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1.
Front Psychol ; 14: 1216450, 2023.
Article in English | MEDLINE | ID: mdl-37744584

ABSTRACT

Introduction: A comprehensive typology of the satisfaction of psychological needs at work and in personal life was developed and tested. The typology proposes five scenarios (Enriched, Middling, Impoverished, Work-Fulfilled, and Personal Life-Fulfilled) accounting for various profiles of employees showing distinct configurations of global and specific levels of need satisfaction at work and in personal life. Methods: The scenarios were tested in a sample of 1,024 employees. Results: Using latent profile analysis, five profiles were identified that were consistent with four or the five scenarios, either aligned (Globally Satisfied, Globally Unsatisfied) or misaligned (Globally Satisfied at Work with High Relatedness, Globally Satisfied in Personal Life with High Autonomy, and Globally Satisfied in Personal Life with Low Autonomy) across domains. No profile corresponding to the Middling scenario was observed. Discussion: The results indicate that perceived job and individual characteristics predicted membership in distinct profiles. More importantly, unlike the profile Globally Unsatisfied, the profile Globally Satisfied contributed substantially to higher well-being (vitality and lower psychological distress), and to more favorable job attitudes (job satisfaction and lower turnover intentions) and behaviors (self-rated job performance and lower absenteeism, presenteeism, and work injuries). Furthermore, two of the misaligned profiles were also substantially associated with highly desirable outcome levels.

2.
Artif Organs ; 47(11): 1786-1793, 2023 Nov.
Article in English | MEDLINE | ID: mdl-37649286

ABSTRACT

BACKGROUND: As the incidence of heart failure in developed countries is on the rise, mechanical circulatory support (MCS) often remains the only treatment option for patients with end-stage heart failure and is well established worldwide. Even though VAD coordinators play a key role in VAD programs, their responsibilities and daily duties are not clearly defined and characterized. Recently published data from the first 5-year multicenter clinical trial assessing experience with the HeartMate 3 left ventricular system (Abbott, Abbott Park, IL) show an overall survival of 61% at 5 years. When it comes to possible improvements to these systems, it is necessary for developers not only to know the status quo but also to determine and consider the visions and wishes of those individuals who take care of patients, provide education and deal with possible complications. This would be helpful a meaningful effort towards implementing a standard of care. METHODS: To fill this knowledge gap, we conducted an online survey using the SurveyMonkey tool, addressing representatives of programs implanting VADs worldwide. Representatives answered a standardized block of 14 questions and were asked to provide responses within 3 months. RESULTS: A total of 91 VAD coordinators from centers of various regions of the world completed the survey. The majority came from European countries. The numbers of patients followed up by the centers ranged from <20 to 390 patients. The majority of VAD coordinators had a nursing background (68%). Seventy-seven percent of the centers operate a 24-h hotline and 3-monthly visits to the outpatient department are most common. Fifty-nine percent of the centers do not use an infection scoring system for driveline wound care. The majority of the centers indicated that an optimized follow-up concept including wound care, medication, and social care is crucial and the key issue for an improved outcome. Smaller components and intensified psychosocial support ranked highest in questions about how to improve quality of life. Surprisingly, the future prospects of telemetric monitoring were not rated high in significance. CONCLUSIONS: There is a wide variability in the composition and tasks of VAD programs worldwide. Implementing a standard of care and improving psychosocial care as well as equipment is regarded most important to improve outcomes and quality of life. From the point of view of those responsible, the significance of telemetric monitoring seemed overrated.


Subject(s)
Heart Failure , Heart-Assist Devices , Humans , Heart-Assist Devices/adverse effects , Quality of Life , Heart Failure/surgery , Surveys and Questionnaires , Europe , Treatment Outcome
3.
Otol Neurotol ; 43(4): e519-e525, 2022 04 01.
Article in English | MEDLINE | ID: mdl-35239617

ABSTRACT

OBJECTIVE: To develop a surgical approach for rapid and minimally traumatic recovery of inner ear tissue from human organ and tissue donors to provide fresh tissue for use in inner ear research. STUDY DESIGN: Exploration of novel surgical methodology and evaluation of the steps necessary for obtaining specimens from donors during the procurement of organs for transplantation. SETTING: Donor procurement locations across multiple local hospitals and tissue processing at the microsurgical temporal bone laboratory. PATIENTS TISSUE SOURCE: Human organ and tissue donors. INTERVENTIONS: Dissection and procurement of the inner ear tissue. MAIN OUTCOME MEASURES: Development of rapid and minimally traumatic inner ear tissue recovery. Primarily, establishing an efficient process which includes collaboration with transplant network, implementing a consent protocol, developing and training an on-call recovery team, and designing a portable surgical kit suitable for use in a variety of settings. RESULTS: The extraction procedure is described in three consecutive steps: the trans-canal exposure, the approach to the vestibule with extraction of the vestibular organs; and the approach to extract inner ear tissues from the cochlear duct. CONCLUSIONS: Organ and tissue donors are a promising and underutilized resource of inner ear organs for purposes of research and future translational studies. Using our modified technique through the trans-canal/trans-otic approach, we were able to extract tissues of the vestibular and auditory end organs in a timely manner.


