bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patients’ autonomy in surgical care: a comparison of nurses’ perceptions in five European countries
Authors: Suhonen R. , Välimäki M. , Dassen T. , Gasull M. , Lemonidou C. , Scott P. A. , Kaljonen A. , Arndt M. , Leino‐Kilpi H. 
Published: December 2004

AbstractBackground: This report forms part of the results of an international comparative study funded by the European Commission (1998–2001). Aim: To describe and compare the maintenance of patients’ autonomy on surgical wards, from the point of view of nursing staff, in five European countries (Finland, Spain, Greece, Germany and Scotland). Autonomy is defined in terms of information received and decision making by patients. Method: The data were collected using a questionnaire specifically designed for use in this study. Responses (response rate 66%) were obtained from 1280 nurses working on surgical wards. Data analysis was based on descriptive statistics, t‐tests, analysis of variance (ANOVA) with posthoc Tukey's HSD test and logistic regression. Results: There were clear between‐country differences in nurses’ perceptions, especially on a north–south axis (Finland and Scotland vs. Greece and Spain), regarding the extent to which the autonomy of surgical patients is supported by nursing staff. Training and ethics education, in particular, were associated with nurses’ perceptions of the maintenance of patient autonomy in Finland and Greece. Conclusion: Further research is needed to establish whether the results obtained are caused by differences in cultures, nursing practices or roles of health‐care personnel or patients in different European countries.
Why an ICNP? Links among quality, information and policy
Authors: Baernholdt M. , Lang N. M. 
Published: December 2004

AbstractWork has been underway for over a decade to develop and use the International Classification for Nursing Practice (ICNP). The International Council of Nurses has released ICNP Alpha and Beta versions. This article is an adaptation of the presentation given at the International Council of Nurses Congress on June 12th, 2001, in Copenhagen, Denmark. When the ICNP was originally drafted, many uses were envisioned. Key among these were that the information generated would be used by clinicians, researchers, administrators and policy makers. This article introduces examples of these uses.
What do women think about menopause? A qualitative study of women's expectations, apprehensions and knowledge about the climacteric period
Authors: Berterö C. 
Published: December 2004

AbstractAim: To identify and describe expectations, apprehensions and knowledge about the menopausal period and climacteric symptoms. Method: Data were collected by semi‐structured interviews/discussions with a convenience sample of 39 women, all 47 years of age. Data interpretation and analysis were based on content analysis, but influenced by a qualitative approach. Findings: These included women's expectations and feelings of freedom. Apprehensions were described as different climacteric symptoms, which were well known to the women through their own or other's experiences. The women were, to some extent, aware of the physical and psychological changes that follow the menopause. However, the women lacked knowledge about these changes or self‐care activities that could prevent problems or mitigate symptoms. Key conclusions and implications for practice: Discussions on health with premenopausal women can increase their knowledge about a natural phase of life, the climacteric period. The study showed that nurses/midwives who have regular contact with some women during their life have an important role to play in providing information, as well as in the treatment of climacteric symptoms.
Decision‐making preferences towards surgical intervention in a Hong Kong Chinese population
Authors: Henderson A. , Shum D. 
Published: December 2004

AbstractBackground: Economic, social, ethical and legal concerns are motivating changes in western‐type health practice to encourage individuals to participate in health‐care decisions. Patient participation in health care is perceived to be beneficial because health care is negotiated with the patient so the selected regimen of care is more likely to be acceptable. Hong Kong, in accordance with contemporary trends in other industrialized countries, has adopted a Patient's Charter that outlines patient's rights regarding health treatment and choices. Studies indicate that not all patients wish to take part in decision making about treatment. Aim: To explore the degree to which a Hong Kong Chinese population desired to participate in decision making about surgical intervention. Method: 96 participants, 49 surgical and medical patients and 47 students of nursing, participated. Participants were given three hypothetical scenarios: cardiac failure, where major surgery is suggested; cholecystitis, where routine surgery is suggested; and the presence of a benign skin lesion, where minor surgery is suggested. Participants were asked about the degree to which they desired to participate in the decision‐making process. There were five choices, ranging from the doctor having full control, to various types of collaborative decision making, to the individual having full control. Results: When the medical condition is not severe, participants desired greater participation in the decision‐making process. Younger participants desired greater collaboration with the doctor in decision making while older participants preferred the doctor to have the greater input with respect to decision making.
Comparison of Electrocardiogram and Intrathoracic Electrogram Signals for Detection of Ischemic ST Segment Changes During Normal Sinus and Ventricular Paced Rhythms
Authors: THERES HEINZ , STADLER ROBERT W. , STYLOS LEE , GLOS MARTIN , LEUTHOLD THOMAS , BAUMANN GERT , NELSON SHANNON D. , KRUCOFF MITCHEL W. 
Published: December 2004

