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Kean KA, Fitzgerald DJ, Ayers MD, Kean AC. The Effects of Cardiac Implantable Electronic Device Personal Protective Equipment Use in Patients with Pediatric and Adult Congenital Heart Disease. Pediatr Cardiol 2023; 44:1721-1725. [PMID: 37573512 DOI: 10.1007/s00246-023-03264-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023]
Abstract
Pediatric and adult congenital heart disease (ACHD) patients encounter physical and emotional barriers. Cardiac implantable electronic devices (CIEDs), including pacemakers and implantable cardiac defibrillators (ICD) often compound these issues. Patient fear associated with damaging the CIED system can lead to avoidance of physical activity and reduced quality of life (QOL). CIED personal protective equipment (PPE) is a potential treatment for decreasing this fear. We sought to determine the effects of CIED PPE use in the pediatric and ACHD population. Patients 5 years or older with a CIED at a single pediatric and ACHD heart rhythm center received a CIED protector and customized athletic shirt. QOL was assessed using the PedsQL TM 4.0 SF15 prior to and after 6-12 months. Of the 77 patients enrolled, 26 completed repeat assessment. The mean age at enrollment was 15.6 years (range 5-36) with a mean device age of 2.2 years (< 1-10 years). Pacemakers were present in 77% and 23% had ICDs. The PPE was used in 92% with no PPE malfunction. Fear associated with physical activity was reduced, z = - 4, p < 0.001, with a large effect size (r = 0.55). There was a trend toward increased physical activity. Total QOL scores improved, z = - 2.771, P < 0.05, with a medium effect size (r = 0.4). This first study of CIED PPE in children shows that providing CIED PPE to pediatric and ACHD patients may decrease their fear of damaging their device system, increasing physical activity levels, and improving quality of life.
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Affiliation(s)
- Kelly A Kean
- School of Nursing, Purdue University College of Health and Human Science, West Lafayette, IN, USA
| | - Donna J Fitzgerald
- Division of Pediatric Cardiology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Mark D Ayers
- Division of Pediatric Cardiology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Adam C Kean
- Division of Pediatric Cardiology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
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2
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Kumthekar R, Webster G. Prediction of Sudden Death Risk in Patients with Congenital Heart Diseases. Card Electrophysiol Clin 2023; 15:493-503. [PMID: 37865522 DOI: 10.1016/j.ccep.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Risk stratification for sudden death should be discussed with patients with congenital heart disease at each stage of personal and cardiac development. For most patients, risk is low through teenage years and the critical factors to consider are anatomy, ventricular function, and symptoms. By adulthood, these are supplemented by screening for atrial arrhythmias, ventricular arrhythmias, and pulmonary hypertension. Therapies include medication, ablation, and defibrillator placement.
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Affiliation(s)
- Rohan Kumthekar
- Division of Cardiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Department of Pediatrics, The Ohio State University College of Medicine, 370 W. 9th Avenue, Columbus, OH, USA
| | - Gregory Webster
- Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 21, Chicago, IL 60611, USA.
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3
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Mondal A, Yoo M, Tuttle S, Mah D, Nelson R, Sachse FB, Hitchcock R, Kaza AK. Cost of Pacing in Pediatric Patients With Postoperative Heart Block After Congenital Heart Surgery. JAMA Netw Open 2023; 6:e2341174. [PMID: 37921766 PMCID: PMC10625035 DOI: 10.1001/jamanetworkopen.2023.41174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/22/2023] [Indexed: 11/04/2023] Open
Abstract
Importance Surgical correction of congenital heart defects (CHDs) has improved the lifespan and quality of life of pediatric patients. The number of congenital heart surgeries (CHSs) in children has grown continuously since the 1960s. This growth has been accompanied by a rise in the incidence of postoperative heart block requiring permanent pacemaker (PPM) implantation. Objective To assess the trends in permanent pacing after CHS and estimate the economic burden to patients and their families after PPM implantation. Design, Setting, and Participants In this economic evaluation study, procedure- and diagnosis-specific codes within a single-institution database were used to identify patients with postoperative heart block after CHS between January 1, 1960, and December 31, 2018. Patients younger than 4 years with postoperative PPM implantation were selected, and up to 20-year follow-up data were used for cost analysis based on mean hospital event charges and length of stay (LOS) data. Data were analyzed from January 1, 2020, to November 30, 2022. Exposure Implantation of PPM after CHS in pediatric patients. Main Outcomes and Measures Annual trends in CHS and postoperative PPM implantations were assessed. Direct and indirect costs associated with managing conduction health for the 20 years after PPM implantation were estimated using Markov model simulation and patient follow-up data. Results Of the 28 225 patients who underwent CHS, 968 (437 female [45.1%] and 531 male [54.9%]; 468 patients aged <4 years) received a PPM due to postoperative heart block. The rate of CHS and postoperative PPM implantations increased by 2.2% and 7.2% per year between 1960 and 2018, respectively. In pediatric patients younger than 4 years with PPM implantation, the mean (SD) 20-year estimated direct and indirect costs from Markov model simulations were $180 664 ($32 662) and $15 939 ($1916), respectively. Using follow-up data of selected patients with clinical courses involving 1 or more complication events, the mean (SD) direct and indirect costs were $472 774 ($212 095) and $36 429 ($16 706), respectively. Conclusions and Relevance In this economic evaluation study, the cost of PPM implantation in pediatric patients was found to accumulate over the lifespan. This cost may represent not only a substantial financial burden but also a health care burden to patient families. Reducing the incidence of PPM implantation should be a focused goal of CHS.
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Affiliation(s)
- Abhijit Mondal
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, Massachusetts
- Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Minkyoung Yoo
- Division of Epidemiology, University of Utah, Salt Lake City
| | - Stephanie Tuttle
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, Massachusetts
| | - Douglas Mah
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Richard Nelson
- Division of Epidemiology, University of Utah, Salt Lake City
| | - Frank B. Sachse
- Department of Biomedical Engineering, University of Utah, Salt Lake City
| | - Robert Hitchcock
- Department of Biomedical Engineering, University of Utah, Salt Lake City
| | - Aditya K. Kaza
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, Massachusetts
- Department of Surgery, Harvard Medical School, Boston, Massachusetts
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Chandrasekar H, Sinclair-McBride K, Lee EH, Iqbal MB, Gauvreau K, Barkas I, Newburger JW, DeMaso DR, Saleeb SF. Feasibility and Caregiver Receptiveness to Anxiety Screening in Pediatric Cardiology Clinic: A Pilot Study. Clin Pediatr (Phila) 2023; 62:597-604. [PMID: 36461155 DOI: 10.1177/00099228221134559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Children with chronic medical conditions, including heart disease, have increased susceptibility to behavioral health concerns. We sought to evaluate the feasibility and parental opinion of anxiety screening in pediatric cardiology clinic. The PROMIS Pediatric Anxiety v2.0 Short Form 8a (PA2-S8) questionnaire was administered to 48 patients presenting to pediatric cardiology clinic for follow-up care. Parents/caregivers were asked their opinion on anxiety screening in cardiology clinic. The survey was completed by 47 out of 48 participants (median age 13, range 9-17). Fourteen (30%) participants had scores suggestive of increased anxiety symptomatology. No trends were identified between PA2-S8 score and age at diagnosis (P = .13), age at survey administration (P = .28), number of lifetime procedures (P = .89), number of noncardiac specialists (P = .13), or underlying cardiac diagnoses (P = .55). Most families (76%) were in favor of the screening effort. This study suggests that anxiety screening in cardiology clinic is both feasible and well-received by families.
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Affiliation(s)
- Hamsika Chandrasekar
- Department of Pediatric Cardiology, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Keneisha Sinclair-McBride
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Erica H Lee
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Mudassera B Iqbal
- Massachusetts General Physician Organization Ambulatory Management, Massachusetts General Hospital, Boston, MA, USA
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ioanna Barkas
- Department of Pediatrics, Hasbro Children's Hospital and Brown University, Providence, RI, USA
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - David R DeMaso
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Susan F Saleeb
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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Kaski JP, Kammeraad JAE, Blom NA, Happonen JM, Janousek J, Klaassen S, Limongelli G, Östman-Smith I, Sarquella Brugada G, Ziolkowska L. Indications and management of implantable cardioverter-defibrillator therapy in childhood hypertrophic cardiomyopathy. Cardiol Young 2023; 33:681-698. [PMID: 37102324 DOI: 10.1017/s1047951123000872] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Sudden cardiac death is the most common mode of death during childhood and adolescence in hypertrophic cardiomyopathy, and identifying those individuals at highest risk is a major aspect of clinical care. The mainstay of preventative therapy is the implantable cardioverter-defibrillator, which has been shown to be effective at terminating malignant ventricular arrhythmias in children with hypertrophic cardiomyopathy but can be associated with substantial morbidity. Accurate identification of those children at highest risk who would benefit most from implantable cardioverter-defibrillator implantation while minimising the risk of complications is, therefore, essential. This position statement, on behalf of the Association for European Paediatric and Congenital Cardiology (AEPC), reviews the currently available data on established and proposed risk factors for sudden cardiac death in childhood-onset hypertrophic cardiomyopathy and current approaches for risk stratification in this population. It also provides guidance on identification of individuals at risk of sudden cardiac death and optimal management of implantable cardioverter-defibrillators in children and adolescents with hypertrophic cardiomyopathy.