Subject(s)
Tissue Donors , Vestibule, Labyrinth , Humans , Temporal Bone/surgery
4.
ASAIO J ; 68(11): 1332-1338, 2022 11 01.
Article in English | MEDLINE | ID: mdl-35184090

ABSTRACT

As patients on long-term left ventricular assist device (LVAD) face a substantial risk for open cardiac reoperation, interventional treatment approaches are becoming increasingly important in this population. We evaluated data of 871 patients who were on LVAD support between January 1, 2016 and December 1, 2020. Interventional treatments for LVAD-associated complications were performed in 76 patients. Seventeen patients underwent transcatheter aortic valve replacements (TAVR) and 61 patients underwent outflow graft interventions (OGI). TAVR improved symptoms in patients with severe symptomatic aortic regurgitation. Postinterventional complications included aggravation of preexisting right heart failure (RHF), third-degree atrioventricular block, and intrapump thrombosis (in 3 [16.7%], 2 [11.1%], and 1 [5.6%] patients, respectively). In outflow graft obstructions, OGI led to recovery of LVAD flow ( p < 0.001), unloading of the left ventricle ( p = 0.004), decrease of aortic valve opening time ( p = 0.010), and improvement of right heart function ( p < 0.001). Complications included bleeding, RHF, and others (in 9 [10.8%], 5 [6.0%], and 5 [6.0%] patients, respectively). Eight (9.6%) patients died within the hospital stay after OGI, including mortality secondary to prolonged cardiogenic shock. In conclusion, interventional procedures are a feasible and safe treatment modality for LVAD-associated complications.


Subject(s)
Aortic Valve Insufficiency , Heart Failure , Heart-Assist Devices , Humans , Heart-Assist Devices/adverse effects , Treatment Outcome , Aortic Valve Insufficiency/etiology , Aortic Valve Insufficiency/surgery , Heart Failure/surgery , Heart Failure/diagnosis , Aortic Valve , Retrospective Studies
5.
ESC Heart Fail ; 9(2): 1038-1049, 2022 04.
Article in English | MEDLINE | ID: mdl-34994094

ABSTRACT

AIMS: Assessing frailty and sarcopenia is considered a valuable cornerstone of perioperative risk stratification in advanced heart failure patients. The lack of an international consensus on a diagnostic standard impedes its implementation in the clinical routine. This study aimed to compare the feasibility and prognostic impact of different assessment tools in patients undergoing continuous-flow left ventricular assist device (cf-LVAD) implantation. METHODS AND RESULTS: We prospectively compared feasibility and prognostic values of six frailty/sarcopenia assessment methods in 94 patients prior to cf-LVAD implantation: bioelectrical impedance analysis (BIA), computed tomography (CT)-based measurement of two muscle areas/body surface area [erector spinae muscle (TMESA/BSA) and iliopsoas muscle (TPA/BSA)], physical performance tests [grip strength, 6 min walk test (6MWT)] and Rockwood Clinical Frailty Scale (RCFS). Six-month mortality and/or prolonged ventilation time >95 h was defined as the primary endpoint. BIA and CT showed full feasibility (100%); physical performance and RCFS was limited due to patients' clinical status (feasibility: 87% grip strength, 62% 6MWT, 88% RCFS). Phase angle derived by BIA showed the best results regarding the prognostic value for 6 month mortality and/or prolonged ventilation time >95 h (odds ratio (OR) 0.66 [95% confidence interval (CI): 0.46-0.92], P = 0.019; area under the curve (AUC) 0.65). It provided incremental value to the clinical risk assessment of EuroSCORE II: C-index of the combined model was 0.75 [95% CI; 0.651-0.848] compared with C-index of EuroSCORE II alone, which was 0.73 (95% CI: 0.633-0.835). Six-month survival was decreased in patients with reduced body cell mass derived by BIA or reduced muscle area in the CT scan compared with patients with normal values: body cell mass 65% (95% CI: 51.8-81.6%) vs. 83% (95% CI: 74.0-93.9%); P = 0.03, TMESA/BSA 65% (95% CI: 51.2-82.2%) vs. 82% (95% CI: 73.2-93.0%); P = 0.032 and TPA/BSA 66% (95% CI: 53.7-81.0%) vs. 85% (95% CI: 75.0-95.8%); P = 0.035. CONCLUSIONS: Bioelectrical impedance analysis parameters and CT measurements were shown to be suitable to predict 6-month mortality and/or prolonged ventilation time >95 h in patients with advanced heart failure prior to cf-LVAD implantation. Phase angle had the best predictive capacity and sarcopenia diagnosed by reduced body cell mass in BIA or muscle area in CT was associated with a decreased 6 month survival.


