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A portable primary-standard level graphite calorimeter for absolute dosimetry in clinical pencil beam scanning proton beams. Phys Med Biol 2023; 68:175005. [PMID: 37414003 DOI: 10.1088/1361-6560/ace50f] [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: 12/06/2022] [Accepted: 07/06/2023] [Indexed: 07/08/2023]
Abstract
Objective. To report the use of a portable primary standard level graphite calorimeter for direct dose determination in clinical pencil beam scanning proton beams, which forms part of the recommendations of the proposed Institute of Physics and Engineering in Medicine (IPEM) Code of Practice (CoP) for proton therapy dosimetry.Approach. The primary standard proton calorimeter (PSPC) was developed at the National Physical Laboratory (NPL) and measurements were performed at four clinical proton therapy facilities that use pencil beam scanning for beam delivery. Correction factors for the presence of impurities and vacuum gaps were calculated and applied, as well as dose conversion factors to obtain dose to water. Measurements were performed in the middle of 10 × 10 × 10 cm3homogeneous dose volumes, centred at 10.0, 15.0 and 25.0 g·cm-2depth in water. The absorbed dose to water determined with the calorimeter was compared to the dose obtained using PTW Roos-type ionisation chambers calibrated in terms of absorbed dose to water in60Co applying the recommendations in the IAEA TRS-398 CoP.Main results.The relative dose difference between the two protocols varied between 0.4% and 2.1% depending on the facility. The reported overall uncertainty in the determination of absorbed dose to water using the calorimeter is 0.9% (k= 1), which corresponds to a significant reduction of uncertainty in comparison with the TRS-398 CoP (currently with an uncertainty equal or larger than 2.0% (k= 1) for proton beams).Significance. The establishment of a purpose-built primary standard and associated CoP will considerably reduce the uncertainty of the absorbed dose to water determination and ensure improved accuracy and consistency in the dose delivered to patients treated with proton therapy and bring proton reference dosimetry uncertainty in line with megavoltage photon radiotherapy.
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ECG-I Phenotyping of Persistent AF Based on Driver Burden and Distribution to Predict Response to Pulmonary Vein Isolation (PHENOTYPE-AF). J Cardiovasc Electrophysiol 2022; 33:2263-2273. [PMID: 35924481 DOI: 10.1111/jce.15644] [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] [Received: 05/21/2022] [Revised: 06/26/2022] [Accepted: 07/18/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND This prospective trial sought to phenotype persistent AF based on AF mechanisms using ECGI mapping to determine whether this would predict long term freedom from arrhythmia after pulmonary vein isolation (PVI). METHODS Patients with persistent AF of < 2 years duration underwent cryoballoon PVI. ECGI mapping was performed prior to PVI to determine potential drivers (PDs) defined as rotational activations completing ≥ 1.5 revolutions or focal activations. The co-primary end point was the association between (1) PD burden (defined as the number of PD occurrences) and (2) PD distribution (defined as the number of segments on an 18 segment model of the atria harbouring PDs) with freedom from arrhythmia at 1 year follow up. RESULTS Of 100 patients, 97 completed follow up and 52 (53.6%) remained in sinus rhythm off antiarrhythmic drugs. Neither PD burden nor PD distribution predicted freedom from arrhythmia (HR 1.01, 95% CI 0.99 - 1.03, p = 0.164; and HR 1.04, 95% CI 0.91 - 1.17, p = 0.591 respectively). Otherwise, the burden of rotational PDs, rotational stability, and the burden of PDs occurring at the pulmonary veins and posterior wall all failed to predict arrhythmia recurrence (all p > 0.10). CONCLUSIONS AF mechanisms as determined using ECGI mapping do not predict outcome after PVI for persistent AF. Further studies using different methodologies to characterise AF mechanisms are warranted. (NCT03394404) This article is protected by copyright. All rights reserved.
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O083 A proof of principle study of cell targeted delivery of sirna guided by innate repair receptor epor/βcr highly expressed by injured tubular epithelial cells in porcine kidneys subjected to extended cold ischaemia times. Br J Surg 2022. [DOI: 10.1093/bjs/znac242.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Introduction
Small interfering RNA (siRNA) has been used in biological models for disease modification. Whilst challenges remain with targeted cell delivery, caspase-3, an executing enzyme of apoptosis and inflammation, plays a crucial role in acute kidney injury. Using caspase-3 siRNA or erythropoietin derived peptide CHBP, we have demonstrated renoprotection against ischaemia-reperfusion injury in isolated kidney preservation, and further applied the conjugate of both.
