a higher incidence of AE (8% vs 24% vs 35%, respectively). In Cox regression analyses, the multiform pattern but not frequency predicted AE.

Conclusions

Multiform PVCs were associated with a 4‐fold increase in AE in patients referred for ambulatory Holter monitoring.
Diffuse Inverted T Waves in a Young Man with Structurally Normal Heart: A Case Report
Authors: Omidvar Bita , Majidi Shahla , Raadi Mehrdad , Alasti Mohammad
Published: November 2012

We discuss a young man with episodes of chest pain and dyspnea accompanied with transient T‐wave inversion in precordial and inferior leads that repeated several times. Cardiovascular evaluation did not disclose any structural abnormality. Memory T wave following episodes of idiopathic left septal ventricular tachycardia was the reason of these changes and did not repeat after arrhythmia ablation.
A Reappraisal on Lidocaine‐Sensitive Repetitive, Uniform Atrial Tachycardia
Authors: Garro Hugo A. , Elizari Marcelo V. , Baranchuk Adrian , Femenía Francisco , Chiale Pablo A.
Published: November 2012

Background

Lidocaine sensitive, repetitive atrial tachycardia is an unusual arrhythmia whose electrophysiologic substrate remains undefined. We aimed to analyze the electropharmacologic characteristics of this arrhythmia with emphasis on its cellular substrate and response to drug challenges.

Methods

We retrospectively analyzed a series of 18 patients from an electrocardiographic and electrophysiologic perspective and the response to pharmacological challenge.

Results

There was no evidence of structural heart disease in 12 patients, 4 patients presented with systemic hypertension; one patient had a prior myocardial infarction and one a mitral valve prolapse. The arrhythmia depicted a consistent pattern in nine patients. The first initiating ectopic beat showed a long coupling interval, the cycle length of the second atrial ectopic beat presented the shortest cycle length and a further prolongation was apparent towards the end of the atrial salvos. Conversely, in the other nine cases, the atrial tachycardia cycle length was erratic. The arrhythmia was suppressed by asynchronous atrial pacing at cycle lengths longer than those of the atrial tachycardia. Intravenous lidocaine eliminated the arrhythmia in all patients, but intravenous verapamil suppressed the atrial tachycardia in only two patients while adenosine caused a transient disappearance in 2/8 patients. Only one patient responded to all the three agents. Radiofrequency ablation was successfully performed in 10 patients.

Conclusions

Repetitive uniform atrial tachycardia can be sensitive to lidocaine. In few cases, this rare focal arrhythmia may be also suppressed by adenosine and/or verapamil, which suggests a diversity of electrophysiologic substrates that deserve to be accurately identified.
Assessment of Ventricular Repolarization Variability with the DeltaT50 Method Improves Identification of Patients with Congenital Long QT Syndromes
Authors: Abrahamsson Christina , Dota Corina , Skallefell Bo , Carlsson Leif , Frison Lars , Berggren Anders , Edvardsson Nils , Duker Göran
Published: November 2012

Background

We analyzed ventricular repolarization variability in genotyped long QT syndrome (LQTS) patients and in healthy volunteers (HV).

Method

The deltaT50, that is, the temporal variability of ventricular repolarization at 50% of the T‐wave downslope, was analyzed every 15th minute on 175 and 390 Holter electrocardiogram (ECG) recordings from HV and genotyped LQTS patients, respectively. The average deltaT50 and QTcF were calculated in each subject.

Results

DeltaT50 was 2.26 ± 0.71 ms (mean ± SD) in the HV and 5.74 ± 2.30 ms in the LQTS population (P < 0.0001). The sensitivity and specificity of QTcF (cutoff value 450 ms) to discriminate between the LQTS patients and the HV were 51.5% and 98.9%, and for deltaT50 (cutoff value 3 ms) 93.9% and 88.6%, respectively. The combination of both variables improved the diagnosis of the LQTS patients even further. Subgroups of LQTS patients at higher risk of cardiac events (with LQTS3, JLN, QTc > 500 ms or symptoms) had higher deltaT50 than subgroups at lower risk (with LQTS1, QTc < 450 ms or without symptoms). The variation in deltaT50 between day and night was concordant with the risk of symptoms; patients with LQTS1 had higher deltaT50 in the daytime and patients with LQTS3 had higher deltaT50 during the night.

Conclusion

DeltaT50 more accurately distinguished between LQTS patients and HV than QTcF and was higher in LQTS patients with a higher risk of cardiac events. DeltaT50 can be used together with QTcF to improve the diagnosis in patients with the LQTS phenotype and tentatively also be of value for risk assessment in such patients.
The Findings of Electrocardiography in Patients with Cardiac Amyloidosis
Authors: Cheng Zhongwei , Zhu Kongbo , Tian Zhuang , Zhao Dachun , Cui Quancai , Fang Quan
Published: November 2012

Objective

The electrocardiography (ECG) was the simplest and common adjunctive diagnostic tool for cardiac amyloidosis (CA). We sought to clarify the findings of ECG in patients with CA in order to early identification of CA according to the findings of ECG.