Subject(s)
Frailty , Heart Failure , Heart-Assist Devices , Sarcopenia , Feasibility Studies , Frailty/complications , Frailty/diagnosis , Heart Failure/complications , Humans
6.
Artif Organs ; 46(5): 908-921, 2022 May.
Article in English | MEDLINE | ID: mdl-34904259

ABSTRACT

BACKGROUND: Cardiopulmonary bypass (CPB) during left ventricular assist device (LVAD) implantation provides circulatory support and allows for safe inspection of the left ventricle (LV), whereas circulatory support by veno-arterial extracorporeal life support (va-ECLS) or off-pump implantation may reduce postoperative bleeding and inflammatory response. METHODS: Retrospective analysis of 616 consecutive adult patients who received an LVAD via median sternotomy between January 1, 2015 and December 31, 2019. All patients undergoing concomitant intracardiac procedures other than closure of persistent foramen ovale or atrial septal defect and redo surgeries were excluded from the analysis. The remaining patients (n = 222) were divided into two groups and 1:1 propensity score-matched regarding preoperative parameters: patients who underwent LVAD implantation with LV inspection employing CPB (CPB group, n = 62) and without LV inspection on va-ECLS or off-pump (non-CPB group, n = 62). RESULTS: The groups were well balanced with regard to preoperative baseline characteristics (standard difference <0.1). Patients in the CPB group required more blood transfusions (median 2 vs. 0 units, p = 0.031) during surgery and in the first 24 h afterwards. The median intensive care unit stay was longer in the CPB group (18 vs. 11 days, p = 0.021). The CPB group showed an absence of perioperative stroke and a smaller number of events per patient-year for postoperative ischemic stroke (0.02 vs. 0.12, p = 0.003). 30-day survival (87% vs. 87.1%) and 1-year survival (80.3% vs. 74%) were similar in both groups (p = 0.78). CONCLUSION: Visual LV inspection on CPB may reduce the risk of postoperative ischemic stroke. Despite the negative effects of employing CPB in lieu of other intraoperative strategies, survival was similar in both groups.


Subject(s)
Extracorporeal Membrane Oxygenation , Heart-Assist Devices , Adult , Cardiopulmonary Bypass , Extracorporeal Membrane Oxygenation/methods , Heart Ventricles , Heart-Assist Devices/adverse effects , Humans , Retrospective Studies , Treatment Outcome
8.
J Card Fail ; 27(12): 1328-1336, 2021 12.
Article in English | MEDLINE | ID: mdl-34157393

ABSTRACT

BACKGROUND: Limited data are available concerning the safety, optimal administration and benefits of contemporary heart failure therapy in patients after left ventricular assist device (LVAD) implantation. METHODS: Between 2015 and 2019, 257 patients underwent LVAD implantation and were included in this observational study. Oral heart failure therapy was initiated and uptitrated during the further course. After propensity matching and excluding patients with immediate postoperative treatment in an affiliated center with different medical standards, hospitalization rates and mortality within 12 months after LVAD implantation were compared between 83 patients who received medical therapy including an angiotensin receptor neprilysin inhibitor (ARNI) and 83 patients who did not receive an ARNI. RESULTS: The overall use of heart-failure medications after 12 months was high: prescriptions: beta-blockers, 85%; angiotensin inhibiting drugs, 90% (angiotensin-converting-enzyme inhibitors 30%, angiotensin receptor blockers 23%, ARNI 37%); mineralocorticoid receptor antagonists, 80%. No serious drug-related adverse events occurred. The conditional 1-year survival in the group with ARNIs was 97% (95% CI: 94%-100%) compared to 88% in the group without an ARNI (95% CI: 80%-96%); P = 0.06. CONCLUSIONS: Contemporary heart failure therapy is safe in patients with LVADs. No increase in serious adverse events was seen in patients receiving ARNIs. No significant difference in the conditional 1-year survival was seen between the ARNI group and the nonARNI group.