Methods
Porcine kidneys (n = 3) subjected to 10 minutes of warm ischemia were retrieved and perfused with 500 mL hyperosmolar citrate. In comparison with the control (Kidney 1) caspase-3 siRNAHBSP (Kidney 2) or CHBP (Kidney 3) conjugate was administered into the kidney and autologous blood and stored for 22 hours in ice. Organs were then preserved by normothermic perfusion (NP) for 3 hours using clinical-grade cardiopulmonary bypass. Functional parameters were recorded, and kidney biopsies were taken at time zero (pre-perfusion) and hourly intervals following NP.
Results
Preliminary findings showed increased arterial flow rate and urine output together with neutralised perfusate pH in the kidneys (2 and 3) receiving both conjugates compared to the control.
Conclusion
Improved physiological outcomes in kidneys subjected to the novel agent treatment suggest protective effects against ischaemia. We hypothesise outcomes should be transferrable to human kidneys, which may facilitate the use of marginal kidneys following prolonged ischaemia, otherwise deemed unsuitable for transplantation. Renal histological and molecular studies of the effect of the agent are underway.
Take-home message
Despite a small sample, this pilot proof of principle study suggests that caspase-3 inhibitors may have a role in limiting the detrimental effects of ischaemia on renal tissues subjected to prolonged cold ischaemic times. It is hoped that this may be beneficial if replicated in the human kidney model at increasing the deceased donor organ pool by enabling use of marginal kidneys subjected to prolonged ischaemic times.
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PD-0167 Acute, late toxicities & early outcomes in children after proton therapy for head & neck malignancy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02772-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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ERRATUM. J Cardiovasc Electrophysiol 2022; 33:567. [PMID: 35166413 DOI: 10.1111/jce.15312] [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: 11/28/2022]
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Effect of Antibiotic Therapy on Immunotherapy Outcomes for Non-Small Cell Lung Cancer: Analysis From the Veterans Health Administration. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.10.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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P53.08 Concomitant Fibrates and Immunotherapy in Non-Small Cell Lung Cancer Patients in the Veterans Health Administration. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Klebsiella pneumoniae ST307 with OXA-181: threat of a high-risk clone and promiscuous plasmid in a resource-constrained healthcare setting. J Antimicrob Chemother 2021; 75:896-902. [PMID: 31953941 DOI: 10.1093/jac/dkz550] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/27/2019] [Accepted: 12/09/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Klebsiella pneumoniae with OXA-48-like enzymes were introduced into Tshwane Tertiary Hospital (TTH) (Pretoria, South Africa) during September 2015, causing nosocomial outbreaks. METHODS PCR methodologies and WGS were used to characterize K. pneumoniae with carbapenemases (n = 124) from TTH (July 2015-December 2016). RESULTS PCR was used to track K. pneumoniae ST307 with OXA-181 among 60% of carbapenemase-positive isolates in different wards/units over time and showed the transmission of IncX3 plasmids to other K. pneumoniae clones. WGS identified different ST307 clades: 307_OXA181 (consisting of two lineages, A and B) with OXA-181 on IncX3 plasmids (named p72_X3_OXA181) and clade 307_VIM with VIM-1 on IncFII plasmids. Clade 307_OXA181 lineage B was responsible for the rapid increase and transmission of OXA-181 K. pneumoniae in various wards/units throughout TTH, while the numbers of clade 307_OXA181 lineage A and clade 307_VIM remained low. Separate outbreaks were due to K. pneumoniae ST17 and ST29 with p72_X3_OXA181 plasmids. CONCLUSIONS The high-risk clone K. pneumoniae ST307 with OXA-181 rapidly spread to different wards/units despite infection and prevention measures. ST307 clades and lineages seemingly acted differently in outbreak situations. This study also highlighted the threat of promiscuous plasmids such as p72_X3_OXA181.
