bluuebunny/crossref_metadata_2025 huggingface dataset:
‘They were talking about me’– elderly women's experiences of taking part in a discharge planning conference
Authors: Efraimsson Eva , Sandman Per‐Olof , Rasmussen Birgit H.
Published: February 2006

Introduction:  Discharge planning procedures needs improving to make transition to care settings in the community smooth, safe and secure. Research about discharge planning that involves a patient perspective is limited. The intention of this study was to focus on the patients’ (elderly women) experiences of taking part in discharge planning conferences (DPCs) to deepen our understanding of the meaning of facing ‘the world of the institution’ from a life‐world perspective.

Aim:  This study aims at describing elderly women's experience of taking part in a DPC as they are about to be discharged from hospital.

Methodological design:  To illuminate the phenomenon from a life‐world perspective, an interview study was chosen. Eight follow‐up interviews with seven elderly women were carried out. The interviews were analysed using a qualitative content analysis methodology.

Findings:  The interpretation of data was that the women's future was as in suspense as they got ill or were hit by accidents. The analysis revealed four themes that reflected the women's experiences of taking part in the DPCs: Being affiliated; Being in focus, Standing outside; and finally Being unprepared.

Study limitations and conclusion:  The limitations of the study are related to: selection of participants; participation in the interview was connected to a video recording study; gap in time between participation in the DPC and the interview. The findings are still seen as trustworthy as the experiences expressed by the participating women in data are to be seen as a contribution to an emerging understanding of the meaning of the phenomenon from a life world perspective. The findings make clear that the institutional world easily and without much resistance from the patients transgresses the boarder of their life worlds. This awakes a need to reconsider how a caring perspective can be established in practice.
Evaluation of a web‐based course for community nurses on postpartum emotional distress
Authors: Ingadóttir Eygló , Thome Marga
Published: February 2006

The purpose of this multicentre and quasi‐experimental study is to evaluate the effect of a web‐based course for community nurses in Iceland with regard to outcome of postpartum emotional distress. A sample of six community health centres was selected and equally divided into an experimental and a control group. All nurses at the experimental centres attended a web‐based course focusing on evidence‐based interventions for postpartum emotional distress. All new mothers were screened 9 weeks postpartum using the Edinburgh Postpartum Depression Scale (EPDS). If they scored 12 points or more they were eligible for the study. Mothers answered the EPDS at three different points in time, (9, 15 and 24 weeks postpartum) and the Parent Stress Index: Short Form (PSI/SF) at two times (9 and 15 weeks). Results showed no significant difference in the rate of depressive symptoms between study centres at 9 weeks. At 15 and 24 weeks there was, however, a significant difference between mothers at the experimental and control centres. Nurses at the experimental centres documented significantly more evidence‐based interventions than did nurses at the control centres, and they had more frequent contact with new mothers suffering from postpartum emotional distress. There was no significant variation in PSI scores between the groups at any time. More women at the experimental centres were on antidepressants compared to the control centres. Of the total of 32 women eligible for the study, 10 declined participation. The findings are limited by small sample size and a probable confounding effect of antidepressants with the nursing interventions. Findings indicate that the web‐based transfer of knowledge to nurses on evidence‐based interventions for postpartum emotional distress has a positive effect on distressed women in the postpartum period and warrants further study.
Is loneliness a psychological dysfunction? A literary study of the phenomenon of loneliness
Authors: Nilsson Brita , Lindström Unni Å. , Nåden Dagfinn
Published: February 2006

The purpose of this investigation was to explore how loneliness is described in literature and research. The study employed a hermeneutic approach rooted in the ideology of humanistic science in a caritative nursing tradition. Data sampling for the study was completed over two different periods of time (1998 and 2004). The main findings are that loneliness is understood as a complex dimension in our lives and it can be experienced at many levels. Through the survey of the theoretical material, loneliness may be understood as a structural dimension of existence and not as an illness. The deep dimension of loneliness, however, can entail suffering that is possibly so intolerable that it may turn towards becoming an illness. Loneliness is assumed as something we are, an ontological structure in our existence. Loneliness can therefore be turned into suffering as well as into health. It is perhaps in the silent reflective loneliness that we paradoxically develop a greater understanding of the benefits of togetherness. Our conclusion is therefore, that the phenomenon of loneliness is not a psychological dysfunction.
Homocysteine Level and Cognitive Function in Patients with Arterial Disease: The Second Manifestations of ARTerial Disease Study
Authors: Raamt Fleur van A. , Kalmijn Sandra , Mali Willem P. Th. M. , Van Zandvoort Martine J. E. , Van Der Graaf Yolanda ,   for the SMART Study Group
Published: February 2006

OBJECTIVES: To assess the relationship between total plasma homocysteine (tHcy) level and cognitive function in patients with manifest arterial disease.

DESIGN: Cross‐sectional.

SETTING: Patients with symptomatic cerebrovascular disease, cardiovascular disease, peripheral arterial disease, or abdominal aortic aneurysm included in the Second Manifestations of ARTerial disease study, a single‐center, longitudinal study with an extensive screening program at baseline.

PARTICIPANTS: Three hundred forty‐five consecutively included patients, mean age 59.

MEASUREMENTS: The patients underwent an extensive neuropsychological test. The cognitive domains assessed were memory, executive function, attention, and visuoperception and construction. Each raw score was transformed into standardized z‐scores, and a sum score for global cognitive function was determined. Risk factors and vascular damage were measured in detail.

