Preterm infants with paroxysmal supraventricular tachycardia: presentation, response to therapy, and outcome.

OBJECTIVES: We investigated the clinical course of preterm infants with paroxysmal supraventricular tachycardia in comparison to their term counterparts. BACKGROUND: Paroxysmal supraventricular tachycardia (PSVT) is the most common arrhythmia in childhood. It is known to cause significant morbidity and rarely mortality, most commonly in infants. Yet, there is minimal information in the literature on preterm infants with PSVT. METHODS: Retrospective review of 40 infants, 26 term and 14 preterm, less than three months of age who presented with PSVT from January 1990 to January 1999. We compared the severity of first clinical presentation, in-hospital response to long-term medications, and outcome after discharge. RESULTS: Symptomatic severity on presentation was not different between preterm and term infants. Preterm infants required fewer medication trials (p=0.01) and had no recurrences after discharge in contrast with 43 % recurrence in the term infants (p<0.0001). No preterm infants had Wolff-Parkinson-White syndrome (WPW) in contrast to 42 % of term infants (p=0.003). Term infants with WPW were more symptomatic (p=0.01), required more medications (p=0.004), but had a similar recurrence frequency as terms infants without WPW (p=0.95). Excluding infants with WPW, preterm infants were more severely symptomatic (p=0.02), yet no longer was there a difference in response to first medication trial (p=0.30). CONCLUSIONS: We found that preterm infants with PSVT are as severely symptomatic on presentation, require fewer medications for adequate in-hospital control, and have fewer recurrences than their term counterparts. Unexpectedly, preterm infants did not present with WPW. The presence of WPW only in the term infants may account for differences in the clinical course between preterm and term infants.

A case of thyrotoxicosis and reversible systolic cardiac dysfunction.

A woman with congestive heart failure and reduced left ventricular ejection fraction associated with hyperthyroidism is reported. Congestive heart failure resolved and left ventricular ejection fraction normalized within three weeks of treatment of her hyperthyroidism. The literature on previously reported cases of reversible systolic heart failure associated with hyperthyroidism is reviewed and the possible mechanisms leading to systolic dysfunction and congestive heart failure in thyrotoxicosis are discussed. One such mechanism may be the action of thyroid hormone on altering gene expression in cardiac cells; another could be the chronic tachycardia associated with thyrotoxicosis. Although it is a not a common cause of systolic heart failure, thyrotoxicosis should be considered in the differential diagnosis of cardiomyopathies because it is a potentially reversible cause.

Hospital--nursing home collaboration.

In the present health care environment, the provision of quality care for the elderly depends on collaboration between hospitals and nursing homes. Nathan Miller Center for Nursing Care, Inc, a skilled nursing facility in White Plains, New York, and Montefiore Medical Center, a tertiary care hospital in Bronx, New York, developed a variety of joint educational programs in geriatrics for their staffs and for the local medical community. These programs not only helped improve patient care directly in such areas as development of care plans but also led to joint projects for research on geriatric care issues.

Interior design preferences of residents, families, and staff in two nursing homes.

The small number of respondents and the absence of specific demographic data concerning the three categories of respondents represented definite limitations. Further investigation in other long-term care facilities clearly is indicated. However, as a preliminary survey of preferences in nursing home interior design, several interesting findings have emerged: Patients, staff and families all emphasized patient safety and function over aesthetics. Yet, more residents than staff and families were concerned with appearance. Although experts advocate creating a home-like atmosphere in the nursing home, 50% or more of each group applied different criteria for specific design elements for private homes and for long-term care institutions. Design preferences for the three groups were similar, with an emphasis on modern furniture, painted walls, resilient tile rather than carpet, blinds, pastel and warm colors, and the use of paintings as accessories. Contrary to study assumptions, design features that promote patient individuality (e.g., patient artwork) received much greater emphasis from staff than from patients and families. Environmental change was considered an important aspect of interior design. Of the three constituencies, staff was most aware of periodic changes in decor and considered change as "very important" more often than did families or patients. As the nature of the nursing home patient population has changed--with residents presenting more disability and less rehabilitation potential and less likelihood of returning home--the ambiance of facilities has assumed even more importance. Clearly, the design preferences of residents who live in the facility are of paramount importance. However, it is also helpful to have an environment that is pleasing to family members who often experience difficulty in ongoing visitations, particularly to intellectually impaired relatives. Maintaining staff morale at a high level is a constant challenge in a long-term care facility because inevitably, in spite of the active rehabilitation efforts of the entire treatment team, the condition of patients eventually will worsen. Thus, an attractive lively setting can prove beneficial to those who visit and work in the nursing home. Effective long-term care, which includes attention to the physical environment, should be concerned with the triad of residents, their families, and staff. Awareness that interior design does indeed impact on overall quality of life should lead the nursing home administrator to collaborate with residents, staff, and families and to share their input with professional design consultants.

Behavioral skills for employment of the intellectually handicapped.

Parents, teachers, and supervisors in competitive industry and sheltered workshops ranked the same behavioral items. Each group followed different directions. The items, thought to be basic requirements for successful employment of the intellectually handicapped, were sorted into four categories corroborated by university students. Chi-square analysis showed many significant differences in ranking among samples at p less than .0005. Parents and teachers emphasized items in the job-task category significantly less than did industry and workshop supervisors. Parents stressed basic reading skills more than other samples. Occupational therapists aware of the handicapped person's potential for employment could take the role of providing experiences stressing behaviors sought by employers.