bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
… 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.