Subject(s)
Heart Failure , Heart-Assist Devices , Angiotensin Receptor Antagonists , Angiotensin-Converting Enzyme Inhibitors , Heart Failure/therapy , Humans , Stroke Volume , Treatment Outcome
9.
Interact Cardiovasc Thorac Surg ; 33(4): 628-630, 2021 10 04.
Article in English | MEDLINE | ID: mdl-34021333

ABSTRACT

Only few patients with heart failure with preserved ejection fraction undergo durable mechanical circulatory support implantation. We identified three patients with heart failure with preserved ejection fraction who needed durable mechanical circulatory support as bridge-to-transplant therapy. In two patients with hypertrophic cardiomyopathy, the hypertrophic papillary muscles and myocardium were resected to allow for subsequent left ventricular assist device implantation. In one patient, all visible parts of the mitral valve were additionally resected. The third patient with restrictive cardiomyopathy underwent Berlin Heart Excor BVAD implantation with left atrial cannulation.


Subject(s)
Cardiomyopathy, Hypertrophic , Heart Failure , Heart-Assist Devices , Cardiomyopathy, Hypertrophic/complications , Cardiomyopathy, Hypertrophic/diagnostic imaging , Cardiomyopathy, Hypertrophic/surgery , Heart Failure/therapy , Humans , Myocardium , Stroke Volume , Treatment Outcome
10.
J Med Syst ; 45(5): 55, 2021 Mar 25.
Article in English | MEDLINE | ID: mdl-33768346

ABSTRACT

The handling of left ventricular assist devices (LVADs) can be challenging for patients and requires appropriate training. The devices' usability impacts patients' safety and quality of life. In this study, an eye tracking supported human factors testing was performed to reveal problems during use and test the trainings' effectiveness. In total 32 HeartWare HVAD patients (including 6 pre-VAD patients) and 3 technical experts as control group performed a battery change (BC) and a controller change (CC) as an everyday and emergency scenario on a training device. By tracking the patients' gaze point, task duration and pump-off time were evaluated. Patients with LVAD support ≥1 year showed significantly shorter BC task duration than patients with LVAD support <1 year (p = 0.008). In contrast their CC task duration (p = 0.002) and pump-off times (median = 12.35 s) were higher than for LVAD support patients <1 year (median = 5.3 s) with p = 0.001. The shorter BC task duration for patients with LVAD support ≥1 year indicate that with time patients establish routines and gain confidence using their device. The opposite effect was found for CC task duration and pump-off times. This implies the need for intermittent re-training of less frequent tasks to increase patients' safety.


Subject(s)
Heart Failure , Heart-Assist Devices , Eye-Tracking Technology , Humans , Quality of Life , Retrospective Studies , Time Factors
11.
Interact Cardiovasc Thorac Surg ; 31(4): 475-482, 2020 10 01.
Article in English | MEDLINE | ID: mdl-32879947

ABSTRACT

OBJECTIVES: Short-term mechanical circulatory support is a life-saving treatment for acute cardiogenic shock (CS). This multicentre study investigates the preoperative predictors of 30-day mortality in CS patients treated with Impella 5.0 and 5.5 short-term left ventricular assist devices. METHODS: Data of patients in CS (n = 70) treated with the Impella 5 (n = 63) and 5.5 (n = 7) in 2 centres in Berlin between October 2016 and October 2019 were collected retrospectively. RESULTS: CS was caused by acute myocardial infarction (n = 16), decompensated chronic heart failure (n = 41), postcardiotomy syndrome (n = 5) and acute myocarditis (n = 8). Before implantation 12 (17%) patients underwent cardiopulmonary resuscitation and 32 (46%) patients were ventilated. INTERMACS level 1, 2 and 3 was established in 35 (50%), 29 (41%) and 6 (9%) of patients, respectively. The mean preoperative lactate level was 4.05 mmol/l. The median support time was 7 days (IR= 4-15). In 18 cases, the pump was removed for myocardial recovery, in 22 cases, durable left ventricular assist devices were implanted, and 30 patients died on support. The overall 30-day survival was 51%. Statistical analysis showed that an increase in lactate per mmol/l [odds ratio (OR) 1.217; P = 0.015] and cardiopulmonary resuscitation before implantation (OR 16.74; P = 0.009) are predictors of 30-day survival. Based on these data, an algorithm for optimal short-term mechanical circulatory support selection is proposed. CONCLUSIONS: Impella treatment is feasible in severe CS. Severe organ dysfunction, as well as the level and duration of shock predict early mortality. An algorithm based on these parameters may help identify patients who would benefit from Impella 5+ support.