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Affiliation(s)
- Juan Pablo Kaski
- Centre for Paediatric Inherited and Rare Cardiovascular Disease, University College London Institute of Cardiovascular Science, London, UK
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK
| | - Janneke A E Kammeraad
- Erasmus MC - Sophia Children's Hospital, Department of Paediatric Cardiology, Rotterdam, the Netherlands
| | - Nico A Blom
- Department of Pediatric Cardiology, University of Leiden, Leiden, the Netherlands
- Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Juha-Matti Happonen
- Department of Paediatric Cardiology, Helsinki University Children's Hospital, Helsinki, Finland
| | - Jan Janousek
- Children's Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Sabine Klaassen
- Department of Pediatric Cardiology, Charite-Universitatsmedizin Berlin, Berlin, Germany
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Disease Unit, AO dei Colli Monaldi Hospital, Universita della Campania "Luigi Vanvitelli", Naples, Italy
| | - Ingegerd Östman-Smith
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Begic Z, Begic N, Granov N, Vila H, Berberovic-Hukeljic B, Begic E, Rebic D. Pacemaker implantation in the pediatric population: Bosnian and herzegovinian experience. HEART AND MIND 2023. [DOI: 10.4103/hm.hm_12_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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7
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Freedenberg VA, Berul CI. Potential for shock leads to potential for stress. Heart Rhythm 2022; 19:1530-1531. [PMID: 35817253 DOI: 10.1016/j.hrthm.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Vicki A Freedenberg
- Children's National Hospital, Washington, District of Columbia; George Washington University School of Medicine, Washington, District of Columbia
| | - Charles I Berul
- Children's National Hospital, Washington, District of Columbia; George Washington University School of Medicine, Washington, District of Columbia.
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8
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Schneider LM, Wong JJ, Adams R, Bates B, Chen S, Ceresnak SR, Danovsky M, Hanisch D, Motonaga KS, Restrepo M, Shaw RJ, Sears SF, Trela A, Dubin AM, Hood KK. Post-Traumatic Stress Disorder in pediatric Implantable Cardioverter Defibrillator patients and their parents. Heart Rhythm 2022; 19:1524-1529. [DOI: 10.1016/j.hrthm.2022.06.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 06/13/2022] [Accepted: 06/22/2022] [Indexed: 12/01/2022]
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9
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Brothers C, Etchegary H, Curtis F, Simmonds C, Houston J, Young TL, Pullman D, Mariathas HH, Connors S, Hodgkinson K. Psychological Distress and Quality of Life in Participants Undergoing Genetic Testing for Arrhythmogenic Right Ventricular Cardiomyopathy Caused by TMEM43 p.S358L: Is It Time to Offer Population-Based Genetic Screening? Public Health Genomics 2021; 24:253-260. [PMID: 34500452 DOI: 10.1159/000517265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 05/18/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE We have identified 27 families in Newfoundland and Labrador (NL) with the founder variant TMEM43 p.S358L responsible for 1 form of arrhythmogenic right ventricular cardiomyopathy. Current screening guidelines rely solely on cascade genetic screening, which may result in unrecognized, high-risk carriers who would benefit from preemptive implantable cardioverter-defibrillator therapy. This pilot study explored the acceptability among subjects to TMEM43 p.S358L population-based genetic screening (PBGS) in this Canadian province. METHODS A prospective cohort study assessed attitudes, psychological distress, and health-related quality of life (QOL) in unselected individuals who underwent genetic screening for the TMEM43 p.S358L variant. Participants (n = 73) were recruited via advertisements and completed 2 surveys at baseline, 6 months, and 1 year which measured health-related QOL (SF-36v2) and psychological distress (Impact of Events Scale). RESULTS No variant-positive carriers were identified. Of those screened through a telephone questionnaire, >95% felt positive about population-genetic screening for TMEM43 p.S358L, though 68% reported some degree of anxiety after seeing the advertisement. There were no significant changes in health-related QOL or psychological distress scores over the study period. CONCLUSION Despite some initial anxiety, we show support for PBGS among research subjects who screened negative for the TMEM43 p.S358L variant in NL. These findings have implications for future PBGS programs in the province.
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Affiliation(s)
- Cassidy Brothers
- Postgraduate Medical Education, Faculty of Medicine, Memorial University, St. John's, Newfoundland, Canada
| | - Holly Etchegary
- Unit of Clinical Epidemiology, Faculty of Medicine, Memorial University, St. John's, Newfoundland, Canada
| | - Fiona Curtis
- Provincial Medical Genetics Program, Eastern Regional Health Authority, St. John's, Newfoundland, Canada
| | - Charlene Simmonds
- Health Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland, Canada
| | - Jim Houston
- Discipline of Genetics, Faculty of Medicine, Memorial University, St. John's, Newfoundland, Canada
| | - Terry-Lynn Young
- Discipline of Genetics, Faculty of Medicine, Memorial University, St. John's, Newfoundland, Canada
| | - Daryl Pullman
- Centre for Bioethics, Memorial University, St. John's, Newfoundland, Canada
| | - Hensley H Mariathas
- Strategy for Patient-Oriented Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland, Canada
| | - Sean Connors
- Division of Cardiology, Eastern Regional Health Authority, St. John's, Newfoundland, Canada
| | - Kathleen Hodgkinson
- Unit of Clinical Epidemiology, Faculty of Medicine, Memorial University, St. John's, Newfoundland, Canada.,Provincial Medical Genetics Program, Eastern Regional Health Authority, St. John's, Newfoundland, Canada
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10
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Rea KE, McCormick AM, Lim HM, Cousino MK. Psychosocial outcomes in pediatric patients with ventricular assist devices and their families: A systematic review. Pediatr Transplant 2021; 25:e14001. [PMID: 33704884 PMCID: PMC8141009 DOI: 10.1111/petr.14001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/17/2021] [Accepted: 02/24/2021] [Indexed: 11/30/2022]
Abstract
Ventricular assist device (VAD) therapy has provided pediatric patients with severe heart failure new therapeutic options. However, pediatric patients and families receiving VAD therapy also experience psychosocial challenges. No synthesis of the literature on psychosocial outcomes within the pediatric VAD population has been conducted; thus, the current review sought to systematically investigate the impact of pediatric VAD on patient, parent, and family psychosocial outcomes and assess variables associated with poorer outcomes. Literature searches were conducted in PsycInfo, PubMed, and Cumulative Index to Nursing and Allied Health Literature databases and full texts were assessed according to pre-established inclusion criteria. Main findings and study quality were reviewed. Sixteen studies were included in the present review. Findings highlighted the likelihood for psychological sequelae among pediatric patients and families receiving VAD therapy, including decreased psychological and emotional well-being, elevated stress, and difficulty coping with changes to family dynamics and responsibilities. Health-related quality of life was reported comparable to that of healthy peers and children with other cardiac conditions. Patients and families on VAD therapy experience significant difficulties in psychological well-being and challenges related to adjustment. The current review underscores the importance of ongoing support for families and continued assessment of psychosocial functioning across VAD support. Three critical periods for increased distress were identified: 1) immediately following VAD implantation, 2) discharge home and the weeks following discharge, and 3) long-term VAD therapy.
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Affiliation(s)
| | | | - Heang M. Lim
- Department of Pediatrics, Michigan Medicine, University of Michigan
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11
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Cyr S, Guo DX, Marcil MJ, Dupont P, Jobidon L, Benrimoh D, Guertin MC, Brouillette J. Posttraumatic stress disorder prevalence in medical populations: A systematic review and meta-analysis. Gen Hosp Psychiatry 2021; 69:81-93. [PMID: 33582645 DOI: 10.1016/j.genhosppsych.2021.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE PTSD is increasingly recognized following medical traumas although is highly heterogeneous. It is difficult to judge which medical contexts have the most traumatic potential and where to concentrate further research and clinical attention for prevention, early detection and treatment. The objective of this study was to compare PTSD prevalence in different medical populations. METHODS A systematic review of the literature on PTSD following medical traumas was conducted as well as a meta-analysis with final pooled result and 95% confidence intervals presented. A meta-regression was used to investigate the impact of potential effect modifiers (PTSD severity, age, sex, timeline) on study effect size between prevalence studies. RESULTS From 3278 abstracts, the authors extracted 292 studies reporting prevalence. Using clinician-administered reports, the highest 24 month or longer PTSD prevalence was found for intraoperative awareness (18.5% [95% CI=5.1%-36.6%]) and the lowest was found for epilepsy (4.5% [95% CI=0.2%-12.6%]). In the overall effect of the meta-regression, only medical events or procedures emerged as significant (p = 0.006) CONCLUSION: This review provides clinicians with greater awareness of medical contexts most associated with PTSD, which may assist them in the decision to engage in more frequent, earlier screening and referral to mental health services.