RESULTS: Linear regression showed that elevated levels of tHcy were related to lower global cognitive function (β=−0.065, 95% confidence interval (CI)=−0.116 to −0.013) and, more specifically, lower performance on memory (β=−0.078, 95% CI=−0.155 to −0.002), attention (β=−0.079, 95% CI=−0.163 to −0.005), and visuoperception and construction (β=−0.125, 95% CI=−0.236 to −0.014) per standard deviation increase in tHcy (SD=6.4 mol/L), after adjustment for age, sex, educational level, extent of atherosclerosis, and location of vascular disease. Silent cerebral infarcts did not influence this relationship.

CONCLUSION: A relationship was found between tHcy levels and cognitive function that was independent of extent and location of arterial disease. The results suggest that vascular mechanisms are not responsible for the relationship between tHcy and cognitive function.
Critical Review of Resident Assessment Protocols
Authors: Dosa David , Bowers Barbara , Gifford David R.
Published: February 2006

OBJECTIVES: To evaluate the quality of all 18 federally mandated Resident Assessment Protocols (RAPs) by measuring their adherence to established criteria for clinical practice guidelines (CPGs).

DESIGN: Analytical evaluation.

SETTING: United States nursing homes.

PARTICIPANTS: Eighteen federally mandated RAPs.

MEASUREMENTS: Each RAP was evaluated using review criteria based on the 1992 Institute of Medicine criteria for measuring the quality of clinical practice guidelines. Criteria included measurements of RAP validity, reliability/reproducibility, clinical applicability, clinical flexibility, clarity/format, scheduled review, expertise needed to complete, multidisciplinary process, and resources needed to complete. Two reviewers, each a geriatrician with expertise in nursing home medicine, evaluated each RAP on the degree of compliance with each criterion using a 2‐point scale for each criterion.

RESULTS: Overall, no individual RAP met all of the review criteria. The Urinary Incontinence RAP best approximated all the review criteria. The Pressure Ulcer RAP received the lowest score. Notable deficiencies in most of the RAPs included poor validity, documentation, reliability, clinical flexibility, and clinical applicability.

CONCLUSION: The RAPs synthesize large amounts of information into key points and recommendations. Nevertheless, RAPs perform poorly when held to formal standards expected for CPGs. Based on these findings, the authors and a technical expert panel convened by the Agency for Health Care Research and Quality generated recommendations that might improve the use and quality of future RAPs.
Geriatric Medicine and Geriatric Psychiatry Clinical Services Affiliated with U.S. Academic Medical Centers
Authors: Warshaw Gregg A. , Bragg Elizabeth J. , Freyberg Ron W.
Published: February 2006

U.S. academic medical centers are providing many geriatric medicine (GM) and geriatric psychiatry (GP) clinical services at Veterans Health Administration (VHA) and non‐VHA sites. This article describes the distribution and scope of GM and GP clinical services being provided. Academic GM leaders of the 146 U.S. allopathic and osteopathic medical schools were surveyed online in the spring of 2004. One hundred four program directors (71.2%) responded. These medical schools provided 1,325 GM and 376 GP clinical services, which included 654 VHA and 1,014 non‐VHA GM and GP services, affiliation with 21 Programs of All‐Inclusive Care for the Elderly, and 12 other specialized services. The mean number±standard deviation of distinct clinical services at each medical center was 16.4±8.2. More geriatrics faculty full‐time equivalents, more time spent on training fellows, and designation as a GM Center of Excellence were associated with providing a wider range of geriatric clinical services. Using data from the survey, the first directory of GM and GP clinical services at academic medical centers was created (http://www.ADGAPSTUDY.uc.edu).
… But Does It Stick? Evaluating the Durability of Improved Knowledge Following an Undergraduate Experiential Geriatrics Learning Session
Authors: Diachun Laura L. , Dumbrell Andrea C. , Byrne Kerry , Esbaugh Jacquelin
Published: February 2006

Canada's aging population, fewer medical students training in geriatric medicine, and inadequate geriatric curricula require that medical schools immediately address how future physicians will be able to care for older people effectively. The medical literature suggests that experiential learning strategies improve undergraduate medical students' knowledge of and interest in less‐popular subjects, but the durability of improvements resulting from these resource‐intensive learning approaches remains unclear.

In October 2001, a convenience sample of all University of Western Ontario medical students attending the geriatric component of their first year was randomized to attend one 3‐hour didactic lecture or 3‐hour experiential learning session. Approximately 1 year later, students completed a follow‐up knowledge and attitudes survey that was matched to their first‐year surveys using date‐of‐birth data.

Of 100 completed follow‐up surveys, 42 were used in formal analysis. Although initially the experiential group demonstrated a better knowledge score, at 1‐year follow‐up, there was no significant difference in knowledge, attitudes toward older people, or interest in geriatric medicine between the didactic (n=17) and experiential (n=25) groups. Nevertheless, these students (n=42) demonstrated better attitude scores than those (n=22) who had not attended either educational intervention.

This study challenges the belief that an experiential approach is a superior training method to a didactic approach. One year after an educational intervention, there was no difference in geriatric knowledge, attitude scores, or interest in geriatric medicine between students who underwent a didactic lecture or a participatory, experiential learning session.
Mild Cognitive Impairment Subtypes and Vascular Dementia in Community‐Dwelling Elderly People: A 3‐Year Follow‐Up Study
Authors: Zanetti Mariella , Ballabio Claudia , Abbate Carlo , Cutaia Chiara , Vergani Carlo , Bergamaschini Luigi
Published: February 2006

OBJECTIVES: To investigate whether mild cognitive impairment (MCI) with multiple impaired cognitive domains (mcd‐MCI) is a prodromal manifestation of vascular dementia (VaD).

DESIGN: Prospective cohort study.