ST Segment Changes in ECG and EGM Signals.
Introduction: The aim of this study was to compare surface ECGs with electrograms (EGM) that are available from implanted devices for the ability to detect ischemic ST segment changes during normal sinus (NS) and ventricular paced (VP) rhythms. Methods and Results: ECG leads I, II, and V2, right atrial ring to left pectoral patch (representing the can of the device), right ventricular ring to left pectoral patch, and right atrial ring to right ventricular ring EGM were recorded continuously during percutaneous transluminal coronary angioplasty. One balloon inflation (≥60 sec) was analyzed from each of 22 NS and 22 VP subjects. The parameter ΔST was defined as the maximum absolute ST segment deviation (from isoelectric) during the first 60 seconds of inflation, measured relative to the baseline (preinflation) ST segment deviation. For EGM, a normalized ΔST was defined as the ΔST divided by the ratio of QRS amplitudes of EGM to ECG. During NS, the ΔST for EGM (0.43 mV) was significantly larger than that of ECG (0.09 mV, P = 0.0001) but the normalized ΔST for EGM (0.11 mV) was comparable to that of ECG (0.09 mV, P = 0.45). During VP, the ΔST for EGM (1.08 mV) was significantly larger than that of ECG (0.17 mV, P = 0.0001), but the normalized ΔST for EGM (0.11 mV) was significantly smaller than that of ECG (0.17 mV, P = 0.02). Conclusion: During both NS and VP, ischemic ST segment changes were significantly larger in EGM than in ECG. Much of this difference appears to be related to larger amplitudes of EGM signals.
Circadian and Seasonal Variation of Malignant Arrhythmias in a Pediatric and Congenital Heart Disease Population
Authors: STEPHENSON ELIZABETH A. , COLLINS KATHRYN K. , DUBIN ANNE M. , EPSTEIN MICHAEL R. , HAMILTON ROBERT M. , KERTESZ NAOMI J. , ALEXANDER MARK E. , CECCHIN FRANK , TRIEDMAN JOHN K. , WALSH EDWARD P. , BERUL CHARLES I. 
Published: December 2004

Circadian Rhythms in Pediatric De. brillator Discharges.
Introduction: Recent studies in adult populations have revealed seasonal variation in the frequency of acute cardiovascular events, including life‐threatening arrhythmias, demonstrating increased events during winter and early spring. Trends in the time of day that arrhythmias occur also were noted. We sought to establish whether pediatric and young adult congenital heart disease implantable cardioverter defibrillator (ICD) recipients have circadian or seasonal variability in shock frequency, similar to adult populations. Methods and Results: Data from ICD patients at six pediatric centers in North America were analyzed to assess the timing of life‐threatening arrhythmias. The populations consisted of children and adults with congenital heart disease and ICDs placed for malignant arrhythmias. Data were considered in 46 patients who received appropriate therapy (total 139 episodes) for ventricular tachycardia or ventricular fibrillation. Multiple variables were analyzed, including time of day, day of week, and month of year. In contrast to previously studied adult patients, fewer events occurred in the early morning (7.5%), with the most therapies occurring between 6 P.M. and midnight (35%). An increased frequency of therapies was observed in the fall and winter (September‐January), representing 60% of all appropriate shocks. Unlike adult populations, Mondays did not have an increased frequency of malignant arrhythmias. Conclusion: Pediatric and adult congenital heart disease populations have moderate seasonal and 24‐hour variation in ICD event rate, with some distinctly different peaks than those seen in typical adult ICD populations. These findings suggest circadian variation in arrhythmia vulnerability that may differ from conventional occupational, physical, or emotional stressors.
Estimated Global Epicardial Distribution of Activation Rate and Conduction Block During Porcine Ventricular Fibrillation
Authors: NEWTON JONATHAN C. , JOHNSON PHILLIP L. , JUSTICE R. KYLE , SMITH WILLIAM M. , IDEKER RAYMOND E. 
Published: December 2004