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Skin Toxicity Profile of Photon Radiotherapy versus Proton Beam Therapy in Paediatric and Young Adult Patients with Sarcomas. Clin Oncol (R Coll Radiol) 2021; 33:507-516. [PMID: 33820695 DOI: 10.1016/j.clon.2021.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/28/2021] [Accepted: 03/12/2021] [Indexed: 12/17/2022]
Abstract
AIMS Radiotherapy is key in the management of patients with both Ewing sarcoma and rhabdomyosarcoma. However, there is little evidence in the literature with regards to radiation-induced skin toxicities (RISTs) for patients treated with conventional radiotherapy with X-rays (XRT) or proton beam therapy (PBT) for these two conditions. In the present study we evaluated acute and late RIST in patients treated within European protocols with either PBT or XRT, taking both clinical and dosimetric variables into consideration. MATERIALS AND METHODS This was a retrospective analysis of 79 paediatric/young adult patients treated with radical radiotherapy (with XRT or PBT) and concurrent chemotherapy. In all cases, radiotherapy was given in conventional fractionation (1.8 Gy/fraction). Acute and late RISTs were registered according to the Radiation Therapy Oncology Group (RTOG) scoring system. RESULTS With regards to acute RIST, 47.9% (23/48) of XRT patients and 48.4% (15/31) of PBT patients had acute grade 2/3 toxicity. When it comes to late RIST, 17.5% (7/40 with known toxicity profile) of XRT patients and 29.0% (9/31) of PBT patients had grade 1/2 toxicity. This difference of -11.5% (95% confidence interval -31.2 to 7.9%) in grade 1/2 toxicity between XRT and PBT was not statistically significant (P = 0.25). Regardless of the radiotherapy technique, V30Gy seems a good predictor of acute RIST. Moreover, for the same value of V30Gy, patients who receive PBT may have a higher risk of moderate-severe acute RIST. Perhaps due to the small sample, definitive conclusions on the predictive factors of late RIST could not be drawn. CONCLUSIONS No clinically meaningful differences in acute and late RIST were observed between PBT and XRT subgroups. Systematic differences in the modelling of the build-up region may exist between XRT and PBT algorithms, which could make the comparison of dose metrics between techniques potentially biased. A more comprehensive analysis of dosimetric data on larger patient cohorts is needed to elucidate the most relevant skin dose metrics. Dose-effect models of RIST for this unique patient population would be an invaluable tool in radiotherapy plan optimisation.
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Long-term outcomes of index cryoballoon ablation or point-by-point radiofrequency ablation in patients with atrial fibrillation and systolic heart failure. J Cardiovasc Electrophysiol 2021; 32:941-948. [PMID: 33527562 DOI: 10.1111/jce.14923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/29/2020] [Accepted: 01/20/2021] [Indexed: 11/29/2022]
Abstract
Catheter ablation is an established effective approach for the treatment of atrial fibrillation (AF) in patients with heart failure, however, the role of cryoablation in this setting is unclear. Procedural success and left ventricular systolic dysfunction (LVEF) improvement in patients with LVEF ≤ 45% undergoing index catheter ablation with cryoablation were evaluated. Freedom from AF recurrence was seen in 43% rising to 59% following repeat procedure. There were significant improvements in LVEF and functional status at long-term follow-up. Results were comparable to a contemporaneous cohort of heart failure patients undergoing index ablation with radiofrequency ablation. Cryoablation is an effective first-line AF ablation approach in the setting of heart failure.
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The association between labour epidural case volume and the rate of accidental dural puncture. Anaesthesia 2021; 76:1060-1067. [PMID: 33492698 DOI: 10.1111/anae.15370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 01/01/2023]
Abstract
Accidental dural puncture is a recognised complication of labour epidural placement and can cause a debilitating headache. We examined the association between labour epidural case volume and accidental dural puncture rate in specialist anaesthetists and anaesthesia trainees. We performed a retrospective cohort study of labour epidural and combined spinal-epidural nerve blocks performed between 1 July 2013 and 31 December 2017 at Waitemata District Health Board, Auckland, New Zealand. The mean (SD) annual number of obstetric epidural and combined spinal-epidural procedures for high-case volume specialists was 44.2 (15.0), and for low-case volume specialists was 10.0 (6.8), after accounting for caesarean section combined spinal-epidural procedures. Analysis of 7976 labour epidural and combined spinal-epidural procedure records revealed a total of 92 accidental dural punctures (1.2%). The accidental dural puncture rate (95%CI) in high-case volume specialists was 0.6% (0.4-0.9%) and in low-case volume specialists 2.4% (1.4-3.9%), indicating probable skill decay. The odds of accidental dural puncture were 3.77 times higher for low- compared with high-case volume specialists (95%CI 1.72-8.28, p = 0.001). Amongst trainees, novices had a significantly higher accidental dural puncture complication rate (3.1%) compared with registrars (1.2%), OR (95%CI) 0.39 (0.18-0.84), p = 0.016, or fellows (1.1%), 0.35 (0.16-0.76), p = 0.008. Accidental dural puncture complication rates decreased once trainees progressed past the 'novice' training stage.