SETTING: Geriatric unit of the Ospedale Maggiore Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy.

PARTICIPANTS: Four hundred community‐dwelling subjects aged 65 and older who came freely to the geriatric unit as part of a comprehensive geriatric assessment program were evaluated for memory impairment or other cognitive disorders. Subjects with MCI were kept under observation for 3 years.

MEASUREMENTS: Subjects with MCI were studied by applying a standardized clinical evaluation and a conducting a computed tomography brain scan. Cognitive performance was assessed using the Mini‐Mental State Examination, the Clock Drawing Test, and a comprehensive battery of neuropsychological tests. Cardiovascular comorbidity was assessed on the basis of medical history and using electrocardiography, echocardiography, and carotid color Doppler ultrasound.

RESULTS: MCI was found in 65 of the 400 community‐dwelling subjects; 31 were classified with amnestic MCI (a‐MCI) and 34 with mcd‐MCI. A dysexecutive syndrome characterized people with mcd‐MCI, who had significantly more vascular comorbidity and signs of vascular disease on brain imaging as well as a higher prevalence of extra pyramidal features, mood disorders, and behavioral symptoms than people with a‐MCI. Twenty of the 65 subjects with MCI (31%) progressed to dementia within 3 years of follow‐up: 11 subjects with Alzheimer's disease (AD) and nine with VaD. All patients who evolved to AD had been classified with a‐MCI at baseline, whereas all patients who evolved to subcortical VaD had been classified with mcd‐MCI at baseline.

CONCLUSION: All subjects who converted to subcortical VaD had been classified with mcd‐MCI, suggesting that mcd‐MCI might be an early stage of subcortical VaD.
Sheathless Implantation of Permanent Coronary Sinus‐LV Pacing Leads
Authors: HOFFMEISTER PETER , CHAUDHRY G. MUQTADA , ORLOV MICHAEL V. , SHUKLA GUNJAN , HAFFAJEE CHARLES I.
Published: February 2006

Background: Implantation of CS‐LV pacing leads is usually accomplished through specialized sheaths with additional use of contrast venography and other steps. Direct implantation at a target pacing site could provide a simplified procedure with appropriate leads.

Methods: A progressive CS‐LV lead implant protocol was used, with initial attempts made to place the lead directly using only fluoroscopy and lead stylet or wire manipulation. Coronary sinus (CS) sheaths were only used later if direct lead placement failed.

Results: There were 105 attempted implants with 96% (101/105) success. Leads were implanted sheathlessly in 69% (70/101) cases. Pacing parameters and final lead position did not differ significantly between implants that did or did not require sheaths for implants. Three peri‐procedural complications occurred in implants where sheaths were used. In 33% (33/101) of implants, the leads were placed without the use of sheaths or contrast venography in 20 minutes or less.

Conclusions: Direct placement of the CS‐LV pacing lead without sheaths can be accomplished successfully in a majority of implants and in ≤20 minutes in a third, without inferior pacing parameters. This may provide for shorter or less technically difficult or expensive procedures with low risk.
Individualized Selection of Pacing Algorithms for the Prevention of Recurrent Atrial Fibrillation: Results from the VIP Registry
Authors: LEWALTER THORSTEN , YANG ALEXANDER , PFEIFFER DIETRICH , RUITER JAAP , SCHNITZLER GÖTZ , MARKERT TILMANN , ASKLUND MOGENS , PRZIBILLE OLIVER , WELZ ARMIN , ESMAILZADEH BAHMAN , LINHART MARKUS , LÜDERITZ BERNDT
Published: February 2006

Objectives: The VIP registry investigated the efficacy of preventive pacing algorithm selection in reducing atrial fibrillation (AF) burden.

Background: There are few data identifying which patients might benefit most from which preventive pacing algorithms.

Methods: Patients, with at least one documented AF episode and a conventional antibradycardia indication for pacemaker therapy, were enrolled. They received pacemakers with AF diagnostics and four preventive algorithms (Selection and PreventAF series, Vitatron). A 3‐month Diagnostic Phase with conventional pacing identified a Substrate Group (>70% of AF episodes with <2 premature atrial contractions [PACs] before AF onset) and a Trigger Group (≤70% of AF episodes with <2 PACs before AF onset). This was followed by a 3‐month Therapeutic Phase where in the Trigger Group algorithms were enabled aimed at avoiding or preventing a PAC and in the Substrate Group continuous atrial overdrive pacing was enabled.

Results: One hundred and twenty‐six patients were evaluated. In the Trigger Group (n = 73), there was a statistically significant 28% improvement in AF burden (median AF burden: 2.06 hours/day, Diagnostic Phase vs 1.49 hours/day, Therapy Phase; P = 0.03304 signed‐rank test), and reduced PAC activity. There was no significant improvement in AF burden in the Substrate Group (median AF burden: 1.82 hours/day, Diagnostic Phase vs 2.38 hours/day, Therapy Phase; P = 0.12095 signed‐rank test), and little change in PAC activity.

