Cost effectiveness of radiofrequency catheter ablation in the treatment of symptomatic supraventricular tachyarrhythmias

How to Manage Diversity and Enhance Team Performance: Evidence from Online Doctor Teams in China

(1) Background: Traditional one-to-one online consultations with doctors often fail to provide timely and accurate treatment plans; consequently, creating cross-hospital and cross-regional teams has become a new pattern for doctors aiming to offer Internet medical services. Because the online doctor team is a new virtual organizational model, it remains to be explained and investigated. (2) Methods: Combining the information processing view and the social categorization view, this study takes the perspective of team diversity and empirically investigates the effect of team diversity on team performance. We consider four kinds of team diversity, including status capital diversity, decision capital diversity, online reputation diversity, and professional knowledge diversity, and we investigate how team composition from the diversity perspective affects online doctor team performance and how leader reputation moderates the effect of team diversity on team performance. We use secondary data from a leading online medical consultation platform in China (Good Doctor), and our research data include 1568 teams with a total of 5481 doctors. (3) Results: The results show that status capital diversity and decision capital diversity negatively affect team performance; diversity in terms of online reputation and professional knowledge positively affect team performance; and leader reputation moderates the impact of status capital diversity and online reputation on team performance. (4) Conclusions: Our study offers management suggestions on how to form a high-performance doctor team and provides advice for the future development of online doctor teams.

Radiofrequency catheter ablation of supraventricular tachycardia in children and adolescents : feasibility and cost-effectiveness in a low-income country

The objective of this study is to provide results and costs of catheter ablation in children and adolescents in a low-income country. Reports from first-world countries have demonstrated the cost-effectiveness of radiofrequency catheter ablation (RFCA) compared to medical treatment of supraventricular tachycardia (SVT). The study included 28 patients younger than 18 years of age with SVT in a pediatric cardiology unit in Guatemala. All patients underwent RFCA. Clinical outcome and cost-effectiveness of RFCA compared to continued medical treatment were the end points. Twenty-four patients had successful ablation (85.7%). Mean age at RFCA was 11.42 +/- 3.49 years. Three patients underwent a second ablation, increasing the success rate to 96.4%. One remaining patient is awaiting a second procedure. At a mean follow-up of 13.69 +/- 7.16 months, all 27 patients who had a successful ablation remained in sinus rhythm. Mean cost per procedure was 4.9 times higher than that of medical treatment. However, the estimated cost of catheter ablation equal that of medical therapy after 5.1 years and is 3.4 times less after 20 years. Radiofrequency catheter ablation of SVT in children and adolescents is safe and cost-effective compared to medical therapy. Resources must be judiciously allocated, especially in low-income countries, to treat the largest number of pediatric patients.

Risk to patients from radiation associated with radiofrequency ablation for supraventricular tachycardia

BACKGROUND

Radiofrequency ablation may be associated with prolonged fluoroscopy times. Previous studies have calculated radiation risks by measuring the radiation dose at a limited number (6) of body sites. This is an inherently inaccurate measure. Our study aimed to quantify more precisely patient-related radiation risks associated with radiofrequency ablation for supraventricular tachycardia.

METHODS AND RESULTS

Nine female patients having radiofrequency ablation for supraventricular tachycardia were studied. The radiation dose was determined at 41 body sites in each patient with the use of thermoluminescent dosimeters and was correlated with that measured simultaneously with a Diamentor dose-area product meter. The estimated mean organ doses (mGy) per 60 minutes of fluoroscopy were: lungs 30.8; bone marrow 4.3; left breast 5.1; right breast 3. 5; and thyroid 2.4. From the average organ doses, the estimated mean total lifetime excess risk of a fatal malignancy was 294 per million cases (0.03%) per 60 minutes of fluoroscopy. The risk calculation from the Diamentor dose-area product and thermoluminescent dosimeters were similar, suggesting that radiation dose was measured accurately. The estimated risk of radiation-induced malignancy increased with increasing body mass index (P=0.03).