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SP-0748: The worst-case scenario survival guide: uncertainties in proton therapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00770-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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PO-1832: Assessment of set up accuracy using an evacuated cushion for Proton Beam Therapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01850-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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PO-1810: Determining the boundaries of the FLASH effect. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01828-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Comparing Proton to Photon Radiotherapy Plans: UK Consensus Guidance for Reporting Under Uncertainty for Clinical Trials. Clin Oncol (R Coll Radiol) 2020; 32:459-466. [PMID: 32307206 DOI: 10.1016/j.clon.2020.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/11/2020] [Accepted: 03/30/2020] [Indexed: 12/11/2022]
Abstract
In the UK, the recent introduction of high-energy proton beam therapy into national clinical practice provides an opportunity for new clinical trials, particularly those comparing proton and photon treatments. However, comparing these different modalities can present many challenges. Although protons may confer an advantage in terms of reduced normal tissue dose, they can also be more sensitive to uncertainty. Uncertainty analysis is fundamental in ensuring that proton plans are both safe and effective in the event of unavoidable discrepancies, such as variations in patient setup and proton beam range. Methods of evaluating and mitigating the effect of these uncertainties can differ from those approaches established for photon therapy treatments, such as the use of expansion margins to assure safety. These differences should be considered when comparing protons and photons. An overview of the effect of uncertainties on proton plans is presented together with an introduction to some of the concepts and terms that should become familiar to those involved in proton therapy trials. This report aims to provide guidance for those engaged in UK clinical trials comparing protons and photons. This guidance is intended to take a pragmatic approach considering the tools that are available to practising centres and represents a consensus across multidisciplinary groups involved in proton therapy in the UK.
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Predictors of mental health and academic outcomes in first-year university students: Identifying prevention and early-intervention targets. BJPsych Open 2020; 6:e46. [PMID: 32381150 PMCID: PMC7331085 DOI: 10.1192/bjo.2020.24] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Although there is growing interest in mental health problems in university students there is limited understanding of the scope of need and determinants to inform intervention efforts. AIMS To longitudinally examine the extent and persistence of mental health symptoms and the importance of psychosocial and lifestyle factors for student mental health and academic outcomes. METHOD Undergraduates at a Canadian university were invited to complete electronic surveys at entry and completion of their first year. The baseline survey measured important distal and proximal risk factors and the follow-up assessed mental health and well-being. Surveys were linked to academic grades. Multivariable models of risk factors and mental health and academic outcomes were fit and adjusted for confounders. RESULTS In 1530 students surveyed at entry to university 28% and 33% screened positive for clinically significant depressive and anxiety symptoms respectively, which increased to 36% and 39% at the completion of first year. Over the academic year, 14% of students reported suicidal thoughts and 1.6% suicide attempts. Moreover, there was persistence and overlap in these mental health outcomes. Modifiable psychosocial and lifestyle factors at entry were associated with positive screens for mental health outcomes at completion of first year, while anxiety and depressive symptoms were associated with lower grades and university well-being. CONCLUSIONS Clinically significant mental health symptoms are common and persistent among first-year university students and have a negative impact on academic performance and well-being. A comprehensive mental health strategy that includes a whole university approach to prevention and targeted early-intervention measures and associated research is justified.
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Initial experience with the convergent procedure for longstanding persistent atrial fibrillation: A 5 year dataset. Data Brief 2020; 30:105417. [PMID: 32258280 PMCID: PMC7118295 DOI: 10.1016/j.dib.2020.105417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/03/2020] [Accepted: 03/05/2020] [Indexed: 12/02/2022] Open
Abstract
In patients with longstanding persistent atrial fibrillation (AF), outcomes from catheter ablation remain suboptimal. The convergent procedure combines minimally invasive surgical ablation with subsequent catheter ablation, and may contribute towards maintenance of sinus rhythm in this patient group. We performed the convergent procedure on 43 patients with longstanding persistent AF from 2013–2018. Patients underwent clinical review at 3, 6, and 12 months and thereafter as necessitated by their symptoms. Our dataset describes patients’ baseline characteristics and rhythm control protocols, as well as outcomes including arrhythmia recurrence, the need for antiarrhythmic drugs, requirement for repeat rhythm control procedures, and complications. These data provide a real world insight into the risks and benefits of the convergent procedure in patients with longstanding persistent AF.
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The convergent procedure versus catheter ablation alone in longstanding persistent atrial fibrillation: A single centre, propensity-matched cohort study. Int J Cardiol 2020; 303:49-53. [DOI: 10.1016/j.ijcard.2019.10.053] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/15/2019] [Accepted: 10/31/2019] [Indexed: 12/11/2022]
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Documenting the Value of Librarians in the Classroom: Results from a Mixed-Methods Research Collaboration with Campus Partners. COLLEGE & RESEARCH LIBRARIES 2020. [DOI: 10.5860/crl.81.3.492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cross-cultural Convergent Validation of the Spanish and English Versions of the Personal Impact of Epilepsy Scale (PIES) in a Cohort of Patients from a Level IV Epilepsy Center in South Florida. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz029.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
To provide further convergent validity on the Personal Impact of Epilepsy Scale (PIES) Spanish version for use in Hispanics with epilepsy.