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Affiliation(s)
- Samuel Cyr
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - De Xuan Guo
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Marie-Joëlle Marcil
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Patrice Dupont
- Health Sciences Library, Université de Montréal, Montreal, Quebec, Canada
| | - Laurence Jobidon
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - David Benrimoh
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center, Montreal, Montreal, Quebec, Canada
| | - Judith Brouillette
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
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12
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Robinson JA, LaPage MJ, Atallah J, Webster G, Miyake CY, Ratnasamy C, Ollberding NJ, Mohan S, Von Bergen NH, Johnsrude CL, Garnreiter JM, Spar DS, Czosek RJ. Outcomes of Pediatric Patients With Defibrillators Following Initial Presentation With Sudden Cardiac Arrest. Circ Arrhythm Electrophysiol 2021; 14:e008517. [PMID: 33401923 DOI: 10.1161/circep.120.008517] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICD) are recommended for secondary prevention after sudden cardiac arrest (SCA). The outcomes of pediatric patients receiving an ICD after SCA remain unclear. The objective of this study is to evaluate outcomes, future risk for appropriate shocks, and identify characteristics associated with appropriate ICD therapy during follow-up. METHODS Multicenter retrospective analysis of patients (age ≤21 years) without prior cardiac disease who received an ICD following SCA. Patient/device characteristics, cardiac function, and underlying diagnoses were collected, along with SCA event characteristics. Patient outcomes including complications and device therapies were analyzed. RESULTS In total, 106 patients were included, median age 14.7 years. Twenty (19%) received appropriate shocks and 16 (15%) received inappropriate shocks (median follow-up 3 years). First-degree relative with SCA was associated with appropriate shocks (P<0.05). In total, 40% patients were considered idiopathic. Channelopathy was the most frequent late diagnosis not made at time of presentation. Neither underlying diagnosis nor idiopathic status was associated with increased incidence of appropriate shock. Monomorphic ventricular tachycardia (hazard ratio, 4.6 [1.2-17.3]) and family history of sudden death (hazard ratio, 6.5 [1.4-29.8]) were associated with freedom from appropriate shock in a multivariable model (area under the receiver operating characteristic curve, 0.8). Time from diagnoses to evaluation demonstrated a nonlinear association with freedom from appropriate shock (P=0.015). In patients >2 years from implantation, younger age (P=0.02) and positive exercise test (P=0.04) were associated with appropriate shock. CONCLUSIONS The risk of future device therapy is high in pediatric patients receiving an ICD after SCA, irrelevant of underlying disease. Lack of a definitive diagnosis after SCA was not associated with lower risk of subsequent events and does not obviate the need for secondary prophylaxis.
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MESH Headings
- Adolescent
- Child
- Child, Preschool
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Electric Countershock/instrumentation
- Female
- Humans
- Incidence
- Infant
- Infant, Newborn
- Male
- Primary Prevention/methods
- Retrospective Studies
- Risk Assessment/methods
- Risk Factors
- Secondary Prevention/methods
- Survival Rate/trends
- Tachycardia, Ventricular/mortality
- Tachycardia, Ventricular/physiopathology
- Tachycardia, Ventricular/therapy
- Treatment Outcome
- United States/epidemiology
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Affiliation(s)
- Jeffrey A Robinson
- The Heart Institute (J.A.R., D.S.S., R.J.C.), Cincinnati Children's Hospital Medical Center, OH
- Dr. C.C. & Mabel L. Criss Heart Center, Children's Hospital & Medical Center, University of Nebraska Medical Center, Omaha (J.A.R.)
| | - Martin J LaPage
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor (M.J.L.)
| | - Joseph Atallah
- Department of Pediatrics, University of Alberta, Edmonton, Canada (J.A.)
| | - Gregory Webster
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, IL (G.W.)
| | | | - Christopher Ratnasamy
- Congenital Heart Center, Spectrum Health, Helen DeVos Children's Hospital, Grand Rapids, MI (C.R.)
| | | | - Shaun Mohan
- University of Kentucky HealthCare, Lexington (S.M.)
| | - Nicholas H Von Bergen
- American Family Children's Hospital, University of Wisconsin School of Medicine & Public Health, Madison (N.H.V.B.)
| | | | | | - David S Spar
- The Heart Institute (J.A.R., D.S.S., R.J.C.), Cincinnati Children's Hospital Medical Center, OH
- Division of Biostatistics & Epidemiology (D.S.S., R.J.C.), Cincinnati Children's Hospital Medical Center, OH
| | - Richard J Czosek
- The Heart Institute (J.A.R., D.S.S., R.J.C.), Cincinnati Children's Hospital Medical Center, OH
- Division of Biostatistics & Epidemiology (D.S.S., R.J.C.), Cincinnati Children's Hospital Medical Center, OH
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13
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Brenner M, Alexander D, Quirke MB, Eustace-Cook J, Leroy P, Berry J, Healy M, Doyle C, Masterson K. A systematic concept analysis of 'technology dependent': challenging the terminology. Eur J Pediatr 2021; 180:1-12. [PMID: 32710305 PMCID: PMC7380164 DOI: 10.1007/s00431-020-03737-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/22/2020] [Accepted: 07/09/2020] [Indexed: 01/08/2023]
Abstract
There are an increasing number of children who are dependent on medical technology to sustain their lives. Although significant research on this issue is taking place, the terminology used is variable and the concept of technology dependence is ill-defined. A systematic concept analysis was conducted examining the attributes, antecedents, and consequences of the concept of technology dependent, as portrayed in the literature. We found that this concept refers to a wide range of clinical technology to support biological functioning across a dependency continuum, for a range of clinical conditions. It is commonly initiated within a complex biopsychosocial context and has wide ranging sequelae for the child and family, and health and social care delivery.Conclusion: The term technology dependent is increasingly redundant. It objectifies a heterogenous group of children who are assisted by a myriad of technology and who adapt to, and function with, this assistance in numerous ways. What is Known: • There are an increasing number of children who require medical technology to sustain their life, commonly referred to as technology dependent. This concept analysis critically analyses the relevance of the term technology dependent which is in use for over 30 years. What is New: • Technology dependency refers to a wide range of clinical technology to support biological functioning across a dependency continuum, for a range of clinical conditions. It is commonly initiated within a complex biopsychosocial context and has wide-ranging sequelae for the child and family, and health and social care delivery. • The paper shows that the term technology dependent is generally portrayed in the literature in a problem-focused manner. • This term is increasingly redundant and does not serve the heterogenous group of children who are assisted by a myriad of technology and who adapt to, and function with, this assistance in numerous ways. More appropriate child-centred terminology will be determined within the TechChild project.
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Affiliation(s)
- Maria Brenner
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, 24 D'Olier Street, Dublin 2, Ireland.
| | - Denise Alexander
- grid.8217.c0000 0004 1936 9705School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, 24 D’Olier Street, Dublin 2, Ireland
| | - Mary Brigid Quirke
- grid.8217.c0000 0004 1936 9705School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, 24 D’Olier Street, Dublin 2, Ireland
| | - Jessica Eustace-Cook
- grid.8217.c0000 0004 1936 9705Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Piet Leroy
- grid.5012.60000 0001 0481 6099Pediatric Intensive Care Unit & Pediatric Procedural Sedation Unit, Maastricht UMC and Faculty of Health, Life Sciences & Medicine, Maastricht University, Maastricht, Netherlands
| | - Jay Berry
- grid.2515.30000 0004 0378 8438Department of Medicine and Division of General Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA USA
| | - Martina Healy
- Department of Paediatric Anaesthesia, Paediatric Critical Care Medicine and Paediatric Pain Medicine, Children’s Health Ireland Crumlin, Dublin, Ireland ,grid.8217.c0000 0004 1936 9705School of Medicine, Faculty of Health Sciences, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Carmel Doyle
- grid.8217.c0000 0004 1936 9705School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, 24 D’Olier Street, Dublin 2, Ireland
| | - Kate Masterson
- grid.8217.c0000 0004 1936 9705School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, 24 D’Olier Street, Dublin 2, Ireland ,grid.416107.50000 0004 0614 0346Paediatric Intensive Care Unit, The Royal Children’s Hospital, Melbourne, Australia
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Impact of Pacemakers and Implantable Cardioverter Defibrillators on the Psychosocial Functioning of Paediatric Patients. Cardiol Young 2021; 31:71-76. [PMID: 33081852 DOI: 10.1017/s1047951120003388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Although implanted cardiac devices improve patients' physical health, long-term psychosocial effects especially in the paediatric population are still unknown. The aim of this study was to evaluate the psychosocial effects of cardiac devices in a paediatric population.Pediatric Quality of Life Questionnaire (PedsQoL) was used to evaluate life quality, Connor-Davidson Resilience Scale was used to evaluate resilience and Brief Symptom Inventory was used to evaluate psychiatric symptoms in a paediatric population with cardiac devices.Seventy-one patients were enrolled in the study. Fifty of them (70.5%) had a cardiac pacemaker and 21 of them (29.5%) had implantable cardioverter defibrillator. When compared to the control group both implantable cardioverter defibrillator and pacemaker using patients had lower quality of life (79.5 ± 12.4 versus 86.7 ± 12.1, p = 0.001) but no difference was observed in resilience and psychological pathologies. Age, gender, family size, and education level had no effect on quality of life. Implantable cardioverter defibrillator bearing patients had higher levels of anxiety than pacemaker patients (0.58 versus 0.30 p = 0.045), and implantable cardioverter defibrillator patients who had received shock in the last year had higher levels of somatisation than the group that did not receive device shock (0.17 versus 0.44 p = 0.022).In conclusion study showed that cardiac devices have negative effects on the psychosocial health of children. Cardiologist working with these patients should be aware of these pathologies and monitor not only physical health but also psychosocial health too.
