Influencing factors and effectiveness of community follow-up in patients with cardiac implantable electronic device / 中华全科医师杂志

Objective:To explore the influencing factors and effectiveness of community follow-up in patients with cardiac implantable electronic device (CIED) implantation.Method:A total of 132 patients who received CIED implantation in the Department of Cardiology of Tongren Hospital, Shanghai Jiao Tong University School of Medicine from February 2021 to February 2022 were enrolled in this prospective cohort study. Among them 33 patients were followed up in community health service centers associated with Tongren Hospital (community follow-up group) and 99 matched patients were followed up in the CIED outpatient clinic of the hospital (outpatient follow-up group) with a ratio of 1∶3. The clinical data of the selected patients were collected through a questionnaire survey; the follow-up data were extracted through the CarelinkExpress electronic follow-up platform and the CIED outpatient information system of Tongren Hospital. Adjustment of the treatment protocol or CIED parameters at follow-up, and the referral from the community health service centers were defined as visit with-an-action (VWA). The endpoint of follow-up was the occurrence of major adverse events. The multivariate logistic regression model was used to analyze the factors influencing patient selection for community follow-up.Results:The univariate analysis showed that the frequency of visits to community health service centers and the service contracting rate in community follow-up group were higher than those of outpatient follow-up group ( P<0.05). The multivariate logistic regression analysis showed that the contracted community physician service was an independent influencing factor of patient choosing community follow-up ( OR=2.143, 95% CI: 1.103-4.166, P=0.025). A total of 469 visits of followed up occurred in 132 patients, including 45 community visits and 424 outpatient visits. VWA accounted for 22.2% (10/45) in the community follow-up group, and 17.2% (73/424) in the outpatient follow-up group ( P>0.05). There was no significant difference in the safety and effectiveness indicators (VWA, major adverse events, and unplanned follow-up) between the two groups ( P>0.05). More patients in the community follow-up group walked to the hospital than the outpatient follow-up group ( P<0.05);and the main transportation for the later was by bus or taxi(42(42.4%)or 41(41.4%)). The average waiting time in the community follow-up group was significantly shorter than that in outpatient follow-up group ( P<0.05). The total time required for a single follow-up in the community follow-up group was 50.0 (45.0, 59.5) minutes, which was significantly shorter than that in the routine outpatient follow-up group (107.0 (90.0, 135.0) minutes, P<0.05). Conclusions:The contracting with community physicians is an independent influencing factor for CIED implanted patients to choose community follow-up. The safety and effectiveness of community follow-up are comparable to routine outpatient follow-up, and community follow-up is more convenient.

Analysis of the characteristics of electronic equipment usage distance for common users / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyse and characterize the pattern of working and mobile phone usage distances(MPUD)for common users of electronic devices and computers.<p>METHODS: Transversal descriptive study consisting of a screening campaign evaluating the visual status of different professionals working with computers or electronic devices more than 2h per day. A total of 100 healthy patients with a mean age of 41.2(range: 20-62)years were revised and subdivided according to job subgroups. A battery of screening tests was performed to all participants in a single session at the working environment of each of them, including measurement of the working distance(WD), arm length, and MPUD.<p>RESULTS:The WD was significantly longer than MPUD(61.22±12.35 <i>vs</i> 32.22±6.35 cm; <i>P</i><0.001). Likewise, MPUD was significantly shorter than the arm length(74.44±4.65 cm; <i>P</i><0.001). A total of 4%(4/100)and 91%(91/100)of patients had a WD and MPUD of 40 cm or below, respectively. A weak although statistically significant correlation was found between WD and MPUD(<i>r</i>=0.387, <i>P</i><0.001)as well as between WD and arm length(<i>r</i>=0.260, <i>P</i>=0.009). Statistically significant differences were detected among job subgroups in WD(<i>P</i>=0.021), being longer for militaries compared to university researchers and lecturers(<i>P</i>=0.025).<p>CONCLUSION:Working and mobile phone usage distances vary significantly among common users of computers and digital devices, although the use of mobile phones tends to be performed at significantly closer distances. This parameter should be considered when planning any type of optical correction, especially for presbyopia.