Block and Frequency Distribution During VF.
Introduction: A proposed mechanism of the maintenance of ventricular fibrillation (VF) determined by studying small hearts or segments of large hearts is that a single stable rotor exists at the site of maximal activation rate, which gives rise to activation fronts that propagate into slower activating regions where they frequently block. We wished to determine if two predictions of this hypothesized mechanism are true during VF in large hearts: (1) there is a single maximum in the distribution of activation rates with the activation rate decreasing with distance away from this maximum; and (2) the incidence of block is greater outside than inside the fastest activating region. Methods and Results: Six 25‐second episodes of VF from each of six pigs were recorded from 504 electrodes over the entire ventricular epicardium. The electrodes were divided into four zones: left ventricular base and apex (LVB and LVA) and right ventricular base and apex (RVB and RVA). A fast Fourier transform was performed on each electrogram, and the mean activation rate was estimated from the dominant (peak) frequency (DF) and block was estimated to be present during those time intervals when double peaks (DPs) were present in the power spectrum. The zones had statistically significant distributions of DF (LVB> LVA> RVA> RVB) and DP incidence (RVA> RVB> LVA> LVB). Conclusion: During VF, the LV base has the highest estimated activation rate and the lowest estimated block incidence, and the RV has the slowest rate but the highest block incidence. This is consistent with the concept of VF being maintained by activation fronts originating from the LV base.
Efficacy and Safety of Targeted Focal Ablation Versus PV Isolation Assisted by Magnetic Electroanatomic Mapping
Authors: MARCHLINSKI FRANCIS E. , CALLANS DAVID , DIXIT SANJAY , GERSTENFELD EDWARD P. , RHO ROBERT , REN JIAN‐FANG , ZADO ERICA 
Published: December 2004

Introduction: Pulmonary vein (PV) triggers initiate atrial fibrillation (AF). The aim of this study was to compare the outcome of focal PV ablation versus targeted PV electrical isolation aided by multipolar catheter recordings in the coronary sinus (CS) and right atrium and magnetic electroanatomic mapping (MEAM) for drug‐refractory AF.
Methods and Results: Multipolar recordings identified PVs with triggers based on PV ostial pace map match for spontaneous and provoked triggers. PV triggers were provoked by isoproterenol, adenosine, and AF induction followed by cardioversion. MEAM defined PV ostial anatomy and assisted in localization of AF trigger and ablation lesions. All focal PV ablation procedures preceded PV isolation procedures at our institution. To limit a learning curve effect and validate the comparison, the results included outcome of procedures by a single experienced operator in the last 32 consecutive patients undergoing focal PV ablation and in 75 consecutive patients undergoing PV isolation. Patient characteristics were similar with respect to mean age (50 vs 52 years), mean left atrial size (4.3 vs 4.2 cm), presence of paroxysmal AF (84% vs 88%), and demonstration of non‐PV triggers (16% in both groups). PV isolation was confirmed in 99% of PVs by multipolar circular catheter. MEAM confirmed noncircumferential ostial ablation in 69% of PVs. Patients undergoing PV isolation had less AF from PV triggers at the end of ablation (1% vs 16%,

P < 0.01

); had less AF at 2 months (17% vs 42%,

P < 0.001

); and had 1‐year freedom from AF of 80% versus 45%

(P < 0.001)

. Adverse events were low in both groups with no stroke or symptomatic PV stenosis.
Conclusion: Using the described techniques, PV electrical isolation of PVs demonstrating spontaneous and/or provoked triggers is superior to focal PV ablation, with marked differences in outcome by 2 months. MEAM confirmed the noncircumferential nature of ostial ablation for effective isolation of most PVs and may play a role in the low risk and good outcome observed. The good outcome of targeted PV isolation as described suggests the need for a prospective comparison of targeted versus empiric PV isolation techniques.
(J Cardiovasc Electrophysiol, Vol. 14, pp. 358‐365, April 2003)
Implantable Cardioverter Defibrillator Lead Complications and Laser Extraction in Children and Young Adults with Congenital Heart Disease: Implications for Implantation and Management
Authors: COOPER JOSHUA M. , STEPHENSON ELIZABETH A. , BERUL CHARLES I. , WALSH EDWARD P. , EPSTEIN LAURENCE M. 
Published: December 2004