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Rafsanjani MHAP, Masoudi S, Radmanesh M, Bostani Z. Comparison of depression and anxiety among pacemaker and implantable cardioverter-defibrillator recipients: A cross-sectional study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 44:235-239. [PMID: 33372277 DOI: 10.1111/pace.14152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/22/2020] [Accepted: 12/27/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Anxiety and depression among implantable cardioverter-defibrillator (ICD) recipients can lead to physical or psychological consequences and reduce the quality of life of these patients. Few studies have compared the frequency and severity of depressive and anxiety disorders in the pacemaker (PM) and ICD recipients. The aim of the present study was to compare depression and anxiety among PM and ICD recipients. METHODS This cross-sectional study was performed on 296 patients referred to a specialized cardiology teaching hospital from October 1, 2019 to July 1, 2020. Patients were selected using convenience sampling method. RESULTS Regarding anxiety, the results showed that the overall prevalence of anxiety in PM, ICD, and control groups was 23.5%, 28%, and 8%, respectively. Results showed no significant difference between PM and ICD recipients regarding the anxiety prevalence (p = .46). With regard to depression, the results showed that the overall prevalence of depression in the PM, ICD, and control groups was 7.1%, 23%, and 4.1%, respectively. The results showed a significant difference between PM and ICD recipients in terms of depression prevalence (p = .03). The results also showed that the prevalence of depression was significantly higher among PM and ICD recipients than the control group (p = .01). CONCLUSION Considering the results of the present study and the high prevalence of anxiety and depression, it seems necessary to focus more on educating patients about the effectiveness of PM and ICD devices in reducing anxiety and depression.
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Affiliation(s)
| | - Sima Masoudi
- Department of Biostatistics and Epidemiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Majid Radmanesh
- Department of Psychiatry, School of Medicine, Razi Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Zahra Bostani
- Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Science, Urmia, Iran
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Quality of life and psychological co-morbidities in children and adolescents with cardiac pacemakers and implanted defibrillators: a cohort study in Eastern Germany. Cardiol Young 2020; 30:549-559. [PMID: 32279696 DOI: 10.1017/s104795112000061x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The implantation of a pacemaker or an implantable cardioverter-defibrillator during childhood may reduce quality of life and lead to mental health problems. This study aimed to evaluate potential mental health problems (i.e., depressive and anxiety symptoms) and quality of life in children with cardiac active devices in comparison to healthy peers. METHODS We analysed data of children with pacemakers or implantable cardioverter-defibrillators aged 6-18 years. Quality of life, depressive and anxiety symptoms were assessed by standardised questionnaires. The results were compared to age-matched reference groups. RESULTS Children with implantable cardioverter-defibrillator showed significant lower quality of life in comparison to reference group (p = 0.03), but there was no difference in quality of life between children with pacemaker and reference group. There was no significant difference in depressive symptoms between children with a cardiac rhythm device compared to reference group (self-report: p = 0.67; proxy report: p = 0.49). There was no significant difference in anxiety (p = 0.53) and depressive symptoms (p = 0.86) between children with pacemaker and children with implantable cardioverter-defibrillator. CONCLUSIONS Living with an implantable cardioverter-defibrillator in childhood seems to decrease the patients' quality of life. Although children with pacemaker and implantable cardioverter-defibrillator don't seem to show more depressive and anxiety symptoms in comparison to their healthy peers, there still can be an increased risk for those children to develop mental health problems. Therefore, treating physicians should be aware of potential mental health problems and provide the patients and their families with appropriate therapeutic offers.
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Schneider LM, Wong JJ, Trela A, Hanisch D, Shaw RJ, Sears SF, Motonaga KS, Ceresnak SR, Hood KK, Dubin AM. An exploratory assessment of pediatric patient and parent needs after implantable cardioverter defibrillator implant. Pacing Clin Electrophysiol 2020; 43:289-296. [DOI: 10.1111/pace.13876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Lauren M. Schneider
- Department of Psychiatry and Behavioral SciencesStanford University School of Medicine Stanford California
| | - Jessie J. Wong
- Division of Pediatric EndocrinologyDepartment of PediatricsStanford University School of Medicine Stanford California
| | - Anthony Trela
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford Palo Alto California
| | - Debra Hanisch
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford Palo Alto California
| | - Richard J. Shaw
- Department of Psychiatry and Behavioral SciencesStanford University School of Medicine Stanford California
| | - Samuel F. Sears
- Department of Psychology and Cardiovascular ScienceEast Carolina University Greenville North Carolina
| | - Kara S. Motonaga
- Division of Pediatric Cardiology, Department of PediatricsStanford University School of Medicine Stanford California
| | - Scott R. Ceresnak
- Division of Pediatric Cardiology, Department of PediatricsStanford University School of Medicine Stanford California
| | - Korey K. Hood
- Division of Pediatric EndocrinologyDepartment of PediatricsStanford University School of Medicine Stanford California
| | - Anne M. Dubin
- Division of Pediatric Cardiology, Department of PediatricsStanford University School of Medicine Stanford California
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18
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Werner H, Lehmann P, Rüegg A, Hilfiker S, Steinmann K, Balmer C. Health-related quality of life outcomes in pediatric patients with cardiac rhythm devices: a cross-sectional study with case-control comparison. Health Qual Life Outcomes 2019; 17:152. [PMID: 31604454 PMCID: PMC6788066 DOI: 10.1186/s12955-019-1219-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/06/2019] [Indexed: 11/20/2022] Open
Abstract
Background Little is known about health-related quality of life (HRQoL) in pediatric patients with cardiac rhythm devices. This study aims to compare self- and proxy-reported HRQoL in patients with pacemaker (PM) and implantable cardioverter-defibrillator (ICD) to that in sex- and age-matched healthy controls and to examine predictors for generic and disease-specific HRQoL. Methods The study included 72 PM and ICD patients (39% females) and 72 sex- and age-matched healthy controls from 3 to 18 years of age. HRQoL data was obtained by the PedsQL 4.0 Generic Core Scales and Pediatric Cardiac Quality of Life Inventory. Medical data was collected retrospectively from medical records. Results Patients had significantly lower self- and proxy-reported generic overall HRQoL and lower physical health than healthy controls, and ICD patients also had lower psychosocial health. On multivariate analyses, generic overall HRQoL and physical health was significantly predicted by current cardiac medication (β = −.39, p = .02 for overall HRQoL, respectively β = −.44, p = .006 for physical health). Disease-specific overall HRQoL was only marginally predicted by child age, device type, and the presence of a structural congenital heart disease (p < .10). Conclusions This study shows that PM and ICD patients have lower HRQoL than healthy controls and that patients who need cardiac medication are seen by their parents at great risk for lower generic overall HRQoL. Our study also indicates a trend towards higher risk for low disease-specific HRQoL in younger patients, ICD patients, and patients with a structural congenital heart disease. Special attention should be given to these patients as they may benefit from a timely clinical evaluation in order to provide supportive interventions.
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Affiliation(s)
- Helene Werner
- Department of Psychosomatics and Psychiatry, University Children's Hospital, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland. .,Division of Child and Adolescent Health, Institute of Psychology, University of Zurich, Binzmühlestrasse 14, Box 8, CH-8050, Zürich, Switzerland. .,Children's Research Center, University Children's Hospital, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland.
| | - Phaedra Lehmann
- Department of Psychosomatics and Psychiatry, University Children's Hospital, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland.,Children's Research Center, University Children's Hospital, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland.,Department of Cardiology, Pediatric Heart Centre, University Children's Hospital, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland
| | - Alina Rüegg
- Department of Cardiology, Pediatric Heart Centre, University Children's Hospital, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland
| | - Silvia Hilfiker
- Children's Research Center, University Children's Hospital, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland.,Department of Cardiology, Pediatric Heart Centre, University Children's Hospital, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland
| | - Karin Steinmann
- Department of Cardiology, Pediatric Heart Centre, University Children's Hospital, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland
| | - Christian Balmer
- Children's Research Center, University Children's Hospital, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland.,Department of Cardiology, Pediatric Heart Centre, University Children's Hospital, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland
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19
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Puri K, Malek J, de la Uz CM, Lantos J, Cabrera AG, Frugé E. Allowing Adolescents to Weigh Benefits and Burdens of High-stakes Therapies. Pediatrics 2019; 144:peds.2018-3714. [PMID: 31167936 DOI: 10.1542/peds.2018-3714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2018] [Indexed: 11/24/2022] Open
Abstract
We present the case of a girl aged 17 years and 10 months who has a strong family history of long QT syndrome and genetic testing confirming the diagnosis of long QT syndrome in the patient also. She was initially medically treated with β-blocker therapy; however, after suffering 1 episode of syncope during exertion, she underwent placement of an implantable cardioverter defibrillator. Since then, she has never had syncope. However, during the few months before this presentation, she experienced shocks on multiple occasions without any underlying arrhythmias. These shocks are disconcerting for her, and she is having significant anxiety about them. She requests the defibrillator to be inactivated. However, her mother, who also shares the diagnosis of long QT syndrome, disagrees and wants the defibrillator to remain active. The ethics team is consulted in this setting of disagreement between an adolescent, who is 2 months shy of the age of maturity and medical decision-making, and her mother, who is currently responsible for her medical decisions. The question for the consultation is whether it would be ethically permissible for the doctors to comply with the patient's request to turn off the defibrillator or whether the doctors should follow the mother's wishes until the patient is 18 years of age.