The Usefulness of a Wearable Device in Daily Physical Activity Monitoring for the Hospitalized Patients Undergoing Lumbar Surgery

OBJECTIVE: Functional outcomes have traditionally been evaluated and compared using subjective surveys, such as visual analog scores (VAS), the Oswestry disability index (ODI), and Short Form-36 (SF-36), to assess symptoms and quality of life. However, these surveys are limited by their subjective natures and inherent bias caused by differences in patient perceptions of symptoms. The Fitbit Charge® (Fitbit Inc., San Francisco, CA, USA) provides accurate and objective measures of physical activity. The use of this device in patients after laminectomy would provide objective physical measures that define ambulatory function, activity level, and degree of recovery. Therefore, the present study was conducted to identify relationships between the number of steps taken by patients per day and VAS pain scores, prognoses, and postoperative functional outcomes.METHODS: We prospectively investigated 22 consecutive patients that underwent laminectomy for spinal stenosis or a herniated lumbar disc between June 2015 and April 2016 by the same surgeon. When patients were admitted for surgery and first visited after surgery, preoperative and postoperative functional scores were recorded using VAS scores, ODI scores, and SF-36. The VAS scores and physical activities were recorded daily from postoperative day (POD) 1 to POD 7. The relationship between daily VAS scores and daily physical activities were investigated by simple correlation analysis and the relationship between mean number of steps taken and ODI scores after surgery was subjected to simple regression analysis. In addition, Wilcoxon’s signed-rank test was used to investigate the significance of pre-to-postoperative differences in VAS, ODI, and SF-36 scores.RESULTS: Pre-to-postoperative VAS (p<0.001), ODI (p<0.001), SF-36 mental composite scores (p=0.009), and SF-36 physical composite scores (p<0.001) scores were found to be significantly different. Numbers of steps taken from POD 1 to POD 7 were negatively correlated with daily VAS scores (r=-0.981, p<0.001). In addition, the mean number of steps from POD 3 to POD 7 and the decrease in ODI conducted one month after surgery were statistically significant (p=0.029).CONCLUSION: Wearable devices are not only being used increasingly by consumers as lifestyle devices, but are also progressively being used in the medical area. This is the first study to demonstrate the usefulness of a wearable device for checking patient physical activity and predicting pain and prognosis after laminectomy. Based on our experience, the wearable device used to provide measures of physical activity in the present study has the potential to provide objective information on pain severity and prognosis.

The Usefulness of a Wearable Device in Daily Physical Activity Monitoring for the Hospitalized Patients Undergoing Lumbar Surgery

OBJECTIVE: Functional outcomes have traditionally been evaluated and compared using subjective surveys, such as visual analog scores (VAS), the Oswestry disability index (ODI), and Short Form-36 (SF-36), to assess symptoms and quality of life. However, these surveys are limited by their subjective natures and inherent bias caused by differences in patient perceptions of symptoms. The Fitbit Charge® (Fitbit Inc., San Francisco, CA, USA) provides accurate and objective measures of physical activity. The use of this device in patients after laminectomy would provide objective physical measures that define ambulatory function, activity level, and degree of recovery. Therefore, the present study was conducted to identify relationships between the number of steps taken by patients per day and VAS pain scores, prognoses, and postoperative functional outcomes. METHODS: We prospectively investigated 22 consecutive patients that underwent laminectomy for spinal stenosis or a herniated lumbar disc between June 2015 and April 2016 by the same surgeon. When patients were admitted for surgery and first visited after surgery, preoperative and postoperative functional scores were recorded using VAS scores, ODI scores, and SF-36. The VAS scores and physical activities were recorded daily from postoperative day (POD) 1 to POD 7. The relationship between daily VAS scores and daily physical activities were investigated by simple correlation analysis and the relationship between mean number of steps taken and ODI scores after surgery was subjected to simple regression analysis. In addition, Wilcoxon’s signed-rank test was used to investigate the significance of pre-to-postoperative differences in VAS, ODI, and SF-36 scores. RESULTS: Pre-to-postoperative VAS (p<0.001), ODI (p<0.001), SF-36 mental composite scores (p=0.009), and SF-36 physical composite scores (p<0.001) scores were found to be significantly different. Numbers of steps taken from POD 1 to POD 7 were negatively correlated with daily VAS scores (r=-0.981, p<0.001). In addition, the mean number of steps from POD 3 to POD 7 and the decrease in ODI conducted one month after surgery were statistically significant (p=0.029). CONCLUSION: Wearable devices are not only being used increasingly by consumers as lifestyle devices, but are also progressively being used in the medical area. This is the first study to demonstrate the usefulness of a wearable device for checking patient physical activity and predicting pain and prognosis after laminectomy. Based on our experience, the wearable device used to provide measures of physical activity in the present study has the potential to provide objective information on pain severity and prognosis.