Participants and Method
This study included 90 patients (22 Hispanic and Spanish speaking - HSS, 30 Hispanic and English speaking – HES, and 38 non-Hispanic and English speaking – NHES) who were diagnosed with epilepsy and referred by their epileptologist for a comprehensive neuropsychological evaluation that, in addition to cognitive measures, also included the Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI), and PIES in English or Spanish- depending on the participant’s primary language. The PIES was created with subscales to measure the effect of seizures, adverse effects of treatment, and comorbidities such as mood disorders on quality of life. We compared scores on the PIES subscales in English and Spanish to determine equivalence. We further examined if language of administration moderated the relationship between PIES subscale scores and depression/anxiety through nonparametric bootstrapping.
Results
There were no significant demographic or clinical differences between the 3 groups examined. ANOVA contrast of mean scores on all PIES subscales between HSS, HES and NHES groups did not reach significance (Seizures F [2,88] = .06 , p = -.93; Medication use F[2,88] = 1.95, p = .14, Comorbidity F[2,88] = .64, p = .52, and total PIES F[2,88] = .19, p = .83). The relationships between PIES and BDI-II/BAI scores were not significantly moderated by language of administration.
Conclusions
Our data suggest clinical equivalency between the English and Spanish versions of the PIES. Furthermore, the relationships between PIES subscales and the BDI-II/BAI were not significantly changed by language of administration. These findings indicate that the Spanish PIES appears to have good convergent validity with the original English version and can be useful in the assessment of quality of life in HSS patients.
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Intellectual, Psychological, and Clinical Predictors of Quality of Life in Patients with Epilepsy from a Level IV Epilepsy Center in South Florida. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz029.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
To examine clinical, cognitive, and psychological predictors of Quality of Life (QOL) among Hispanics and non-Hispanics with epilepsy.
Participants and Method
Data was collected from 90 patients (52 Hispanic; H, 38 Non-Hispanic; NH) diagnosed with epilepsy and referred for neuropsychological evaluation that included measures of depression (BDI-II), anxiety (BAI), and QOL using the Personal Impact of Epilepsy Scale (PIES). We conducted multiple linear regression models with patient’s full-scale IQ, age of seizure onset, duration of seizure disorder, and anxiety and depression symptom severity entered as predictors, with the PIES as outcome measure.
Results
There were no significant differences between H and NH on any demographic or clinical variable except for longer duration of seizure disorder (t = 2.20, p = 0.03) in H. For the complete sample, higher FSIQ predicted better QOL in relation to the perceived disabling effects of seizures (β = .28, p =.02), higher BDI-II scores predicted more negative medication side effects and greater mood related disruption in QOL (β = -2.27, p =.03; β = -3.82, p =.00), and higher BAI scores were the best predictor for worse overall QOL (β = -.29, p = .05). When the sample was divided according to ethnic background, longer seizure duration was associated with the adverse effects of less medication in the H group (β = .32, p =.04), with all other findings being identical to those of the complete sample. When results for NH patients were analyzed, none of the intellectual, psychological and clinical variables were significantly associated with any of the QOL scales; however, the relationship between the BAI and comorbid mood dysfunction approached significance (β = -1.45, p = .059).
Conclusions
Our data indicates that overall QOL was primarily predicted by the severity of anxiety symptoms, but not influenced by overall intelligence, symptoms of depression, and clinical seizure variables.
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206 Social Factors That Influence Frequent Utilization of the Emergency Department for Adults Presenting to an Urban Emergency Department With Suicidal Ideation. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ninety years of change on a low wooded island, Great Barrier Reef. ROYAL SOCIETY OPEN SCIENCE 2019; 6:181314. [PMID: 31312467 PMCID: PMC6599766 DOI: 10.1098/rsos.181314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 05/09/2019] [Indexed: 06/10/2023]
Abstract
We assess 90 years of change on a Low Wooded Island (Low Isles, Great Barrier Reef), employing drones and topographic profiling to accurately survey ramparts, mangroves, the reef flat and the sand cay. A comparison with maps from the 1928-1929 Great Barrier Reef Expedition revealed the redistribution of an outer rampart and inward movement of shingle ridges. Remarkable lateral expansion of the mangrove woodland some 400 m has occurred as carbonate sand deposition has increased reef flat elevation, obscuring coral microatolls. The sand cay has stayed relatively constant in size, moving approximately 44 m in a northeasterly direction and rotating slightly. We conclude that the existing configuration of landforms probably represents an equilibrium with local biophysical conditions, including sea level, wave dynamics, vegetation growth, storms and cyclones. The variable nature of ramparts and the presence of a trough that prevents the continuous spread of mangroves across a uniformly flat colonization surface precludes the interpretation of landform changes with respect to a geomorphic evolutionary sequence. Moreover, longer-term implications of environmental change for these landforms can only be evaluated once the specific nature of the local carbonate budget, including the relative contribution of corals, foraminifera and Halimeda has been elucidated.