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Affiliation(s)
- Kriti Puri
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas;
| | - Janet Malek
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
| | - Caridad Maylin de la Uz
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - John Lantos
- Department of Pediatrics, School of Medicine, University of Missouri-Kansas City and Children's Mercy Hospital, Kansas City, Missouri; and
| | - Antonio Gabriel Cabrera
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Ernest Frugé
- Section of Hematology-Oncology, Department of Pediatrics, Center for Medical Ethics and Health Policy, Baylor College of Medicine and Texas Children's Cancer and Hematology Centers, Houston, Texas
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20
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HajKheder S, Haase-Fielitz A, Butter C. [Cardiac implantable electronic devices and health-related quality of life]. Herzschrittmacherther Elektrophysiol 2019; 30:160-167. [PMID: 30969354 DOI: 10.1007/s00399-019-0619-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 03/24/2019] [Indexed: 06/09/2023]
Abstract
Patients, scientists and healthcare providers are increasingly interested in identifying interventions that not only reduce mortality but also improve symptoms, function and health-related quality of life. Health-related quality of life is a strong, independent predictor of mortality, cardiovascular events, hospitalization and treatment costs in patients with cardiac diseases. Remote monitoring of pacemakers has a positive effect on health-related quality of life and functional capacity and is equivalent to monitoring these patients in hospitals. Implantation of an implantable cardioverter defibrillator has a major impact on mental health, with the majority of patients experiencing the fear of ICD shocks as particularly detrimental to the quality of life. Variables, such as age, gender and duration of implantation should be considered in the assessment and planning of strategies for improving the quality of life of patients with electronic implantable cardiac devices.
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Affiliation(s)
- Salma HajKheder
- Abteilung für Kardiologie, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Hochschulklinikum der Medizinischen Hochschule Brandenburg (MHB) Theodor Fontane, Ladeburger Str. 17, 16321, Bernau bei Berlin, Deutschland
| | - Anja Haase-Fielitz
- Abteilung für Kardiologie, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Hochschulklinikum der Medizinischen Hochschule Brandenburg (MHB) Theodor Fontane, Ladeburger Str. 17, 16321, Bernau bei Berlin, Deutschland.
| | - Christian Butter
- Abteilung für Kardiologie, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Hochschulklinikum der Medizinischen Hochschule Brandenburg (MHB) Theodor Fontane, Ladeburger Str. 17, 16321, Bernau bei Berlin, Deutschland
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21
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Posttraumatic stress and health-related quality of life in parents of children with cardiac rhythm devices. Qual Life Res 2019; 28:2471-2480. [PMID: 31098798 DOI: 10.1007/s11136-019-02202-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Studies have shown a high prevalence of post-traumatic stress disorders (PTSD) among parents of children with life-threatening diseases. However, it is yet unknown whether parents of children with cardiac rhythm device develop posttraumatic stress symptoms or even PTSD. METHODS This cross-sectional investigation is part of a comprehensive single-center study of long-term medical and psychosocial outcomes in pediatric patients with pacemaker (PM) and implantable cardioverter defibrillator (ICD). 69 patients (78%) were included in the study, with the participation of 69 mothers and 57 fathers. Parents completed the Posttraumatic Diagnostic Scale and Medical Outcomes Study Short Form-36 item questionnaire. Child's medical data was collected retrospectively from patients' hospital records. RESULTS At assessment, the patients (39% females) were on average 11.2 years old. The predominant device type was PM in 56 cases (81%). The mean time since device implantation was 6.3 years (SD = 4.3). Full heart-disease related PTSD was diagnosed in one mother and no father, while partial heart-disease-related PTSD was diagnosed in 3 mothers (4%) and 2 fathers (4%). Parental HRQoL-especially regarding the mental health dimension-was affected in both parents. In both parents, total PTSD symptom severity scores were a significant predictor for mental health summary scores after controlling for child age at implantation, presence of other non-cardiac disease in the child, parental age, and presence of own chronic disease. CONCLUSIONS Special attention should be given to parental PTSD symptoms in the clinical follow-up of PM and ICD patients as some parents might probably benefit from psychological support.
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Pyngottu A, Werner H, Lehmann P, Balmer C. Health-Related Quality of Life and Psychological Adjustment of Children and Adolescents with Pacemakers and Implantable Cardioverter Defibrillators: A Systematic Review. Pediatr Cardiol 2019; 40:1-16. [PMID: 30539238 DOI: 10.1007/s00246-018-2038-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 12/06/2018] [Indexed: 10/27/2022]
Abstract
The absence of cardiac symptoms, the improved exercise tolerance and the increased life expectancy are the advantages of a successful cardiac device therapy. Nevertheless, the fact of a lifelong device dependency, the inherent possibility of device malfunction and the progression of the underlying heart disease may impact the health-related quality of life (HRQoL) and the psychological adjustment of these individuals. To date, an overview of findings on these topics is lacking. The objective of this study was to evaluate and summarize the current evidence on generic and disease-specific HRQoL and psychological adjustment in paediatric patients with a pacemaker (PM) or an implantable cardioverter defibrillator (ICD). A systematic literature search was conducted using relevant databases and predefined keywords. Study selection was conducted based on predefined inclusion criteria. Fourteen studies were selected which were of varying methodological quality. Overall, the studies indicated that PM/ICD patients themselves and their parents scored lower than healthy controls on generic HRQoL scales and reported similar disease-related HRQoL as patients with severe forms of congenital heart disease. Regarding psychological adjustment outcome, PM recipients and norms were not significantly different with respect to anxiety and depression symptoms, while ICD patients showed more signs of anxiety than depression. HRQoL and psychological health should be considered when setting therapy goals and evaluating medical treatment success. This approach allows an early intervention in patients at risk of maladaptation, which is especially important in the young patient undergoing crucial developmental stages.
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Affiliation(s)
- Ashima Pyngottu
- Department of Cardiology, Pediatric Heart Centre, University Children's Hospital Zurich, Steinwiesstr. 75, 8032, Zurich, Switzerland
| | - Helene Werner
- Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Steinwiesstr. 75, 8032, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Steinwiesstr. 75, 8032, Zurich, Switzerland
| | - Phaedra Lehmann
- Department of Cardiology, Pediatric Heart Centre, University Children's Hospital Zurich, Steinwiesstr. 75, 8032, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Steinwiesstr. 75, 8032, Zurich, Switzerland
| | - Christian Balmer
- Department of Cardiology, Pediatric Heart Centre, University Children's Hospital Zurich, Steinwiesstr. 75, 8032, Zurich, Switzerland. .,Children's Research Center, University Children's Hospital Zurich, Steinwiesstr. 75, 8032, Zurich, Switzerland. .,Department of Cardiology, Pediatric Heart Centre, Children's Research Center, University Children's Hospital Zurich, Steinwiesstr. 75, 8032, Zurich, Switzerland.
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Allam LE, Nabih MAE, El-Missiry MA. The psychological impact of permanent cardiac pacemakers on pediatric patients and their parents: A case control study. Indian Heart J 2018; 70:872-878. [PMID: 30580859 PMCID: PMC6306355 DOI: 10.1016/j.ihj.2018.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 01/05/2018] [Accepted: 02/28/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND This study assessed anxiety and depression in children with permanent pacemakers (PPM) and quality of life of their parents. METHODS Ninety children (63.3% males and 36.6% females) and their parents were included in the study and were divided into three groups. The control group (Group 1) included 30 normal healthy children (57% males and 43% females), the PPM group (Group 2) included 30 age-matched children (70% males and 30% females) with PPM and structurally normal heart, while the Group 3 included 30 children (63% males and 37% females) with PPM and congenital heart disease (PPM+CHD). Psychological assessment of children and their parents was carried out using an interview-based questionnaires. RESULTS Psychiatric disorders were more prevalent in PPM+CHD group including depression (P=0.04), anxiety (P=0.02) and lower parents' QoL (P=0.01). The PPM group had higher depression and lower parents' QoL than the control group. Family income was independent factor for depression (r2=-6.3, with P<0.05). Sex of the child and CCU admission were independent factors for anxiety (r2=-9.5, P<0.05 & r2=10.5, P=0.001) in PPM group. CONCLUSION Children with pacemakers have higher psychiatric disorders and their parents have lower QoL.