Conclusions: We identified a subgroup of patients for whom the selection of appropriate pacing algorithms, based on individual diagnostic data, translated into a reduced AF burden. Trigger AF patients were more likely responders to preventive pacing algorithms as a result of PAC suppression.
Sleep Parameters in Patients Using Pacemakers with Sleep Rate Function on
Authors: GRECO OSWALDO T. , BITTENCOURT LIA R.A. , VARGAS REMY N.A. , BORGES MOACIR A. , MATEOS JOSÉ C.P. , NETO AUGUSTO CARDINALLI , COELHO ORMUZ D.C. , SILVA ROGÉRIO S. , MAZZO ROSANA A. , MELATTO DOUGLAS M.B. , TUFIK SÉRGIO , GAUCH PAULO R.A.
Published: February 2006

Introduction: The cardiovascular system (CVS) is heavily influenced by the autonomic nervous system. Additionally, there is a functional alteration during the various stages of sleep. In nonrapid eye movement (NREM), a state of cardiovascular relaxation occurs during stages three and four. A large amount of rapid ocular movements is concentrated in rapid eye movement (REM) sleep. During this phase, fluctuations in arterial pressure (AP) and heart rate (HR) can be readily noted. Sleep disordered breathing (SDB) has been associated with cardiac rhythm disorders. Recently, cardiac rhythm disorder treatment with pacemaker (PM) highlighted a reduction in abnormal respiratory events during sleep.

Objective: Comparison of sleep parameters of patients using PM with a sleep rate (SR) algorithm based on its rate‐modulated capability during physical activity (Integrity™ PM with SR function on and off).

Methods: Twenty‐two patients (14 women, 8 men), implanted with an Integrity PM (St. Jude Medical Cardiac Rhythm Management Division, Sylmar, CA) with SR function for standard clinical indications, were evaluated utilizing a double‐blind protocol. The indication for pacing included sinus node disease (SND), atrium ventricular blockage (AVB), and atrial fibrillation (AF). Following randomization, half of our patients had SR function switched to “on” mode while the other half were on “off” mode. During the first stage of the protocol, all patients underwent two consecutive nights of polysomnographic sleep recordings (PSG). During the first night patients slept in the sleep lab only for adaptation purpose. PSG full recording was carried out in the subsequent night. At a later stage, the programing of SR functions was shifted to “on” or “off” modes. One week later, a third assessment was undertaken.

Results: Twelve patients (54%) showed sleep efficiency improvement (total sleeping time/recording time) with PM SR on. This group had the least effective sleep efficiency with PM off, if compared with the others who highlighted no change in this sleep parameter (72 ± 12 vs 81 ± 7%, P = 0.01, respectively). This first group displayed a lower latency for REM sleep than the last one (89 ± 55 vs 174 ± 107 minutes, P = 0.01, respectively). In 11 (50%) patients, the number per sleep hour of microarousals was reduced when PM SR was switched on. When we compared such findings to the group whose parameters had not changed, we noted that the first set of patients were sleepier (ESE: 9 ± 4 vs 5 ± 5, P = 0.04, respectively), and showed more microarousals with PM SR off (20 ± 14 vs 7 ± 5 microarousal/hour, P = 0.007).

Conclusion: In PM patients with sleep‐related issues, the SR function activation improved sleep both from a qualitative and quantitative perspective.
Renal Insufficiency and the Risk of Infection from Pacemaker or Defibrillator Surgery
Authors: BLOOM HEATHER , HEEKE BRIAN , LEON ANGEL , MERA FERNANDO , DELURGIO DAVID , BESHAI JOHN , LANGBERG JONATHAN
Published: February 2006

Background: Pacemakers and implanted cardioverter defibrillator (ICD) infection rates are rising. Renal insufficiency impairs immune function and is known to increase the risk of infection following implantation of orthopedic hardware. The purpose of the current study is to characterize the risk factors for pacemaker and ICD infection and to evaluate the role of renal insufficiency in this complication.

Methods and Results: A large (n = 4,856) single center experience with pacemaker and ICD procedures was reviewed. Of these, 141 were extractions of infected devices and 76 of these patients had been implanted in the Emory system and had preimplant creatinine information available for analysis. These cases were compared to 76 control patients undergoing device implantation matched by date of implant who had no infective complications. Demographic and clinical data from both groups were compared using both univariate and multivariate analysis. The overall rate of infection was 1.5%. Patients with device infection were more likely to have congestive heart failure (CHF), be diabetic, have generator exchanges, and to take warfarin than controls. There was no difference in the prevalence of coronary disease, atrial fibrillation, steroid use, or malignancy between the two groups. Elevated creatinine (Cr ≥1.5 mg/dL) was much more frequent in patients with infection than in controls (38% vs 12%, odds ratio 4.6, P < 0.001). Moderate to severe renal disease (GFR ≤60 cc/min/1.73 m2) was the most potent risk factor for infection, with a prevalence of 42% in infected patients versus 13% in controls (odds ratio of 4.8).

Conclusions: Renal insufficiency dramatically increases the risk of infection complicating pacemaker or ICD surgery. This association should be part of the risk‐benefit consideration prior to device implantation. Additional study of more extensive perioperative antibiotic therapy in this subset of patients is warranted.
Sustained Slow Pathway Conduction: Superior to Dual Atrioventricular Node Physiology in Young Patients with Atrioventricular Nodal Reentry Tachycardia?
Authors: KANNANKERIL PRINCE J. , FISH FRANK A.
Published: February 2006

Background: Young patients with atrioventricular nodal reentry tachycardia (AVNRT) frequently do not display discrete dual AV node physiology (DAVNP) as classically defined. The purpose of the study was to investigate the prevalence of sustained slow pathway conduction (SSPC; PR > RR during atrial pacing) in young patients with AVNRT and compare it to dual atrioventricular node physiology.

Methods: The presence of SSPC and DAVNP was prospectively assessed before and after radiofrequency catheter ablation in 61 young patients (age 4–23 years) with typical AVNRT.