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Sexually transmitted infection testing and rates in men who have sex with men (
MSM
) using
HIV
pre‐exposure prophylaxis. HIV Med 2019; 20:e12. [DOI: 10.1111/hiv.12736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Advances in management of electrophysiology and atrial fibrillation in the cardiac catheter laboratory: implications for anaesthesia. BJA Educ 2018; 18:349-356. [PMID: 33456801 DOI: 10.1016/j.bjae.2018.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2018] [Indexed: 01/24/2023] Open
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P5773Atrial fibrillation catheter ablation in patients with hypertrophic cardiomyopathy: multi-centre experience and application of HCM-Risk SCD score to predict ablation outcome. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5773] [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: 11/12/2022] Open
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Impact of attributed audit on procedural performance in cardiac electrophysiology catheter laboratory. J Interv Card Electrophysiol 2018; 56:199-203. [PMID: 29858762 DOI: 10.1007/s10840-018-0383-6] [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] [Received: 01/31/2018] [Accepted: 05/15/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE Audit has played a key role in monitoring and improving clinical practice. However, audit often fails to drive change as summative institutional data alone may be insufficient to do so. We hypothesised that the practice of attributed audit, wherein each individual's procedural performance is presented will have a greater impact on clinical practice. This hypothesis was tested in an observational study evaluating improvement in fluoroscopy times for AF ablation. METHODS Retrospective analyses of fluoroscopy times in AF ablations at the Barts Heart Centre (BHC) from 2012-2017. Fluoroscopy times were compared pre- and post- the introduction of attributed audit in 2012 at St Bartholomew's Hospital (SBH). In order to test the hypothesis, this concept was introduced to a second group of experienced operators from the Heart Hospital (HH) as part of a merger of the two institutions in 2015 and change in fluoroscopy times recorded. RESULTS A significant drop in fluoroscopy times (33.3 ± 9.14 to 8.95 ± 2.50, p < 0.0001) from 2012-2014 was noted after the introduction of attributed audit. At the time of merger, a significant difference in fluoroscopy times between operators from the two centres was seen in 2015. Each operator's procedural performance was shared openly at the audit meeting. Subsequent audits showed a steady decrease in fluoroscopy times for each operator with the fluoroscopy time (min, mean±SD) decreasing from 13.29 ± 7.3 in 2015 to 8.84 ± 4.8 (p < 0.0001) in 2017 across the entire group. CONCLUSIONS Systematic improvement in fluoroscopy times for AF ablation procedures was noted byevaluating individual operators' performance. Attributing data to physicians in attributed audit can promptsignificant improvement and hence should be adopted in clinical practice.