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Affiliation(s)
- Lamyaa Elsayed Allam
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | | | - Marwa Adel El-Missiry
- Department of Neuro-psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
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Hopgood DA, Czosek RJ, Bakas T, Garritano N, Gillespie GL. The Capture Gap: Implantable Cardioverter-Defibrillator Quality of Life. Clin Nurs Res 2018; 29:97-107. [PMID: 30295057 DOI: 10.1177/1054773818803741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We aimed to compare salient characteristics and antecedents of quality of life (QOL) in adolescents and young adults with implantable cardioverter-defibrillators (ICDs) from qualitative methods with quantitative measurement of QOL and correlations between QOL (PedsQL) and measured participant characteristics. Concurrent parallel mixed methods design was used to collect survey data from the PedsQL electronic health record, demographic questionnaire, and semistructured interview data. A convenience sample of 16 individuals with ICDs, aged 13 to 25 years, was obtained from a tertiary pediatric facility. Overall QOL and subdomains of physical, psychosocial, and academic/work were examined by PedsQL and visual analog scale. Select demographics were collected to develop a participant profile. Females with ICDs appear to be at risk of poor QOL given some unknown factors. Financial status of the individual and the family was positively related to QOL. For new ICD persons involved in physical activities that must be stopped, peer support appears to improve QOL.
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Affiliation(s)
- Daniel A Hopgood
- University of Cincinnati, OH, USA.,Ohio University, Athens, OH, USA
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Glotzbach K, May L, Wray J. Health related quality of life and functional outcomes in pediatric cardiomyopathy. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Goldstein SA, LaPage MJ, Dechert BE, Serwer GA, Yu S, Lowery RE, Bradley DJ. Decreased inappropriate shocks with new generation ICDs in children and patients with congenital heart disease. CONGENIT HEART DIS 2018; 13:413-418. [PMID: 29372620 DOI: 10.1111/chd.12585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/17/2017] [Accepted: 12/22/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Inappropriate implantable cardioverter defibrillator (ICD) shocks in children and patients with congenital heart disease (CHD) remain a major complication of device therapy, occurring in as many as 50% of children with ICDs. New generation devices include algorithms designed to minimize inappropriate shocks. This study aimed to evaluate the effect of new generation ICDs on the incidence of inappropriate shocks in the pediatric and CHD population. DESIGN Retrospective study of patients with CHD or under age 25 receiving ICDs between 2000 and 2015. New generation ICDs were defined as those with Medtronic "SmartShock" algorithms. RESULTS Two hundred eight devices were implanted in 146 patients. Rates of inappropriate shocks were similar between diagnoses (P = .71). The rate of inappropriate shock was 15% over median 5.8 years follow-up. In the 36 patients (25%) with new generation ICDs, the rate of inappropriate shock was 6.3% over 4 years. Comparing old to new generation ICDs, freedom from first inappropriate shock was 90.6% versus 97.1% at 1 year and 80.4% versus 97.1% at 3 years (P = .01). Lead fracture was associated with having inappropriate shock (hazard ratio 8.5, P < .0001), and there was no significant difference between the device groups when lead fractures were excluded. Clinical actions were taken in 69% of patients after initial inappropriate shock (such as medication or program change, system revision, or explant). When an action was taken, subsequent inappropriate shock was reduced (5.3% vs 49.2% at 1 year; P = .002). CONCLUSIONS Pediatric and CHD patients are experiencing reduced inappropriate shocks with new generation ICD systems, though reduced lead fracture may account for this improvement. Clinical interventions after inappropriate shock favorably impact the subsequent rate of shocks once an inappropriate shock occurs.
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Affiliation(s)
| | - Martin J LaPage
- University of Michigan Congenital Heart Center, Ann Arbor, Michigan, USA
| | - Brynn E Dechert
- University of Michigan Congenital Heart Center, Ann Arbor, Michigan, USA
| | - Gerald A Serwer
- University of Michigan Congenital Heart Center, Ann Arbor, Michigan, USA
| | - Sunkyung Yu
- University of Michigan Congenital Heart Center, Ann Arbor, Michigan, USA
| | - Ray E Lowery
- University of Michigan Congenital Heart Center, Ann Arbor, Michigan, USA
| | - David J Bradley
- University of Michigan Congenital Heart Center, Ann Arbor, Michigan, USA
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Mindfulness-Based Stress Reduction and Group Support Decrease Stress in Adolescents with Cardiac Diagnoses: A Randomized Two-Group Study. Pediatr Cardiol 2017; 38:1415-1425. [PMID: 28702717 DOI: 10.1007/s00246-017-1679-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 07/04/2017] [Indexed: 01/13/2023]
Abstract
Adolescents with cardiac diagnoses face unique challenges that can cause psychosocial distress. This study compares a Mindfulness-Based Stress Reduction (MBSR) program to a video online support group for adolescents with cardiac diagnoses. MBSR is a structured psycho-educational program which includes yoga, meditation, cognitive restructuring, and group support. A published feasibility study by our group showed significant reduction in anxiety following this intervention. Participants were randomized to MBSR or video online support group, and completed measures of anxiety, depression, illness-related stress, and coping pre- and post-6-session interventions. Qualitative data were obtained from post-intervention interviews. A total of 46 teens participated (mean 14.8 years; 63% female). Participants had congenital heart disease and/or cardiac device (52%), or postural orthostatic tachycardia syndrome (48%). Illness-related stress significantly decreased in both groups. Greater use of coping skills predicted lower levels of depression in both groups post-study completion. Higher baseline anxiety/depression scores predicted improved anxiety/depression scores in both groups. Each group reported the benefits of social support. The MBSR group further expressed benefits of learning specific techniques, strategies, and skills that they applied in real-life situations to relieve distress. Both the MBSR intervention and video support group were effective in reducing distress in this sample. Qualitative data elucidated the added benefits of using MBSR techniques to manage stress and symptoms. The video group format is useful for teens that cannot meet in person but can benefit from group support. Psychosocial interventions with stress management techniques and/or group support can reduce distress in adolescents with cardiac diagnoses.
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de la Uz CM, Burch AE, Gunderson B, Koehler J, Sears SF. How active are young cardiac device patients? Objective assessment of activity in children with cardiac devices. Pacing Clin Electrophysiol 2017; 40:1286-1290. [PMID: 28901013 DOI: 10.1111/pace.13197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 07/25/2017] [Accepted: 08/14/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The daily activity of pediatric patients with implantable cardiac devices provides behavioral evidence of functional outcomes. Modern devices provide continuous accelerometer data that are sensitive to movement, but normative values have not been published for pediatric activity rates. This study provides the first normative accelerometer data on activity rates in a large sample of pediatric cardiac device patients. METHODS Patients were between 3 and 18 years old (N = 1,905) and implanted with a cardiac device from a single device company, and enrolled in remote monitoring. RESULTS The median age at implant was 14 years (interquartile range = 12-16); 61.3% were male. Data for 4 weeks were extracted from a company database at 53 weeks postimplant and an average of daily activity was calculated. Daily average activity for all patients was 5.4 hours (standard deviation = 2.0). In a multivariate analysis, increased level of activity was associated with: being male, having a pacemaker versus implantable cardioverter defibrillator (ICD), epicardial device location, rate response turned off, having experienced a shock, and younger age. CONCLUSIONS These results provide the first baseline data of physical activity in children with implanted cardiac devices and provide a clinical guide to physical activity assessment in this population. Further, our data suggest physical activity in children with implantable cardiac devices may differ based on demographic variables, device type, device location, indication for implantation, and history of ICD shock.
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Affiliation(s)
- Caridad M de la Uz
- The Lillie Frank Abercrombie Section of Pediatric Cardiology Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Ashley E Burch
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | | | | | - Samuel F Sears
- Department of Psychology and Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
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29
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Khan S, Berul CI. Long QT syndrome: Who needs a transplant? Heart Rhythm 2017; 14:1189-1190. [DOI: 10.1016/j.hrthm.2017.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Indexed: 11/29/2022]
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Manuel A, Brunger F. Embodying a New Meaning of Being At Risk: Living With an Implantable Cardioverter Defibrillator for Arrhythmogenic Right Ventricular Cardiomyopathy. Glob Qual Nurs Res 2017; 3:2333393616674810. [PMID: 28462346 PMCID: PMC5342860 DOI: 10.1177/2333393616674810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/20/2016] [Accepted: 09/27/2016] [Indexed: 11/16/2022] Open
Abstract
Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia (ARVC/D) is a genetic condition that can cause fatal arrhythmias. The implantable cardioverter defibrillation (ICD) is a primary treatment for ARVC/D. Using a grounded theory approach, this study examines the experiences of 15 individuals living with an ICD. The ability to cope with and adjust to having an ICD is influenced by the acceptance of the ICD as something needed to survive, an understanding of the ICD's function, existing support networks, and ones' ability to manage everyday challenges. Coping well requires reshaping ideas about the meaning of being at risk and understanding how the ICD fits into that changing personal risk narrative. A thorough understanding of the unique needs of individuals with ARVC/D and of the specific factors contributing to the psychosocial distress related to having an ICD (vs. having the disease itself) is needed. Nurses must be prepared to provide ongoing support and education to this population.