Results: Prior to ablation, 32 (52%) displayed DAVNP, while 46 (75%) displayed SSPC; 7 patients (11%) had neither marker. Patients with DAVNP were older than those without (15 ± 3 vs 13 ± 4, P = 0.027) and the prevalence increased with age (38% <13 years, 50% 13–15, 70% >15, P = 0.041), while SSPC showed no age predilection. Patients under 13 years displayed SSPC more commonly than DAVNP (81% vs 38%, P = 0.004). DAVNP persisted after ablation in 10/32 (31%) patients, compared to 6/46 (13%) with persistent SSPC after ablation. The ability to use loss of the marker (present before, absent after ablation) as a surrogate for successful ablation was greater for SSPC than for DAVNP (66% vs 36%, P = 0.001).

Conclusion: SSPC is more common than DAVNP in young patients with AVNRT. SSPC is eliminated more frequently than DAVNP after acutely successful ablation, and appears to be a better indicator of the substrate for AVNRT. Elimination of SSPC may serve as a useful surrogate endpoint for slow pathway ablation.
Angiotensin‐Converting Enzyme Inhibitor Suppresses the Incidence of Prolonged and Fractionated Right Atrial Electrograms
Authors: SHIBATA RIYAKO , NAKAO KOJIRO , FUKAE SATOKI , MATSUO KIYOTAKA , YANO KATSUSUKE
Published: February 2006

Introduction: Although prolonged and fractionated right atrial electrograms have been reported as predictors of the development of chronic atrial fibrillation in patients with paroxysmal atrial fibrillation (PAF), the effects of angiotensin‐converting enzyme inhibitor (ACEI) on these electrophysiologic abnormalities remain unknown. The purpose of this study was to evaluate whether ACEI influences these electrophysiologic abnormalities of atrial muscle in patients with PAF.

Methods: While taking oral ACEI for hypertension, 12 patients (ACEI group) with PAF underwent electrophysiologic study (EPS). Catheter mapping of 12 right atrial sites and right atrial extrastimulation were performed during sinus rhythm. Twenty‐four age‐matched patients with PAF but not taking oral ACEI were included as a control group.

Results: The longest duration of the right atrial electrogram was significantly shorter and the maximum number of fragmented deflections per patient was significantly lower in the ACEI group than in the control group (79 ± 15 ms vs 100 ± 15 ms, P < 0.005; 5.5 ± 1.9 vs 7.9 ± 2.4, P < 0.001, respectively). The number of abnormal atrial electrograms per patient was significantly lower in the ACEI group than in the control group (0.5 ± 1.4 vs 2.1 ± 1.8, P < 0.05). The percentage of patients with at least one abnormal atrial electrogram was significantly lower in the ACEI group than in the control group (16.7% vs 79.2%, P < 0.0005).

Conclusions: ACEI use is associated with a decrease in the incidence of prolonged and fractionated right atrial electrograms in patients with PAF. In addition, we suggest that ACEI may help prevent PAF from becoming chronic.
Atresia of the Coronary Sinus in Patients with Supraventricular Tachycardia
Authors: LUIK ARMIN , DEISENHOFER ISABEL , ESTNER HEIDI , NDREPEPA GJIN , PFLAUMER ANDREAS , ZRENNER BERNHARD , SCHMITT CLAUS
Published: February 2006

Background: Atresia of the coronary sinus (CS) ostium with retrograde drainage of the cardiac veins via the persistent left superior vena cava (PLSVC) is a rare abnormality and only a few case reports in association with electrophysiological studies have been reported.

Methods: During standard electrophysiological study in three patients with a focal left atrial tachycardia, atrial fibrillation and common type right atrial flutter, the CS could not be cannulated despite several attempts. Assuming an occluded CS ostium we advanced a multipurpose catheter via the right atrium and the right superior vena cava in a PLSVC and performed CS angiography.

Results: CS angiography showed that the CS was occluded in all 3 patients and the PLSVC was used as a drainage route to the superior vena cava. After retrograde placement of a 2.5 Fr nonsteerable diagnostic catheter via the PLSVC in the CS, the intracardiac CS electrogram was recorded. Successful ablation could be performed in all three cases.

Conclusions: The cases highlight the possibility that failure to access the CS during electrophysiological studies may be related to this anomaly and that retrograde cannulation via PLSVC enables the CS access and acquisition of its electrograms.
Evaluation of Myocardial Glucose Metabolism Before and After Recovery of Myocardial Function in Patients with Tachycardia‐Induced Cardiomyopathy
Authors: MATSUMOTO KATSUMI , TAKAHASHI NOBUKAZU , ISHIKAWA TOSHIYUKI , SUMITA SHINICHI , MATSUSHITA KOHEI , INOUE NORIKO , KOBAYASHI TSUKASA , UCHINO KAZUAKI , KIMURA KAZUO , INOUE TOMIO , UMEMURA SATOSHI
Published: February 2006

Background: We assessed left ventricular (LV) function and myocardial glucose metabolism by fluoro‐18‐deoxyglucose (18F‐FDG) positron emission tomography (PET) in patients with tachycardia‐induced cardiomyopathy (TC).

Methods: The subjects were 42 patients with heart disease, consisting of 7 patients with TC (61.4 ± 19.0 years, LVEF 34.1%± 10.6%) and 35 with ischemic heart disease (IHD) (63.1 ± 10.8 years, LVEF 49.9%± 13.5%). Five volunteers with normal ECG were the control group. All of the patients underwent 18F‐FDG PET and echocardiography, and all of the patients with TC underwent 18F‐FDG PET and echocardiography before and 6 months after antitachycardia therapy. Six patients underwent radiofrequency catheter ablation (RFCA) and 1 patient was medically treated with antitachycardia therapy. Myocardial glucose metabolism was assessed semiquantitatively by using the % dose uptake of 60 kg of BW (% dose uptake).