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414 A fitst-in-human study of BLZ-100 (tozuleristide) demonstrates tolerability and fluorescence contrast in skin cancer. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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The Boolean is Dead, Long Live the Boolean! Natural Language versus Boolean Searching in Introductory Undergraduate Instruction. COLLEGE & RESEARCH LIBRARIES 2018. [DOI: 10.5860/crl.79.4.517] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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47Radiofrequency balloon catheter ablation for paroxysmal atrial fibrillation, RADIANCE STUDY–a UK experience. Europace 2017. [DOI: 10.1093/europace/eux283.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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44Early experience of intra-operative use of ECGI during VT ablation. Europace 2017. [DOI: 10.1093/europace/eux283.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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55Impact of open audit on procedural performance in electrophysiology catheter laboratory. Europace 2017. [DOI: 10.1093/europace/eux283.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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48Catheter ablation for atrial fibrillation on uninterrupted NOACs: a safe approach? Europace 2017. [DOI: 10.1093/europace/eux283.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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95Fluoroscopy times in electrophysiology and device procedures: impact of single frame location fluoroscopy. Europace 2017. [DOI: 10.1093/europace/eux283.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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45Atrial tachyarrhythmia ablation in lateral tunnel fontan patients: a case series. Europace 2017. [DOI: 10.1093/europace/eux283.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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24Long-term outcomes of supraventricular tachycardia ablation in congenital heart disease: single centre UK experience. Europace 2017. [DOI: 10.1093/europace/eux283.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23Empiric versus entrained cavotricuspid isthmus line ablation in congenital heart disease: a single centre experience. Europace 2017. [DOI: 10.1093/europace/eux283.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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2A multi-centre study into the use of Ripple Mapping to differentiate atrial scar from conducting tissue during tachycardia ablation. Europace 2017. [DOI: 10.1093/europace/eux283.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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239Long-Term follow-up of thromboembolic complications in left ventricular endocardial pacing: outcomes from a multi centre uk registry. Europace 2017. [DOI: 10.1093/ehjci/eux139.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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P1726Catheter ablation for atrial fibrillation on uninterrupted NOACs: a safe approach? Europace 2017. [DOI: 10.1093/ehjci/eux161.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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P1569Long-term survival in patients undergoing cardiac resynchronization therapy: the importance of an age-adjusted comorbidity index. Europace 2017. [DOI: 10.1093/ehjci/eux158.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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P1550Predictive role of Rhesus status and blood group for death/transplant in patients undergoing cardiac resynchronization therapy (CRT). Europace 2017. [DOI: 10.1093/ehjci/eux158.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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P1564Full blood count parameters predict long-term outcomes in heart failure patients undergoing cardiac resynchronization therapy. Europace 2017. [DOI: 10.1093/ehjci/eux158.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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P1470Retrograde aortic access of the pulmonary venous atrium provides equivalent outcomes to right atrial or transeptal access of the left atrium in patients with congenital heart disease. Europace 2017. [DOI: 10.1093/ehjci/eux158.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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P1465A single centre experience of empiric versus entrained cavotricuspid isthmus line ablation in congenital heart disease. Europace 2017. [DOI: 10.1093/ehjci/eux158.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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P962Trends in ICD and CRT-D lead parameters for patients with ARVC and DCM. Europace 2017. [DOI: 10.1093/ehjci/eux151.