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Affiliation(s)
- April Manuel
- Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Fern Brunger
- Memorial University, St. John's, Newfoundland and Labrador, Canada
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31
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Etchegary H, Pullman D, Connors SP, Simmonds C, Young TL, Hodgkinson KA. “There are days I wish it wasn’t there, and there’s days I realize I’m lucky”: A qualitative study of psychological sequelae to the implantable cardioverter defibrillator as a treatment for the prevention of sudden cardiac death in arrhythmogenic right ventricular cardiomyopathy. JRSM Cardiovasc Dis 2017; 6:2048004017698614. [PMID: 35186284 PMCID: PMC8851103 DOI: 10.1177/2048004017698614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/06/2017] [Accepted: 02/07/2017] [Indexed: 11/17/2022] Open
Abstract
Objectives Arrhythmogenic right ventricular cardiomyopathy caused by a TMEM43 p.S358L mutation is a fully penetrant autosomal dominant cause of sudden cardiac death where prophylactic implantable cardioverter defibrillator therapy significantly reduces mortality by returning lethal cardiac rhythms to normal. This qualitative study assessed the psychological ramifications of the implantable cardioverter defibrillator on recipients, their spouses and their mutation negative siblings. Design Qualitative interview study. Participants Twenty-one individuals (nine mutation positive, eight mutation negative and four spouses) from 15 families completed semi-structured interviews. Results No theoretical assumptions about the data were made: inductive sub-coding was accomplished with the constant comparison method and cohesive themes across all respondent interviews were determined. All interviewees had a family history of sudden cardiac death and appropriate implantable cardioverter defibrillator therapy in themselves or family members. Average length of time with an implantable cardioverter defibrillator was 10 years. Major themes included: (1) acceptance and gratitude, (2) grudging acceptance, (3) psychological effects (on emotional and psychological well-being; functioning of the broader family unit; and relationships), and (4) practical concerns (on clothes, travel, loss of driving licence and the effects of an implantable cardioverter defibrillator discharge). These affected all family members, regardless of mutation status. Conclusions Despite the survival advantage of implantable cardioverter defibrillator therapy, the intervention carries psychological and practical burdens for family members from kindreds manifesting p.S358L TMEM43 ARVC that does not appear to dissipate with time. A move towards integrating psychology services with the cardiac genetics clinic for the extended family may provide benefit.
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Affiliation(s)
- Holly Etchegary
- Faculty of Medicine, Genetics and Clinical Epidemiology, Memorial University, Canada
| | - Daryl Pullman
- Faculty of Medicine, Community Health and Humanities, Memorial University, Canada
| | - Sean P Connors
- Faculty of Medicine, Cardiology, Memorial University, Canada
| | - Charlene Simmonds
- Faculty of Medicine, Community Health and Humanities, Memorial University, Canada
| | | | - Kathy A Hodgkinson
- Faculty of Medicine, Genetics and Clinical Epidemiology, Memorial University, Canada
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Behavioural and emotional implications of implantable cardioverter-defibrillators in the young and in athletes. Cardiol Young 2017; 27:S138-S142. [PMID: 28084974 DOI: 10.1017/s1047951116002389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Despite the life-saving capabilities of implantable cardioverter-defibrillators, they may have implications on behavioural and emotional well-being and have been shown to negatively affect patients' psychosocial functioning. Children and CHD patients with these devices are at higher risk for complications, and therefore may have higher risk of psychosocial dysfunction including depression, anxiety, and a decrease in overall quality of life. In addition, these patients may be restricted from activities, which may also contribute to psychosocial dysfunction. Recommendations published in 2015 support a more liberal approach to athletic participation in this patient population compared with previous guidelines. Approaches to limit psychosocial dysfunction include education, minimisation of shocks, and psychosocial therapy. Psychosocial dysfunction should be assessed at each clinic visit, and information regarding intervention should be provided to patients and their families as needed. Psychosocial dysfunction may be debilitating, and healthcare providers should facilitate and support normal psychosocial function by offering resources as needed.
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33
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Ng CY, Mela T. A Primer on Cardiac Devices: Psychological and Pharmacological Considerations. Psychiatr Ann 2016. [DOI: 10.3928/00485713-20161107-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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35
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Graham RJ, Rodday AM, Weidner RA, Parsons SK. The Impact on Family of Pediatric Chronic Respiratory Failure in the Home. J Pediatr 2016; 175:40-6. [PMID: 27289498 DOI: 10.1016/j.jpeds.2016.05.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/15/2016] [Accepted: 05/04/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the family impact of managing severe, chronic respiratory failure (CRF) at home. Better understanding will inform parental counseling and serve as a point of reference for interventions. STUDY DESIGN Families of children with CRF completed the Impact on Family Scale (IFS) and Consumer Assessment of Healthcare Providers and Systems. Using multivariable linear regression, we assessed the relationship between IFS and family, clinical, and utilization characteristics. RESULTS A total of 118 parents (60%) completed the IFS; 114 parents (58%) completed all measures. The 15-item IFS mean total score was 40 (SD = 10) with a possible range of 15-60 (greater scores indicate more impact). Modeling identified a negative association with parent emotional functioning, parent-rated child health, and private insurance only (compared with both private/public), and other family characteristics (eg, parental education, marital status, and income) were not associated with IFS scores. CONCLUSION Families of children with CRF are greatly impacted by their child's health. In contrast to other children with special health care needs, family characteristics were not associated with IFS scores, excluding insurance type. These results may reflect more uniform demands and stressors related to CRF. Future research should identify interventions to attenuate the impact of CRF.
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Affiliation(s)
- Robert J Graham
- Division of Critical Care, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Angie Mae Rodday
- Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, MA; Tufts University School of Medicine, Boston, MA
| | - Ruth Ann Weidner
- Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, MA
| | - Susan K Parsons
- Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, MA; Tufts University School of Medicine, Boston, MA
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36
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Migliore F, Silvano M, Zorzi A, Bertaglia E, Siciliano M, Leoni L, De Franceschi P, Iliceto S, Corrado D. Implantable cardioverter defibrillator therapy in young patients with cardiomyopathies and channelopathies. J Cardiovasc Med (Hagerstown) 2016; 17:485-93. [DOI: 10.2459/jcm.0000000000000395] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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37
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Berul CI. Shocking numbers--Reeducation to reduce inappropriate ICD utilization for congenital long QT syndrome. Heart Rhythm 2016; 13:886-7. [PMID: 26724491 DOI: 10.1016/j.hrthm.2015.12.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Charles I Berul
- Division of Cardiology, Children's National Health Systems, Department of Pediatrics, George Washington University School of Medicine, Washington, DC.
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38
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Webster G, Monge MC. Left Cardiac Sympathetic Denervation: Should We Sweat the Side Effects? Circ Arrhythm Electrophysiol 2016; 8:1007-9. [PMID: 26487619 DOI: 10.1161/circep.115.003413] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gregory Webster
- From the Divisions of Cardiology (G.W.) and Cardio-Thoracic Surgery (M.C.M.), Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, IL.
| | - Michael C Monge
- From the Divisions of Cardiology (G.W.) and Cardio-Thoracic Surgery (M.C.M.), Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, IL
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39
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Antiel RM, Bos JM, Joyce DD, Owen HJ, Roskos PL, Moir C, Ackerman MJ. Quality of life after videoscopic left cardiac sympathetic denervation in patients with potentially life-threatening cardiac channelopathies/cardiomyopathies. Heart Rhythm 2015; 13:62-9. [PMID: 26341607 DOI: 10.1016/j.hrthm.2015.09.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Left cardiac sympathetic denervation (LCSD) provides an additive or potentially alternative treatment option for patients with life-threatening cardiac channelopathies/cardiomyopathies. OBJECTIVE We sought to examine the effects of LCSD on quality of life (QOL). METHODS From November 2005 to May 2013, 109 patients who underwent LCSD were subsequently sent postoperative QOL surveys. RESULTS Of 109 patients, 8 (7%) could not be contacted. Of the remaining 101 patients, 62 returned surveys (response rate 61%). There were an average of 4.1 ± 1.8 self-reported side effects immediately after LCSD. The most common anticipated side effects included unilateral hand dryness, color or temperature variance between sides of the face, and abnormal sweating. Although parent-reported pediatric physical QOL scores were lower than national norms, there were no differences in psychosocial QOL or disability scores (P = .09 and .33, respectively). QOL scores for adult patients were not significantly different from a US normative sample. Adult LCSD patients reported less disability than a US normative sample (P < .01). There was no correlation between QOL scores and the presence of anticipated side effects. However, among the subset of pediatric patients who continued to receive ventricular fibrillation-terminating implantable cardioverter-defibrillator shocks after LCSD, there was a correlation between their disability scores and the number of reported shocks (Spearman correlation = 0.56). The majority of patients/parents reported that they were very or somewhat satisfied with their surgery (or their child's surgery) and would definitely or probably recommend LCSD to another patient. CONCLUSION Despite the anticipated side effects associated with LCSD, patients are satisfied with their surgery and indicate that they would recommend the surgery to another patient.