Methods

A total of 276 patients with diagnosis of systemic amyloidosis admitted to Peking Union Medical College Hospital from January 2000 to December 2011, were enrolled. Two groups were classified according to the cardiac involvement or not, namely CA (n = 189) and control (n = 87) groups. The low voltage on limb leads defined by the amplitude of the QRS complex in each limb leads ≤0.5 mV. The pseudo‐infarct pattern defined by the presence of pathologic Q waves on at least two contiguous leads on ECG without obstructive coronary artery disease.

Results

The mean age was 55 ± 12 (15–88) years, 168 patients (61%) were male. Atrial arrhythmia (15.9% vs 3.4%, P = 0.003), low voltage on limb leads (54.5% vs 20.7%, P < 0.001), atrioventricular block (14.8% vs 1.1%, P = 0.001) and pseudo‐infarct pattern (40.2% vs 4.6%, P < 0.001) were more prevalent in CA than control groups. The combination of low voltage on limb leads and pseudo‐infarct pattern was more common (28.0% vs 2.3%, P < 0.001) in CA than control groups. The sensitivity, specificity, positive and negative predictive values of the presence of low voltage on limb leads and pseudo‐infarct pattern for the diagnosis of CA were 28%, 98%, 96%, and 39%, respectively.

Conclusion

In CA patients, low voltage on limb leads and pseudo‐infarct pattern were the most common ECG findings. Atrial arrhythmia and atrioventricular block were the most common arrhythmias in CA patients. The combination of low voltage on limb leads and pseudo‐infarct pattern had high specificity and positive predictive value for the diagnosis of CA.
Educational strategies in performing cesarean section
Authors: Madsen Kristine , Grønbeck Lene , Rifbjerg Larsen Christian , Østergaard Jeanett , Bergholt Thomas , Langhoff‐Roos Jens , Sørensen Jette Led
Published: November 2012

Cesarean section is a common operation and one of the first surgeries performed independently by trainees/residents in obstetrics and gynecology. Determination of trainees' technical skills level is dependent upon subjective faculty assessment. Based on three studies on learning curves in cesarean section, it is recommended that trainees perform between 10–15 and 40 supervised cesarean sections before operating independently. Surgical technical skills of trainees/residents may be assessed by Objective Structured Assessment of Technical Skills (OSATS), which provides a foundation for constructive feedback during surgical training. The Danish, Swedish and British Obstetric and Gynecological Societies' guidelines on cesarean section were reviewed regarding cesarean section surgical technique. Placental removal by traction on the umbilical cord is recommended uniformly; however, the Danish guidelines recommend one‐layer uterine incision closure, whereas the Swedish and British guidelines recommend two‐layer closure. Maternal complications at cesarean section increase when the primary surgeon is a trainee/resident rather than an experienced surgeon. Basic surgical proficiencies regarding instruments, sutures and surgical technique as well as basic anatomy, should be verified before entering a training program for cesarean section. Such a training program for technical and non‐technical skills in cesarean section should include theoretical instruction, video tutorials, practical experience and direct supervision. Development of a specific OSATS for cesarean section is recommended. Training must be individually structured accommodating the differences in trainees' competencies. Before clinical training in the operating room begins, all trainees must attain standardized cognitive and technical skills.
Neonatal and parental predictors of executive function in very preterm children
Authors: Aarnoudse‐Moens Cornelieke Sandrine Hanan , Weisglas‐Kuperus Nynke , Duivenvoorden Hugo Joseph , Oosterlaan Jaap , van Goudoever Johannes Bernard
Published: November 2012

Aim

To examine neonatal and parental predictors of executive function in very preterm (gestational age ≤30 weeks) children aged 4.0–12.0 years.

Methods

Two‐hundred very preterm (mean age 8.2 ± 2.5 years) children without severe disabilities, born between 1996 and 2004, were assessed with measures of executive function including working memory, verbal fluency, planning and inhibitory control. Neonatal predictors were obtained from clinical records. Parental predictors included parental education, which was derived from questionnaires. Multiple linear regression analyses identified associations between neonatal and parental predictors and executive function in very preterm children.

Results

Better postnatal growth at 6 weeks of corrected age‐predicted better spatial span (R² = 0.03, β = 0.17, p = 0.02) and planning (R² = 0.03, β = 0.16, p = 0.04). A higher level of parental education predicted better verbal fluency (R² = 0.02, β = 0.12, p = 0.02). Verbal working memory was not predicted by neonatal risk factors or by parental education (βs < 0.09, ps > 0.20).

Conclusions

Executive function in very preterm children is associated with early postnatal growth and level of parental education but not with neonatal complications.
One‐year maintenance outcomes among patients with moderately‐to‐severely active ulcerative colitis who responded to induction therapy with adalimumab: subgroup analyses from ULTRA 2
Authors: Sandborn W. J. , Colombel J.‐F. , D'Haens G. , Van Assche G. , Wolf D. , Kron M. , Lazar A. , Robinson A. M. , Yang M. , Chao J. D. , Thakkar R.
Published: November 2012

Background

Patients with moderately‐to‐severely active ulcerative colitis (UC) are unlikely to continue anti‐TNF therapy in the absence of early therapeutic response.