Introduction: Implantable cardioverter defibrillators (ICDs) are being implanted for primary and secondary prevention of sudden death in children and young adults with congenital heart disease. Over time, ICD leads adhere to venous endothelium and endocardium. Lead removal, when necessary, often requires disruption of this fibrous tissue.
Methods and Results: We retrospectively reviewed and analyzed our experience with ICD lead extraction in children and young adults with congenital heart disease. From April 1999 through January 2002, 14 patients underwent 15 lead extraction procedures to remove 21 leads (17 ICD leads and 4 pacing or sensing leads). Seven patients had surgically corrected structural heart disease (5 transposition of the great arteries with atrial switch repair and 2 corrected tetralogy of Fallot). Mean patient age at extraction was

17.9 ± 5.7 years

(range 9–32), and mean duration of lead implantation was

42.0 ± 18.9 months

(range 15–75). Fourteen of 15 procedures were performed for lead fracture or failure. A laser sheath was used for 20 of 21 lead extractions. Twenty of 21 leads (95%) were completely extracted. There were three instances of blood loss requiring transfusion. There were no major complications or deaths.
Conclusion: Young congenital heart disease patients with an ICD are at risk for growth‐related lead distortion. The use of a laser sheath is safe and effective for ICD lead extraction in congenital heart disease patients, despite coil adherence and altered anatomy. It may be advisable to avoid dual‐coil leads in patients with the potential for future growth.
(J Cardiovasc Electrophysiol, Vol. 14, pp. 344‐349, April 2003)
Prospective Randomized Study of Mode Switching in a Clinical Trial of Pacemaker Therapy for Sinus Node Dysfunction
Authors: SWEENEY MICHAEL O. , HELLKAMP ANNE S. , ELLENBOGEN KENNETH A. , GLOTZER TAYA V. , SILVERMAN RUSSELL , YEE RAYMOND , LEE KERRY L. , LAMAS GERVASIO A. ,   for the MOST Investigators
Published: December 2004

Introduction:Atrial fibrillation (AF) is common in pacemaker patients with sinus node dysfunction (SND) and may result in rapid ventricular pacing (RVP) in the DDDR mode. Mode switching (MS) reduces RVP, but its clinical benefit in patients with SND is unknown.Methods and Results:Two hundred two patients in the Mode Selection Trial (MOST; 2,010‐patient, 6‐year trial of DDDR vs VVIR pacing in SND) randomized to DDDR pacemakers with atrial high‐rate episode (AHRE) storage capabilities were subrandomized to MS ON (N = 96) or MS OFF (N = 106). Cardiovascular symptoms, quality of life (QOL), reprogramming due to RVP, death, stroke, and heart failure hospitalization (HFH) were compared between groups. The treatment groups were similar with regard to AF history (59% MS ON vs 57% MS OFF). AHREs occurred in 49% patients during median follow‐up of 2.2 years. Median AHRE duration (in min; MS ON 116 vs MS OFF 58, P = 0.29), frequency AHREs/week (MS ON 3.5 vs MS OFF 6.4, P = 0.23), and time spent in AHRE (min/week) (MS ON 450, MS OFF 268) were similar. Reprogramming due to any RVP during AHREs occurred more in MS OFF vs MS ON (13.2% vs 3.1%, P = 0.011) and marginally more for symptomatic RVP (8.5% vs 2.1%, P = 0.062). Cardiovascular symptoms occurred in 93.6% MS ON vs 90.2% MS OFF (P = 0.38). Median number of symptoms reported per visit was similar (MS ON 1.3 vs MS OFF 1.5, P = 0.62). Median symptom frequency/severity, summed and averaged over visits, was similar (MS ON 4.3 vs MS OFF 4.5, P = 0.74). QOL was not different between groups. Death, stroke, and HFH were not different between groups.Conclusion:MS reduces pacemaker reprogramming due to RVP during AHREs in a small number of patients but does not improve QOL or cardiovascular symptoms overall among patients with SND.(J Cardiovasc Electrophysiol, Vol. 15, pp. 153‐160, February 2004)
Ablation of Focally Induced Atrial Fibrillation:
Authors: DILLING‐BOER DAGMARA , MERWE NICO VAN DER , ADAMS JOZEF , FOULON STEFAAN , GOETHALS HUBERT , WILLEMS RIK , ECTOR HUGO , HEIDBÜCHEL HEIN 
Published: December 2004