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Affiliation(s)
- Ryan M Antiel
- Department of General Surgery, Division of Pediatric Surgery
| | - J Martijn Bos
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology; Department of Medicine, Division of Cardiovascular Diseases; Department of Molecular Pharmacology and Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory
| | | | - Heidi J Owen
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology
| | - Penny L Roskos
- Department of General Surgery, Division of Pediatric Surgery
| | | | - Michael J Ackerman
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology; Department of Medicine, Division of Cardiovascular Diseases; Department of Molecular Pharmacology and Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory,.
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VERKERK AGNESJ, VERMEER ALEXAM, SMETS ELLENM, DEKKER LUKASR, WILDE ARTHURA, VAN LANGEN IRENEM, CHRISTIAANS IMKE, NIEUWKERK PYTHIAT. Quality of Life in Young Adult Patients with a Cardiogenetic Condition Receiving an ICD for Primary Prevention of Sudden Cardiac Death. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:870-7. [DOI: 10.1111/pace.12649] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 03/03/2015] [Accepted: 04/12/2015] [Indexed: 11/30/2022]
Affiliation(s)
- AGNES J. VERKERK
- Department of Clinical and Experimental Cardiology, Heart Centre AMC; Academic Medical Center; Amsterdam the Netherlands
| | - ALEXA M. VERMEER
- Department of Clinical Genetics; Academic Medical Center; Amsterdam the Netherlands
| | - ELLEN M. SMETS
- Department of Medical Psychology; Academic Medical Center; Amsterdam the Netherlands
| | - LUKAS R. DEKKER
- Department of Cardiology; Catharina Hospital; Eindhoven the Netherlands
| | - ARTHUR A. WILDE
- Department of Clinical and Experimental Cardiology, Heart Centre AMC; Academic Medical Center; Amsterdam the Netherlands
| | - IRENE M. VAN LANGEN
- Department of Clinical Genetics; University Medical Center Groningen; Groningen the Netherlands
| | - IMKE CHRISTIAANS
- Department of Clinical Genetics; Academic Medical Center; Amsterdam the Netherlands
| | - PYTHIA T. NIEUWKERK
- Department of Medical Psychology; Academic Medical Center; Amsterdam the Netherlands
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Abstract
Implantable cardioverter-defibrillators (ICD) have become an integral component in the management of children with life-threatening cardiac arrhythmias complicating a variety of different inherited and congenital cardiovascular conditions. Implantation often requires novel approaches and configurations to overcome the size and anatomic limitations posed by many children needing ICDs. While their use has undoubtedly saved many lives, ICD use may be associated with significant morbidity, so detailed case selection and individualised postimplant programming is critical.
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Affiliation(s)
- Elizabeth S DeWitt
- Division of Cardiac Electrophysiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Dominic J Abrams
- Division of Cardiac Electrophysiology, Boston Children's Hospital, Boston, Massachusetts, USA
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42
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DeWitt ES, Triedman JK, Cecchin F, Mah DY, Abrams DJ, Walsh EP, Gauvreau K, Alexander ME. Time dependence of risks and benefits in pediatric primary prevention implantable cardioverter-defibrillator therapy. Circ Arrhythm Electrophysiol 2014; 7:1057-63. [PMID: 25262116 DOI: 10.1161/circep.114.001569] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICDs) used to prevent sudden cardiac arrest in children not only provide appropriate therapy in 25% of patients but also result in a significant incidence of inappropriate shocks and other device complications. ICDs placed for secondary prevention have higher rates of appropriate therapy than those placed for primary prevention. Pediatric patients with primary prevention ICDs were studied to determine time-dependent incidence of appropriate use and adverse events. METHODS AND RESULTS A total of 140 patients aged <21 years (median age, 15 years) at first ICD implantation at Boston Children's Hospital (2000-2009) in whom devices were placed for primary prevention were retrospectively identified. Demographics and times to first appropriate shock; adverse events (including inappropriate shock, lead failure, reintervention, and complication); generator replacement and follow-up were noted. During mean follow-up of 4 years, appropriate shock occurred in 19% patients and first adverse event (excluding death/transplant) occurred in 36%. Risk of death or transplant was ≈1% per year and was not related to receiving appropriate therapy. Conditional survival analysis showed rates of appropriate therapy and adverse events decrease soon after implantation, but adverse events are more frequent than appropriate therapy throughout follow-up. CONCLUSIONS Primary prevention ICDs were associated with appropriate therapy in 19% and adverse event in 36% in this cohort. The incidence of both first appropriate therapy and device-related adverse events decreased during longer periods of follow-up after implantation. This suggests that indications for continued device therapy in pediatric primary prevention ICD patients might be reconsidered after a period of nonuse.
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Affiliation(s)
- Elizabeth S DeWitt
- From the Department of Cardiology (E.S.D., K.G., J.K.T., F.C., D.Y.M., D.J.A., E.P.W., M.E.A.) and Arrhythmia Service (J.K.T., F.C., D.Y.M., D.J.A., E.P.W., M.E.A.), Boston Children's Hospital, MA; and Department of Pediatrics, Harvard Medical School, Boston, MA (E.S.D., K.G., J.K.T., F.C., D.Y.M., D.J.A., E.P.W., M.E.A.)
| | - John K Triedman
- From the Department of Cardiology (E.S.D., K.G., J.K.T., F.C., D.Y.M., D.J.A., E.P.W., M.E.A.) and Arrhythmia Service (J.K.T., F.C., D.Y.M., D.J.A., E.P.W., M.E.A.), Boston Children's Hospital, MA; and Department of Pediatrics, Harvard Medical School, Boston, MA (E.S.D., K.G., J.K.T., F.C., D.Y.M., D.J.A., E.P.W., M.E.A.)
| | - Frank Cecchin
- From the Department of Cardiology (E.S.D., K.G., J.K.T., F.C., D.Y.M., D.J.A., E.P.W., M.E.A.) and Arrhythmia Service (J.K.T., F.C., D.Y.M., D.J.A., E.P.W., M.E.A.), Boston Children's Hospital, MA; and Department of Pediatrics, Harvard Medical School, Boston, MA (E.S.D., K.G., J.K.T., F.C., D.Y.M., D.J.A., E.P.W., M.E.A.)
| | - Doug Y Mah
- From the Department of Cardiology (E.S.D., K.G., J.K.T., F.C., D.Y.M., D.J.A., E.P.W., M.E.A.) and Arrhythmia Service (J.K.T., F.C., D.Y.M., D.J.A., E.P.W., M.E.A.), Boston Children's Hospital, MA; and Department of Pediatrics, Harvard Medical School, Boston, MA (E.S.D., K.G., J.K.T., F.C., D.Y.M., D.J.A., E.P.W., M.E.A.)
| | - Dominic J Abrams
- From the Department of Cardiology (E.S.D., K.G., J.K.T., F.C., D.Y.M., D.J.A., E.P.W., M.E.A.) and Arrhythmia Service (J.K.T., F.C., D.Y.M., D.J.A., E.P.W., M.E.A.), Boston Children's Hospital, MA; and Department of Pediatrics, Harvard Medical School, Boston, MA (E.S.D., K.G., J.K.T., F.C., D.Y.M., D.J.A., E.P.W., M.E.A.)
| | - Edward P Walsh
- From the Department of Cardiology (E.S.D., K.G., J.K.T., F.C., D.Y.M., D.J.A., E.P.W., M.E.A.) and Arrhythmia Service (J.K.T., F.C., D.Y.M., D.J.A., E.P.W., M.E.A.), Boston Children's Hospital, MA; and Department of Pediatrics, Harvard Medical School, Boston, MA (E.S.D., K.G., J.K.T., F.C., D.Y.M., D.J.A., E.P.W., M.E.A.)
| | - Kimberlee Gauvreau
- From the Department of Cardiology (E.S.D., K.G., J.K.T., F.C., D.Y.M., D.J.A., E.P.W., M.E.A.) and Arrhythmia Service (J.K.T., F.C., D.Y.M., D.J.A., E.P.W., M.E.A.), Boston Children's Hospital, MA; and Department of Pediatrics, Harvard Medical School, Boston, MA (E.S.D., K.G., J.K.T., F.C., D.Y.M., D.J.A., E.P.W., M.E.A.)
| | - Mark E Alexander
- From the Department of Cardiology (E.S.D., K.G., J.K.T., F.C., D.Y.M., D.J.A., E.P.W., M.E.A.) and Arrhythmia Service (J.K.T., F.C., D.Y.M., D.J.A., E.P.W., M.E.A.), Boston Children's Hospital, MA; and Department of Pediatrics, Harvard Medical School, Boston, MA (E.S.D., K.G., J.K.T., F.C., D.Y.M., D.J.A., E.P.W., M.E.A.).
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