Aim

To assess week 52 efficacy, safety and benefit/risk balance of adalimumab treatment in patients with moderately‐to‐severely active UC failing conventional therapy who achieved clinical response at week 8 in the 52‐week ULTRA 2 trial.

Methods

Patients randomised to adalimumab (160/80 mg, week 0/2; 40 mg, every other week thereafter) in ULTRA 2 who achieved clinical response at week 8 per partial Mayo score (Mayo score without endoscopy subscore) were assessed for week 52 clinical remission, clinical response, mucosal healing, steroid‐free remission and steroid discontinuation rates, overall and by prior anti‐TNF use. Benefit/risk balance for the overall ITT population (regardless of week 8 responder status) was assessed using ‘net efficacy adjusted for risk’ (NEAR) odds ratios. Safety was assessed using adverse event rates.

Results

Of 248 adalimumab‐treated patients, 123 (49.6%) achieved clinical response at week 8. Of these, 30.9%, 49.6%, and 43.1% achieved clinical remission, clinical response, and mucosal healing, respectively, at week 52. Of the week 8 responders using corticosteroids at baseline (N = 90), 21.1% achieved steroid‐free remission and 37.8% were steroid‐free at week 52. NEAR odds ratios indicated a positive benefit/risk balance for achievement of week 8 and week 52 response or remission without serious adverse events or serious infections. No safety concerns were identified.

Conclusions

Adalimumab treatment was associated with a positive benefit/risk balance in the overall population of patients with moderately‐to‐severely active ulcerative colitis in ULTRA 2; early response was predictive of a positive outcome at 1 year (NCT00408629).
Outcomes of splenectomy in patients with common variable immunodeficiency (CVID): a survey of 45 patients
Authors: Wong G K , Goldacker S , Winterhalter C , Grimbacher B , Chapel H , Lucas M , Alecsandru D , McEwen D , Quinti I , Martini H , Schmidt R E , Ernst D , Espanol T , Vidaller A , Carbone J , Fernandez-Cruz E , Lougaris V , Plebani A , Kutukculer N , Gonzalez-Granado L I , Contreras R , Kiani-Alikhan S , Ibrahim M A A , Litzman J , Jones A , Gaspar H B , Hammarstrom L , Baumann U , Warnatz K , Huissoon A P
Published: November 2012

Splenectomy has been used in patients with common variable immunodeficiency disorders (CVID), mainly in the context of refractory autoimmune cytopenia and suspected lymphoma, but there are understandable concerns about the potential of compounding an existing immunodeficiency. With increasing use of rituximab as an alternative treatment for refractory autoimmune cytopenia, the role of splenectomy in CVID needs to be re-examined. This retrospective study provides the largest cohesive data set to date describing the outcome of splenectomy in 45 CVID patients in the past 40 years. Splenectomy proved to be an effective long-term treatment in 75% of CVID patients with autoimmune cytopenia, even in some cases when rituximab had failed. Splenectomy does not worsen mortality in CVID and adequate immunoglobulin replacement therapy appears to play a protective role in overwhelming post-splenectomy infections. Future trials comparing the effectiveness and safety of rituximab and splenectomy are needed to provide clearer guidance on the second-line management of autoimmune cytopenia in CVID.
Assessing and addressing cardiovascular risk in adults with Turner syndrome
Authors: Turtle Emma J. , Sule Ashish A. , Bath Louise E. , Denvir Martin , Gebbie Ailsa , Mirsadraee Saeed , Webb David J.
Published: November 2012

Turner syndrome (TS), the result of a structurally abnormal or absent X chromosome, occurs in one in 2 000 live born females. The phenotype is highly variable, but short stature and gonadal dysgenesis are usually present. The main objective in adults with TS is health surveillance, but TS still causes a reduction in life expectancy of up to 13 years, with cardiovascular disease, congenital or acquired, as the major cause of an early death. While it has been established that all women with TS should undergo in‐depth cardiovascular examination at diagnosis, advice on the cardiovascular management of women with TS is limited. Here, we provide a summary of our current practice within a multidisciplinary team, supported by our expertise in various aspects of cardiovascular risk management, and the evidence from research where it is available, with the aim of providing optimal support to our patients with TS.

Background

A dedicated Adult Turner Clinic was established in South East Scotland in 2002. This gynaecology‐led clinic serves a population of roughly 1·2 million and, currently, reviews around 50 women with TS annually. Referrals for adult care come from paediatrics or general practice. Following a series of individual case discussions regarding the management of more complex cardiovascular problems, we have assembled a dedicated multidisciplinary group to determine a timely cardiovascular screening strategy, a basis for specialist referral, and appropriate hypertension management. This team now includes a paediatric endocrinologist, gynaecologist, cardiologist (with an interest in inherited disorders), vascular radiologist and hypertension specialist.

Here, we review the literature on cardiovascular disease in women with TS and, make recommendations, based on relatively limited high‐quality evidence, together with our experience, on the optimal timing of cardiovascular screening.