Results: Mean % dose uptake of the control group was 5.52 ± 0.54%. After antitachycardia therapy, LVEF significantly improved (34.1 ± 10.6% vs 54.3 ± 13.6%, P < 0.01), and % dose uptake also significantly improved (1.26 ± 0.55% vs 1.49 ± 0.62%, P < 0.05). Patients with IHD showed higher % dose uptake than those with TC before antitachycardia therapy (3.18 ± 1.36 vs 1.26 ± 0.55%, P < 0.01), controls showed higher value of % dose uptake than TC before antitachycardia therapy (5.52 ± 0.54% vs 1.26 ± 0.55%, P < 0.01).

Conclusion: Semiquantitative analysis of 18F‐FDG PET showed that antitachycardia therapy improved myocardial glucose metabolism in patients with TC.
Altered Autonomic Cardiac Control Predicts Restenosis After Percutaneous Coronary Intervention
Authors: GOERNIG MATTHIAS , GRAMSCH MATTHIAS , BAIER VICO , FIGULLA HANS‐RAINER , LEDER UWE , VOSS ANDREAS
Published: February 2006

Background: Early and late restenosis in up to 30% remains a major problem for long‐term success after percutaneous coronary intervention (PCI). Compared to bare metal stents, the use of drug‐eluting stents reduces restenosis below 10%, but implant coasts have to be considered. In restenosis noninvasive testing lacks diagnostic power. We applied a new approach to identify patients with a high risk for restenosis after PCI by combining heart rate (HR) and blood pressure variability (BPV) analyses.

Methods: In 52 patients with clinical suspicion of restenosis and history of PCI, we investigated patterns of cardiovagal autonomic regulation prior to cardiac catheterization. The patients were separated in (i) patients with restenosis (CAD+R) and (ii) patients without restenosis (CAD−R), where restenosis is defined as a stenosis greater than 75% of luminal diameter in at least one main vessel. The following parameters/methods were evaluated: Canadian Cardiovascular Society grade (CCS‐grade), vessel disease score (CAD‐level), left ventricular ejection fraction (LVEF), heart rate variability (HRV), BPV, baroreflex sensitivity (BRS), as well as HR turbulence and blood pressure (BP) potentiation caused by premature ventricular complexes.

Results: Whereas age, LVEF, CAD‐level, CCS‐grade, and mean BP did not differ between CAD+R and CAD−R, significant differences were found in (i) BPV: diastolic LF/P, systolic, and diastolic UVLF, (ii) in BRS: slope of tachycardic sequences, and (iii) in extrasystolic parameters: heart rate turbulence onset (HRTO) and potentiation of systolic BP (SBPP). Standard HRV parameters did not show significant differences between the groups. Using the two parameters diastolic LF/P (threshold >0.2) and HRTO (threshold >0) restenosis were predicted in 83.4%.

Conclusions: These results demonstrate that indicators of sympathetic activation or vagal depression identify restenosis in patients after PCI, thus opening a perspective for a new noninvasive monitoring.
Acute Pericarditis Unmasks ST‐Segment Elevation in Asymptomatic Brugada Syndrome
Authors: KURISU SATOSHI , INOUE ICHIRO , KAWAGOE TAKUJI , ISHIHARA MASAHARU , SHIMATANI YUJI , MITSUBA NAOYA , HATA TAKAKI , NAKAMA YASUHARU , KIJIMA YASUFUMI , KISAKA TOMOHIKO
Published: February 2006

A 26‐year‐old man was admitted to our hospital because of acute pericarditis. The current patient had a saddle‐back type ST‐segment elevation shortly after the onset of acute pericarditis. Interestingly, it converted into a coved type ST‐segment elevation, subsequently regressed gradually as acute inflammation improved. After 3 months, right ventricular rapid pacing induced ventricular fibrillation, and intravenous sodium channel blocker induced a coved type ST‐segment elevation. The current case implies that a Brugada‐type ST‐segment elevation, which is thought to be false in acute pericarditis, may be true in some patients with asymptomatic Brugada syndrome.
Brugada‐Type ECG Association with Unexpected Sick Sinus Syndrome
Authors: FAZELIFAR AMIR FARJAM , HAGHJOO MAJID , EMKANJOO ZAHRA , ALIZADEH ABOLFATH , ALASTI MOHAMMAD , PEIGHAMBARI MEHDI , SADR‐AMELI MOHAMMAD ALI
Published: February 2006

A 23‐year‐old man was referred to our center for atrial flutter ablation. After arrhythmia termination sinus node dysfunction unmasked and persisted after 2 months drug‐free follow‐up. Secondary causes such as antiarrhythmic drug consumption, organic heart disease, or electrolyte disturbance could be excluded. Standard 12‐lead ECG showed a coved‐type ST elevation in V1–V3, which increased after flecainide provocative test. Following an unexpected sick sinus syndrome, a Brugada‐type ECG should be noted.
Focal Atrial Fibrillation Associated with Multiple Breakout Sites at the Crista Terminalis
Authors: YAMADA TAKUMI , MURAKAMI YOSHIMASA , OKADA TARO , MUROHARA TOYOAKI
Published: February 2006

A 34‐year‐old man with permanent atrial fibrillation (AF) underwent electrophysiologic testing. Spontaneous AF was observed even after successful pulmonary vein (PV) isolation of all four PVs. Intracardiac electrograms recorded from a basket catheter deployed around the crista terminalis during triggered atrial premature beats exhibited low‐amplitude potentials which were suggested to reflect focal ectopic activity, preceding high‐frequency atrial potentials. The firing from those focal activity sites induced a shift in the breakout sites and conduction block to the right atrium, which suggested the participation of preferential conduction. Radiofrequency catheter ablation targeting the focal origin and preferential conduction sites eliminated the AF.
An Ill Wind‐Iatrogenic Air Embolus Around Pacing Leads During Defibrillator Implant with Coexisting Pulmonary Fibrosis
Authors: NINIO DANIEL M. , HII JOHN T.
Published: February 2006