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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1166Long-term outcomes of supraventricular tachycardia ablation in congenital heart disease: single centre uk experience. Europace 2017. [DOI: 10.1093/ehjci/eux153.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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041 Regulatory T cells drive stem cell differentiation during skin barrier repair. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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POSTERS (1)59MULTIPOLAR CONTACT MAPPING GUIDED ABLATION OF TEMPORALLY STABLE HIGH FREQUENCY AND COMPLEX FRACTIONATED ATRIAL ELECTROGRAM SITES IN PATIENTS WITH PERSISTENT ATRIAL FIBRILLATION60INTRA-CARDIAC AND PERIPHERAL LEVELS OF BIOCHEMICAL MARKERS OF FIBROSES IN PATIENTS UNDERGOING CATHETER ABLATION FOR ATRIAL FIBRILATION61THE DON'T WAIT TO ANTICOAGULATE PROJECT (DWAC) BY THE WEST OF ENGLAND ACADEMIC HEALTH SCIENCE NETWORK (AHSN) OPTIMISES STROKE PREVENTION FOR PATIENTS WITH ATRIAL FIBRILLATION (AF) WITHIN PRIMARY CARE IN LINE WITH NICE CG180 IN THE WEST OF ENGLAND62ILLNESS AND TREATMENT REPRESENTATIONS, COPING AND DISTRESS: VICIOUS CYCLES OF EVERYDAY EXPERIENCES IN PATIENTS WITH PERSISTENT ATRIAL FIBRILLATION63THE NEEDS OF THE ADOLESCENT LIVING WITH AN INHERITED CARDIAC CONDITION: THE PATIENTS' PERSPECTIVE64SAFETY AND EFFICACY OF PARAMEDIC TREATMENT OF REGULAR SUPRAVENTRICULAR TACHYCARDIA (PARA-SVT)65NATURAL PROGRESSION OF QRS DURATION FOLLOWING IMPLATABLE CARDIOVERTER DEFIBRILLATORS (ICD) - IMPLANTATION66COMPARISON OF EFFICACY OF VOLTAGE DIRECTED CAVOTRICUSPID ISTHMUS ABLATION USING MINI VS CONVENTIONAL ELETRODES67CRYOBALLOON ABLATION (CRYO) FOR ATRIAL FIBRILLATION (AF) CANNOT BE GUIDED BY TEMPERATURE END-POINTS ALONE68MODERATOR BAND ECTOPY UNMASKED BY ADENOSINE AS A CAUSE OF ECTOPIC TRIGGERED IDIOPATHIC VF69EARLY CLINICAL EXPERIENCE WITH TARGETED SITE SELECTION FOR THE WiCS-LV ELECTRODE FOR CRT70DOES VECTOR MAPPING PRIOR TO IMPLANTABLE LOOP RECORDER INSERTION IMPROVE THE DETECTION OF ARRHYTHMIA?71THE ROLE OF SPECKLE TRACKING STRAIN IMAGING IN ASSESSING LEFT VENTRICULAR RESPONSE TO CARDIAC RESYNCHRONISATION THERAPY IN RESPONDERS AND NON-RESPONDERS72EVALUATING PATIENTS' EXPERIENCE AND SATISFACTION OF THE ATRIAL FIBRILLATION ABLATION PROCEDURE: A RETROSPECTIVE ANALYSIS73TROUBLESHOOTING LV LEAD IMPLANTATION - NOVEL “UNIRAIL TECHNIQUE”74SUBCLINICAL ATHEROSCELEROSIS AND COGNITIVE IMPAIRMENT75EFFECT OF LOZARTANE ON DEVELOPMENT OF THE ELECTRICAL INSTABILITY OF THE MYOCARDIUM76THE INTERPLAY BETWEEN BODY COMPOSITION AND LEFT VENTRICULAR REMODELLING IN CARDIAC RESYNCHRONISATION THERAPY77FAMILY SCREENING IN IDIOPATHIC VENTRICULAR FIBRILLATION78MANAGEMENT OF ATRIAL FIBRILLATION IN A LARGE TEACHING HOSPITAL79THE EFFECT OF LEFT VENTRICULAR LEAD POSITION ON SURVIVAL IN PATIENTS WITH BINVENTRICULAR PACEMAKRS/DEFIBRILLATORS80ACUTE DEVICE IMPLANT-RELATED COMPLICATIONS DO NOT INCREASE LATE MORTALITY81ABORTED CARIDAC ARREST AS THE SENTINEL PRESENTATION IN A COHORT OF PATIENTS WITH THE CONCEALED BRUGADA PHENOTYPE82POST-CARDIAC DEVICE IMPLANTATION MOBILISATION ADVICE: A NATIONAL SURVEY83DO RISK SCORES DEVELOPED TO PROTECT ONE-YEAR MORTALITY ACTUALLY HELP IN ACCURATELY SELECTING PATIENTS RECEIVING PRIMARY PREVENTION ICD?84ATRIAL TACHYCARDIA ARISING FROM THE NON-CORONARY AORTIC CUSP85THE EFFECT OF DIFFERENT ATRIAL FIBRILLATION ABLATION STRATEGIES ON SURFACE ECG P WAVE DURATION86PRESCRIBING DRONEDARONE: HOW IS IT DONE ACROSS THE UK AND IS IT SAFE?87A CASE OF WIDE COMPLEX TACHYCARDIA88TRANSITION TO DEDICATED DAY CASE DEVICES - SAFETY AND EFFICACY IN A LARGE VOLUME CENTRE89SEQUENTIAL REGIONAL DOMINANT FREQUENCY MAPPING DURING ATRIAL FIBRILLATION: A NOVEL TEQUNIQUE90ELECTIVE CARDIOVERSION ENERGY PROTOCOLS: A RETROSPECTIVE COMPARISON OF ESCALATION STRATEGIES91THE INCIDENCE OF CLINCALLY RELEVANT HAEMATOMAS WITH PERIOPERATIVE USE OF NEWER P2Y12 INHIBITORS AND INTERRUPTED NOAC THERAPY IN CARDIAC IMPLANTABLE ELECTRONIC DEVICE INSERTION92AN AUDIT OF THE OUTCOMES FOR CHEMICAL AND DIRECT CURRENT CARDIOVERSION FOR ATRIAL FIBRILLATION AT OUR DGH OVER A 3 YEAR DURATION93REAL LIFE ACUTE MANAGEMET OF HAEMODYNAMICALLY TOLERATED MONOMORPHIC VENTRICULAR TACHYCARDIA. ARE WE MAKING EVIDENCE BASED ON DECISIONS?94A SERVICE EVALUATION TO ASSESS THE EFFICACY AND SAFETY OF NOVEL ORAL ANTICOAGULANTS VERSUS WARFARIN FOR ELECTIVE CARDIVERSION IN PATIENTS WITH NON VALVULAR AF IN A NURSE LED CARDIOVERSION SERVICE95PICK UP RATE OF IMPLANTED LOOP RECORDER AT A DISTRICT HOSPITAL. Europace 2016. [DOI: 10.1093/europace/euw273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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