Introduction: Focally induced atrial fibrillation (AF) often is due to ectopic activity in the pulmonary veins (PV). Although initial approaches were aimed at ablating only the ectopic foci, more extensive ablation approaches have evolved that isolate all PVs empirically and/or create circumferential ablation lines in the left atrium (LA). These techniques last longer and may be associated with more risks. We retrospectively evaluated the outcome and risks of ablation for focally induced AF in a single‐center patient population. Methods and Results: We report on 47 patients (32 men and 15 women; age 47 ± 10 years) in whom 52 ablations were performed. In 19 patients (22 sessions), ablation was directed at the site(s) of overt ectopic activity (“selective” group), whereas in 28 patients (30 sessions) without sufficient ectopy to determine the culprit PV a mean of 3.5 PVs were empirically targeted for bidirectional disconnection from the LA (“extensive” group). On a preprocedural Holter recording, the “selective” group had significantly more isolated atrial ectopy (3,276 ± 2,933 vs 620 ± 937 beats/24 hours) and runs of atrial tachycardia (330 ± 202 vs 53 ± 87 runs/24 hours) than the “extensive” group (P < 0.01 for both). Only 11% had persistent AF before ablation. Acute procedural success was 81% (elimination of all ectopy) and 83%, respectively (bidirectional and fully circumferential isolation of all targeted PVs). Procedure and fluoroscopy times were significantly shorter in the “selective” group. There were no major complications, but 7 minor complications and 2 acute PV stenoses > 50% in the 30 “extensive” procedures were observed. Mean follow‐up was 8.4 ± 8.5 months (median 6.9). Kaplan‐Meier analysis, excluding recurrences during only the first month (“delayed cure”), showed AF recurrence in 45% after 6 months and in 55% after 1 year. Outcome was not dependent on ablation approach (“selective” or “extensive”) nor was time to first AF (22 ± 64 days and 30 ± 69 days). AF recurrence tended to be higher in patients with larger LA (P = 0.08), underlying heart disease or hypertension (P = 0.08), and those “extensive” patients in whom not all 4 PVs were targeted (P = 0.07). Conclusion: Trigger‐directed ablation for focally induced AF is associated with a relatively high recurrence rate during follow‐up. Apart from recurrence of the ectopic trigger, this may point to underlying structural changes in the atrial substrate not addressed by the ablation. Prospective evaluation of the risk‐to‐benefit profile of any technique (selective, extensive, including linear lines) is required. (J Cardiovasc Electrophysiol, Vol. 15, pp. 200‐205, February 2004)
Enhanced Detection of Arrhythmia Vulnerability Using T Wave Alternans, Left Ventricular Ejection Fraction, and Programmed Ventricular Stimulation:
Authors: RASHBA ERIC J. , OSMAN AHMED F. , MACMURDY KAREN , KIRK MALCOLM M. , SARANG SAMANTHA E. , PETERS ROBERT W. , SHOROFSKY STEPHEN R. , GOLD MICHAEL R. 
Published: December 2004

Introduction: In previous studies, the prognostic value of T wave alternans (TWA) was similar to that of programmed ventricular stimulation (PVS). However, presently it is unclear if TWA and PVS identify the same patients or provide complementary risk stratification information. In addition, the effects of left ventricular ejection fraction (LVEF) on the prognostic value of TWA are unknown. The aim of this study was to determine if combined assessment of TWA, LVEF, and PVS improves arrhythmia risk stratification. Methods and Results: This was a prospective study of 144 patients with coronary artery disease and LVEF ≤40% who were referred for PVS for standard clinical indications. The endpoint was the combined incidence of death, sustained ventricular arrhythmias, and appropriate implantable cardioverter defibrillator (ICD) therapy. TWA (hazard ratio 2.2, P = 0.03) and PVS (hazard ratio 1.9, P = 0.05) both were significant predictors of endpoint events, and TWA was the only independent predictor. LVEF markedly influenced the prognostic value of TWA, which was a potent predictor of events in subjects with LVEF between 30% and 40% (event rates: TWA+ 36%, TWA‐ 0%, P = 0.001) but did not predict events in subjects with LVEF <30% (hazard ratio 1.1, P > 0.5). PVS successfully identified additional low‐risk patients within the cohort with negative or indeterminate TWA results (hazard ratio 4.7, P = 0.015) but did not provide incremental prognostic information for TWA+ patients (hazard ratio 0.9, P > 0.5). Conclusion: The combined use of TWA, LVEF, and PVS is a promising new approach to arrhythmia risk stratification that permits identification of high‐risk and very‐low‐risk patients. (J Cardiovasc Electrophysiol, Vol. 15, pp. 170‐176, February 2004)