Application of remote monitoring systems for cardiac implantable electronic devices in elderly patients / 中华老年医学杂志

Objective To investigate the application of remote monitoring systems for cardiac implantable electronic devices (CIED) and its success rate of data transmission in elderly patients.Methods A total of 97 elderly patients who had previously undergone procedures for pacemaker implantation,implantable cardioverter defibrillators (ICD) or cardiac resynchronization therapy (CRT) with remote monitoring capabilities between January 2013 and October 2016 at our hospital were enrolled.We evaluated the effect of the remote monitoring systems for data transmission,compared the outpatient follow-up rates between the groups one year after implantation,and conducted a telephone survey of patients.Results A total of 97 elderly patients,including 70 with pacemakers,20 with ICD and 7 with CRT,were enrolled in this study.Participants had a mean age of (78.2-±-6.4) years and 64 were male (66.0％).The Home Monitoring system was used for 85 cases and the Merlin.net remote monitoring system was used for 12 cases.Overall,95 patients (97.9 ％) completed the remote monitoring procedure,68 patients (70.1％) completed the outpatient follow-up,and 90 patients (92.8％) completed the telephone survey during a one-year follow-up period.The satisfaction rate for the remote monitoring systems was 94.4％ (85 patients),and 80 patients (90.0％％) expressed a willingness to continue to use the remote monitoring system if a replacement was needed.Conclusions For elderly patients with CIED,the remote monitoring systems can improve the follow-up rate with a high degree of satisfaction.

Heart rate control in chronic heart failure patients received cardiovascular implantable electronic device therapy: effects of optimized medication / 中华心血管病杂志

Objective@#To investigate the heart rate control situation of chronic heart failure (CHF) patients who received cardiovascular implantable electronic device (CIED) therapy, and to assess the heart rate control efficacy by optimized medication adjustment.@*Methods@#We performed a perspective study in heart failure with reduced left ventricular ejection fraction (HFrEF) patients who received CIED according to guideline recommendations, patients were enrolled from January 2012 to January 2017. Resting heart rate (RHR) recorded by electrocardiogram after 10 minutes' rest and medication usage within 1 month were recorded at baseline. RHR less than 70 beats per minute (bpm) was regarded as well controlled. β-receptor blockers and (or) ivabradine would be added in patients whose RHR were over 70 bpm. RHR after optimized medication adjustment was recorded during follow-up period.@*Results@#One hundred and fifty patients were included in this study with average RHR (80.6±11.9) bpm. RHR was<70 bpm in 27.3% (41/150) patients at baseline and β-receptor blockers was underused in 80.7% patients (88/109) whose RHR was>70 bpm. The overall RHR decreased to (73.1±10.4) bpm and percent of patients with RHR<70 bpm increased to 70.0% (105/150) after up-titration of β-receptor blockers compared to baseline (χ2=52.958, P<0.001). Ivabradine was added in the rest 45 patients and RHR was<70 bpm in 43 out of 45 patients after ivabradine use. The overall RHR decreased to (67.1±2.7) bpm and percent of RHR<70 bpm significantly increased to 98.7% (148/150) (χ2=44.504, P<0.001 vs. up-titration of β-receptor blockers only).@*Conclusion@#RHR in CHF patients who received CIED therapy is not ideally controlled in this patient cohort, individual up-titration ofβ-receptor blockers and ivabradine use may help to optimize RHR in these patients.

Automatic Electronic Device Used for the Evaluation of Cyclic-Fatigue Resistance of Nickel-Titanium Instruments

he aim of this study was to evaluate the cyclic-fatigue fracture of different Nickel-Titanium motor-driven rotary instruments (ProTaper® Universal, ProFile®, and Mtwo® systems) in artificial canals by means of an Automatic Electronic Device (AED). The study was performed using NickelTitanium instruments 25/0.06 evaluated in canals with a 45-degree curvature and 2-mm radius. The analyses evaluated two parameters: fracture by cyclic fatigue, and time of fracture; in addition, the length of separated fragment was evaluated. Medians and range values were calculated for each group. Data were analyzed by the Kruskall-Wallis and Mann-Whitney U tests to determine statistical difference. The ProFile motor-driven rotator system exhibited highest resistance to fracture due to cyclic fatigue and highest fracture time compared with the ProTaper and Mtwo systems (p <0.05). The equipment proposed in this study (AED) demonstrated efficiency for recording information, automation, scheduled work times and durations, cycle number, time of fracture, pressure changes and, principally control of the human factor.