CONCLUSIONS

Prolonged fluoroscopy during radiofrequency ablation may potentially cause a small increase in the lifetime risk of fatal malignancy, with lung malignancy being most likely. This risk is small only with the use of techniques and x-ray equipment optimized to keep radiation as low as possible. The risk is increased in obese patients.

Cost effectiveness of day stay versus inpatient radiofrequency (RF) ablation for the treatment of supraventricular tachyarrhythmias

BACKGROUND

It is well established that radiofrequency (RF) ablation is the most cost effective treatment strategy for patients with supraventricular tachycardia. Previous cost estimates assumed at least an overnight stay following RF ablation. Day stay RF ablation however appears to be a safe alternative.

AIMS

The aim of this study was to compare day stay and inpatient catheter ablation in terms of cost, efficacy and safety.

METHODS

This was a retrospective cost effectiveness analysis. The study population consisted of 25 consecutive patients who underwent day stay RF ablation and 25 consecutive patients who underwent inpatient RF ablation (historical controls). Economic analysis was based upon a detailed clinical costing.

RESULTS

The mean overall cost per patient of inpatient RF ablation in 1994 Australian dollar values is $2354 (SD, $642) compared with $1876 (SD, $595) for day stay RF ablation (p < 0.01). Day stay RF ablation is a cost effective alternative to inpatient RF ablation.

Radiofrequency ablation: a review of its application and nursing considerations

Radiofrequency ablation (RFA), a therapeutic electrophysiological procedure, has become the treatment of choice for a number of cardiac arrhythmias. These arrhythmias include those of anomalous pathways, as seen in AV nodal re-entry tachycardia and Wolff-Parkinson-White syndrome, and re-entry tachycardias of atrial and ventricular origins. This paper discusses the mechanism of RFA and the physiology of re-entry circuits, and outlines the cardiac arrhythmias treated by RFA. The nursing responsibilities associated with the RFA procedure--including patient education, observation for potential complications, and other peri- and post-procedure considerations--are then addressed.

Paediatric cardiac catheterization: innovations

In recent years interventional procedures have been introduced to the field of paediatric cardiac catheterization. These procedures continue to develop in complexity and increasingly are being applied to patients with reduced cardiovascular reserve, as an alternative to cardiac surgery or when cardiac surgery with cardiopulmonary bypass is contraindicated. More frequently anaesthetists are being called upon to provide support in sedating, anaesthetizing or/and resuscitating these patients. The purpose of this review is to give a comprehensive update of the interventional procedures and to review the anaesthetic management techniques as they apply to the catheterization laboratory. We will discuss possible complications and management strategies from our own experience and the experience of others. We have observed that as more complicated procedures are performed the anaesthetist plays a pivotal role in the management of the patient from arrival to departure from the cardiac catheterization laboratory, and in preventing mortality and major morbidity. Although the economic consequences of interventional cardiological techniques remain unclear, the field continues to expand and more complex procedures are continually being introduced.

Day stay transcatheter radiofrequency ablation for supraventricular tachyarrhythmias

OBJECTIVE

To describe our initial experience with transcatheter radiofrequency ablation as a day stay procedure for patients with supraventricular tachyarrhythmias resulting from aberrant atrioventricular pathways.

DESIGN

Prospective study of the first 50 patients at the Royal Perth Hospital whom we intended to treat and discharge on the same day. Patients underwent a combined electrophysiological study and radiofrequency ablation.

RESULTS

Accessory pathways were identified in 32 patients (successfully ablated in 30) and dual atrioventricular nodal pathways in 18 patients (with successful ablation of the slow pathway in 17). Thirty-eight patients were discharged on the same day (24 treated for accessory pathways, and 14 treated for dual atrioventricular nodal pathways). There were no late complications or readmissions in patients discharged on the same day.

CONCLUSIONS

In patients with supraventricular tachyarrhythmia, day stay transcatheter ablation can be planned without a definitive prior diagnosis of the physiological cause. Complications or other reasons for overnight admission are apparent at completion of the procedure.