We present a case of air embolism during biventricular defibrillator implantation in a 58‐year‐old man with pulmonary fibrosis. To prevent air entry after the dilator was removed, the subclavian venous sheath was covered before the lead was introduced. Air embolism occurred during inspiration around the lead body in the appropriate sized sheath but without a hemostatic valve. Extraordinary swings in intrathoracic pressure due to noncompliant lungs may have contributed to this unusual complication.
Influence of fluorescence‐controlled Er:YAG laser radiation, the Vector™ system and hand instruments on periodontally diseased root surfaces in vivo
Authors: Schwarz F. , Bieling K. , Venghaus S. , Sculean A. , Jepsen S. , Becker J.
Published: February 2006

Objectives: The aim of the present study was to evaluate the effects of fluorescence‐controlled Er:YAG laser radiation, an ultrasonic device or hand instruments on periodontally diseased root surfaces in vivo.

Material and Methods: Seventy‐two single‐rooted teeth (n=12 patients) were randomly treated in vivo by a single course of subgingival instrumentation using (1–3) an Er:YAG laser (ERL1: 100 mJ; ERL2: 120 mJ; ERL3: 140 mJ; 10 Hz), or (4) the Vector™ ultrasonic system (VUS) or (5) hand instruments (SRP). Untreated teeth served as control (UC). Areas of residual subgingival calculus (RSC) and depth of root surface alterations were assessed histo‐/morphometrically.

Results: Highest values of RSC areas (%) were observed in the SRP group (12.5±6.9). ERL(1–3) (7.8±5.8, 8.6±4.5, 6.2±3.9, respectively) revealed significantly lower RSC areas than SRP. VUS (2.4±1.8) exhibited significantly lower RSC areas than SRP and ERL(1, 2). Specimens treated with SRP revealed conspicuous root surface damage, while specimens treated with ERL(1–3) and VUS exhibited a homogeneous and smooth appearance.

Conclusion: Within the limits of the present study, it may be concluded that ERL and VUS enabled (i) a more effective removal of subgingival calculus and (ii) a predictable root surface preservation in comparison with SRP.
Clinical outcomes of quadrant root planing versus full‐mouth root planing
Authors: Jervøe‐Storm P.‐M. , Semaan E. , AlAhdab H. , Engel S. , Fimmers R. , Jepsen S.
Published: February 2006

Objectives: To determine the clinical effects of full mouth compared with quadrant wise scaling and root planing.

Method: Twenty patients with chronic periodontitis (2 teeth per quadrant with probing pocket depths (PPD)5 mm and bleeding on probing (BOP) were randomized into a test group treated in two sessions with subgingival scaling and root planing within 24 h (full‐mouth root planing (FMRP)) and a control group treated quadrant by quadrant in four sessions in intervals of 1 week (quadrant root planing (QRP)). PPD, relative attachment level (RAL) and BOP were recorded at baseline, 3 and 6 months.

Results: Analysing first quadrant data, in moderately deep pockets (5 mmPPD<7 mm) there was no evidence for a difference (FMRP–QRP) between both groups for PPD reduction (mean: −0.128 mm; CI: [−0.949, 0.693]; p=0.747), RAL gain (mean: 0.118 mm; CI: [−0.763, 1.000]; p=0.781), and BOP reduction (mean: −20.1%; CI: [−44.3, 4.2]; p=0.099). Likewise, no significant differences between treatments were found for initially deep pockets (PPD7 mm), neither for first quadrant nor for whole mouth data.

Conclusion: The results of the present study demonstrated equally favourable clinical results following both treatment modalities.
Measuring plaque in clinical trials: index or weight?
Authors: McCracken G. I. , Preshaw P. M. , Steen I. N. , Swan M. , DeJager M. , Heasman P. A.
Published: February 2006

Aim: To explore the possibility of using plaque weight rather than plaque index as a more objective, clinical outcome measure in periodontal clinical trials.

Materials and methods: The study initially recruited 12 healthy volunteers who abstained from tooth cleaning for 24 h on each of the three occasions and then for 48 h on each of a further three occasions to accumulate plaque. On a further three visits, the subjects abstained from tooth cleaning for 24 h and then brushed with a powered toothbrush for 2 min. A split‐mouth design with target teeth was adopted and plaque was first scored separately on each side of the mouth using the Turesky modification of the Quigley and Hein plaque index. Post‐brushing residual plaque was also scored after tooth cleaning. Inter‐proximal plaque was dried, removed, pooled and weighed: on one side of the mouth from the entire inter‐proximal surfaces; and from beneath the contact points on the contra‐lateral side.

Results: Discriminant validity showed the index to have an advantage over weight in discerning between 24‐ and 48‐h plaque deposits, and between 24‐h plaque and post‐brushing plaque. Test‐retest validity confirmed that for repeated plaque growth, variability within subjects was greater than the variability between subjects. There was an association between plaque weight and plaque index although the regression lines were non‐linear.

Conclusion: There appears to be no significant advantage in using plaque weight in periodontal clinical trials.
Estimation of the remaining periodontal ligament from attachment‐level measurements
Authors: Yamamoto T. , Kinoshita Y. , Tsuneishi M. , Takizawa H. , Umemura O. , Watanabe T.
Published: February 2006

Aim: Accurate assessment of the remaining area of periodontal attachment assists in determining the prognosis of a tooth. The aim of this study was to determine formulae to estimate the remaining area of periodontal attachment from attachment‐level measures.