l objetivo del presente estudio fue evaluar la fractura a la fatiga cíclica de diferentes instrumentos rotatorios de Niquel-Titanio (sistemas ProTaper® Universal, ProFile® y Mtwo®) en conductos artificiales por medio de un Dispositivo Electrónico Automático (DEA). Se usaron instrumentos de Niquel-Titanio 25/0.06, los cuales se evaluaron en conductos con una curvatura de 45 grados y 2 milímetros de radio. Se analizaron dos parámetros: Fractura a la fatiga cíclica y tiempo a la fractura; además se evaluó la longitud del fragmento separado. Medianas y rangos fueron calculados para cada uno de los grupos. Los resultados fueron analizados por las pruebas de Kruskall-Wallis y U de Mann-Whitney para determinar diferencias estadísticas. El Sistema ProFile mostró una mayor resistencia y tiempo a la fractura en comparación con los sistemas ProTaper y Mtwo (p <0.05). El equipo propuesto en este estudio (DEA) demostró eficiencia para el registro de la información, tiempos de trabajo y duración, número de ciclos, tiempo a la fractura, cambios en la presión y principalmente control del factor humano.

Interferences and suppression methods in use of medical electronic devices / 医疗卫生装备

Objective To explore the methods for suppressing the interferences during the application of medical electronic devices.Methods Kinds of signal sources interfering medical electronic devices were analyzed,and the suppression methods were discussed from the aspects of shielding protection,selection of ground point,filtering,circuit design and etc.Results Interference suppression could be executed by proper grounding,shielding protection,component protection and etc.Conclusion Suppression methods have to be selected according to inference source during the clinical application of medical electronic devices.

Prevalence of Dry Eye Syndrome and Association with Life Behaviors in Adolescents

PURPOSE: To investigate the prevalence and risk factors of dry eye syndrome (DES) among adolescents based on the Ocular Surface Disease Index (OSDI) questionnaire. METHODS: A questionnaire survey was conducted on middle and high school students in Daejeon. DES was diagnosed by an OSDI score ≥ 13. According to the OSDI score, DES was classified as mild (13-22 points), moderate (23-32 points), or severe (33-100 points). Additionally, responses to the questions regarding adolescents' life behaviors including the duration of electronic device use per week (cellphone, computer, TV), study hours per day, sleeping hours per day, contact lenses use, glasses use, and humidifier use were analyzed to determine the associations with DES. RESULTS: Of 332 students, DES was diagnosed in 147 (44.3%), and 54 (16.3%) complained of severe DES. The prevalence of DES was higher in female students (p = 0.004), long-time electronic device users (divided on the basis of the mean value, 15.3 hours per week, p = 0.011), and contact lenses users (p = 0.001). The prevalence of DES was 53.9% in groups with ≥ 14 hours of electronic device usage time per week, 40.2% in groups with ≥ 7 hours, and 33.7% in groups with < 7 hours (p = 0.002). The duration of electronic device use per week was a significant risk factor of DES for male students, and contact lenses use was a significant risk factor of DES for female students (p = 0.009). CONCLUSIONS: The prevalence of DES was high among adolescents. Long-time electronic device usage and contact lenses wear were associated with DES and increased the risk of DES.

Double valve replacement in a patient with implantable cardioverter defibrillator with severe left ventricular dysfunction.

Recent data from landmark trials suggest that the indications for cardiac pacing and implantable cardioverter defibrillators (ICDs) are set to expand to include heart failure, sleep‑disordered breathing, and possibly routine implantation in patients with myocardial infarction and poor ventricular function.[1] This will inevitably result in more patients with cardiac devices undergoing surgeries. Perioperative electromagnetic interference and their potential effects on ICDs pose considerable challenges to the anesthesiologists.[2] We present a case of a patient with automatic ICD with severe left ventricular dysfunction posted for double valve replacement.