Materials and Methods: Roots of 30 extracted teeth of each tooth type were coated with vinyl acetate solution and α‐cyanoacrylate monomer to produce a membrane. The membrane was removed after guidelines were drawn to simulate various attachment levels. The root surface area on the apical side of each simulated attachment level was measured using image analysis software. The net or percent root surface area and corresponding attachment level data were fitted to a linear, quadratic, cubic, and exponential functions and a growth curve.

Results: The linear function provided the most appropriate fit for the data. For net root surface area, a steeper slope was evident for tooth types with a larger mean total root surface area. For percent root surface area, a steeper slope was evident for tooth types with a shorter root length.

Conclusions: A linear function provides the most appropriate formula for estimation of the remaining area of periodontal attachment based on the attachment‐level measurement.
Interviews and assessments of returning non‐compliant periodontal maintenance patients
Authors: Fardal Øystein
Published: February 2006

Background: Periodontal therapy without a maintenance programme has been shown to be of doubtful value. Most studies show a low‐level of compliance with periodontal maintenance therapy. Many suggestions as to the reasons for this have been put forward, but it has been difficult to confirm these, as the patients are not available to be interviewed.

Aim: To identify, interview and assess returning non‐compliant periodontal maintenance patients.

Method: All patients who had undergone periodontal therapy between 1986 and 2004 but not complied with the maintenance therapy were interviewed and assessed when they later returned to the specialist office for treatment.

Results: Sixty‐one patients with an average age of 56.4 years (SD 11,1) were studied. There were 18 males and 43 females. The patients were compliant for 3.4 years (SD 3.2) before leaving and returning after 5.5 years (SD 3.3) of non‐compliance. Average tooth loss while non‐compliant was 1.6 teeth (SD 2.8). The interviews revealed that 37 patients attended their own dentist's office exclusively for maintenance therapy, eight patients gave health reasons and seven patients lack of motivation or failure to cooperate. Thirty‐six patients were re‐referred by their own dentist, 13 changed dentist and were referred by this dentist, while 12 patients contacted the specialist office directly. Fifty‐three patients claimed to have been fully compliant with their own dentist while non‐compliant with the specialist office.

Conclusion: The main reason for non‐compliance was that the patients did attend their own dentist exclusively for maintenance therapy. Tooth loss and periodontal deterioration was more marked in this group than patients who in addition attended the specialist office for maintenance therapy.
Effects of smoking and gingival inflammation on salivary antioxidant capacity
Authors: Buduneli Nurcan , Kardesşler Levent , Isşık Hasan , Willis C. Steadman , Hawkins Samuel I. , Kinane Denis F. , Scott David A.
Published: February 2006

Aim: This study evaluated possible effects of smoking and gingival inflammation on salivary antioxidants in gingivitis patients.

Methods: Twenty otherwise healthy gingivitis patients (10 self‐reported smokers) and 20 periodontally and systemically healthy volunteer subjects were enrolled in the study. Whole saliva samples and full‐mouth clinical periodontal recordings were obtained at baseline and one month following initial phase of treatment in gingivitis patients. Salivary cotinine, glutathione and ascorbic acid concentrations, and total antioxidant capacity were determined, and the data generated were tested by non‐parametric tests.

Results: Salivary cotinine measurements resulted in re‐classification of three self‐reported non‐smokers as smokers. Smoker patients revealed significantly higher probing depths but lower bleeding values than non‐smoker patients (p=0.044 and 0.001, respectively). Significant reductions in clinical recordings were obtained in non‐smoker (all p<0.05) and smoker (all p<0.01) patients following periodontal treatment. Salivary total glutathione concentrations were reduced following therapy in gingivitis patients who smoke (p<0.01). Otherwise, no statistically significant differences were found between the groups in biochemical parameters at baseline or following treatment (p>0.05).

Conclusions: Within the limits of this study, neither smoking nor gingival inflammation compromised the antioxidant capacity of saliva in systemically healthy gingivitis patients.
Inhibitory effect of Weissella cibaria isolates on the production of volatile sulphur compounds
Authors: Kang Mi‐Sun , Kim Byung‐Gook , Chung Jin , Lee Hyun‐Chul , Oh Jong‐Suk
Published: February 2006

Aims: The objective of this study was to characterize the inhibitory effects of Weissella cibaria isolates on volatile sulphur compounds (VSC) production both in vitro and in vivo.

Material and Methods: We isolated and identified three hydrogen peroxide‐generating lactobacilli from children's saliva, and assessed their inhibitory effects on VSC production and Fusobacterium nucleatum proliferation. Clinical studies were conducted with 46 subjects in order to measure the VSC of their mouth air.

Results: These lactobacilli were identified as W. cibaria. These isolates inhibited the production of VSC by F. nucleatum (p<0.05). The concentration of F. nucleatum was decreased by 5‐log cycles as a result of exposure to the W. cibaria strains (p<0.05), whereas the catalase‐treated W. cibaria cultures exerted no evident inhibitory effects on F. nucleatum replication. In the clinical studies, gargling with one isolate resulted in a significant reduction in the levels of H2S and CH3SH by approximately 48.2% (p<0.01) and 59.4% (p<0.05), respectively.

Conclusions: These results indicate that W. cibaria isolates possess the ability to inhibit VSC production under both in vitro and in vivo conditions, demonstrating that they bear the potential for development into novel probiotics for use in the oral cavity.