Influence of high frequency electrosurgical equipment application in cardiac impalntable elect ornic device implantation pro cedure on the rate of pocket hematoma / 中国介入心脏病学杂志

Objective To investigate the influence of high frequency electrosurgical equipment ( HFEE) application in cardiac implantable electronic device ( CIED) implantation procedure on the rate of pocket hematoma .Methods Patients who received CIED implantation in General Hospital of Shenyang Military Region were analyzed retrospectively .HFEE was applied during CIED implantation procedure in every patient who was classified into HFEE group .Other patients without HFEE application were classified as the control group . Patients with or without bleeding tendency were sub-classified into the bleeding tendency subgroup or non-bleeding tendency subgroup respectively .Bleeding tendency subgroup was further divided into heparin bridging group and direct implantation group .The occurance rate of CIED pocket hematoma was recorded in all groups .Results A total of 3884 patients were enrolled .There were 3115 patients in the HFEE group and 769 patients in the control group .The baseline data of two groups was similar.The overall rate of CIED pocket hematoma in the total patient population during perioperative period were 2.2%(86/3884), and the rate of long term pocket infection or rupture in patients with CIED pocket hematoma was 10.5%(9/8).In the HFEE group, the rate of pocket hematoma was lower than that in the control group (1.5%vs.5.2%, P<0.001).The rates of CIED pocket hematoma in respective subgroups in the HFEE group including the bleeding tendency subgroup ( 1.8% vs.11.5%, P=0.004 ) , the non-bleeding tendency subgroup ( 1.4% vs.4.7%, P<0.001 ) and the heparin bridging group ( 2.0% vs. 11.5%, P=0.046 ) were markedly decreased as compared with the corresponding subgroups in the control group.In the control group , the rate of CIED pocket hematoma in the bleeding tendency subgroup was higher than that in the non-bleeding tendency subgroup (11.5%vs.4.7%, P=0.0046).In HFEE group, there was no significant difference in the rate of CIED pocket hematoma between bleeding tendency subgroup and non-bleeding tendency subgroup; and there was also no significant difference in the rate of CIED pocket hematoma between the heparin bridging group and the direct implantation group .Conclusion Application of HFEE in CIED implantation procedure could reduce the incidence of pocket hematoma , and there was no significant difference in the incidence of pocket hematoma in patients with or without oral anticoagulation or antiplatelet agents.

Infections of Cardiac Implantable Electronic Devices: Diagnosis and Approach.

With the expansion of the indications for implantation of cardiac electronic devices, there was an increase in these procedures and, consequently, there was an increase of the infection rate. The risk of infection depends on many factors, including device type and the number of implantation procedures. In addition to significant morbidity, one-year mortality is approximately 20%. Knowledge of the factors associated with this unfavorable outcome, clinical manifestations, diagnosis and treatment are very important for proper approach. This review presents all these aspects and strategies for the prevention of infection related to implantable electronic cardiac devices.

A practical approach to perioperative management of cardiac implantable electronic devices

With the increased use of cardiac implantable electronic devices (CIEDs), it is increasingly important to recognise the unique challenges involved in the management of patients with CIEDs who are undergoing surgery. Practice advisories and consensus statements have been issued by the American Society of Anesthesiologists and the Heart Rhythm Society, advocating a multidisciplinary approach. This review discusses and presents a practical approach to perioperative CIED management in the Singapore context.

Superior Vena Cava Echocardiography as a Screening Tool to Predict Cardiovascular Implantable Electronic Device Lead Fibrosis

BACKGROUND: Currently there is no noninvasive imaging modality used to risk stratify patients requiring lead extractions. We report the novel use of superior vena cava (SVC) echocardiography to identify lead fibrosis and complex cardiac implantable electronic device (CIED) lead extraction. With an aging population and expanding indications for cardiac device implantation, the ability to deal with the complications associated with chronically implanted device has also increased. METHODS: This was a retrospective analysis of Doppler echocardiography recorded in our outpatient Electrophysiology/Device Clinic office over 6 months. Images from 109 consecutive patients were reviewed. RESULTS: 62% (68/109) did not have a CIED and 38% (41/109) had a CIED. In patients without a CIED, 6% (4/68) displayed turbulent color flow by Doppler in the SVC, while 22% (9/41) of patients with a CIED displayed turbulent flow. Fisher's exact test found a statistically significant difference between the two groups (p value or = 2 years). Of the CIED implanted for > or = 2 years, 27% (9/33) had turbulent flow in the SVC by Doppler, while no patients (0/8) with implant durations < 2 years demonstrated turbulent flow. Nine patients underwent subsequent lead extraction. A turbulent color pattern successfully identified all 3 patients that had significant fibrosis in the SVC found during extraction. CONCLUSION: Our data suggests that assessing turbulent flow using color Doppler in the SVC may be a valuable noninvasive screening tool prior to lead extraction in predicting complex procedures.