Subject(s)
Heart-Assist Devices , Shock, Cardiogenic/surgery , Thoracic Surgical Procedures/methods , Aged , Female , Germany/epidemiology , Humans , Male , Middle Aged , Prosthesis Design , Retrospective Studies , Shock, Cardiogenic/mortality , Survival Rate/trends , Treatment Outcome
12.
Pacing Clin Electrophysiol ; 43(10): 1078-1085, 2020 10.
Article in English | MEDLINE | ID: mdl-32696523

ABSTRACT

BACKGROUND: Cardiac cachexia and frailty are major complications of advanced heart failure (AHF). Bioelectrical impedance analysis (BIA) may provide valuable information regarding fluid balance, muscle mass and prognosis. The main concerns regarding the use of BIA in AHF patients remain arrhythmias and electromagnetic interferences with cardiac implantable electronic devices (CIEDs). Reliable data regarding patients on continuous-flow ventricular assist device (cf-VAD) remain scarce. The aim of this study is to evaluate the safety of BIA in AHF patients on pro-arrhythmogenic therapy with an implanted CIED and/or with a cf-VAD. METHODS: We prospectively performed 217 BIA measurements in 143 AHF patients at risk of severe arrhythmias due to inotropic support/a history of ventricular arrhythmias and/or treated with CIED, including 104 patients with an ICD, CRT or pacemaker and 95 patients with a cf-VAD. All patients were under continuous Electrocardiogram (ECG) monitoring and clinical surveillance for 24 hours. RESULTS: No adverse events were observed during the 217 BIA measurements: No rhythm disturbances were documented in the telemetric monitoring during or within 30 minutes after the measurement. CIEDs showed no malfunction, regardless of the location measured or the device manufacturer. In particular, no inappropriate shocks were observed. No alarms, flow disturbances, or malfunctions of the cf-VAD occurred during or after the measurements. CONCLUSION: We consider BIA a safe measurement with major clinical relevance in our cohort of AHF patients, despite an increased arrhythmic potential on inotropic support or the presence of implanted electronic devices (ICD, CRT, pacemaker and cf-VAD).


Subject(s)
Electric Impedance , Electrodes, Implanted , Equipment Safety , Heart Failure/physiopathology , Cachexia/etiology , Electrocardiography , Female , Frailty/etiology , Heart Failure/complications , Heart Failure/therapy , Humans , Male , Middle Aged , Prognosis , Prospective Studies , Sarcopenia/etiology , Telemetry
14.
Neuroreport ; 31(9): 672-677, 2020 06 07.
Article in English | MEDLINE | ID: mdl-32398421

ABSTRACT

Despite the regenerative capacity of the peripheral nerve system (PNS), functional recovery after mechanical nerve trauma is often incomplete, resulting in motor, sensory, and autonomic deficits. The elucidation of key molecules involved in trauma-induced Wallerian degeneration and the ensuing regeneration processes is a prerequisite for the development of disease modifying drugs. The chemokine (C-X-C motif) receptor 3 (CXCR3) has been implicated in the recruitment of macrophages, the major immune cell population during the process of Wallerian degeneration. In this study, we examined whether deletion of CXCR3 affects macrophage recruitment, the expression of the proinflammatory cytokine tumor necrosis factor (TNF)- α and the CXCR3 agonist interferon gamma-induced protein 10 (CXCL10), and functional recovery in the sciatic nerve crush model. CXCR3 mice displayed significantly reduced macrophage counts preceded by diminished expression of CXCL10 and TNF- α. Furthermore, functional recovery of sciatic nerve motor function was significantly accelerated. In summary, these data indicate that the deletion of CXCR3 leads to a diminished inflammatory response and an accelerated functional recovery following sciatic nerve crush injury. Therefore, CXCR3 may be an interesting target for therapeutic interventions after traumatic nerve lesions.


Subject(s)
Inflammation/physiopathology , Macrophages/physiology , Receptors, CXCR3/physiology , Recovery of Function , Sciatic Neuropathy/physiopathology , Wallerian Degeneration/physiopathology , Animals , Mice, Inbred C57BL , Mice, Knockout , Receptors, CXCR3/genetics
15.
Eur J Cardiothorac Surg ; 57(6): 1160-1165, 2020 06 01.
Article in English | MEDLINE | ID: mdl-32298426

ABSTRACT

OBJECTIVES: Various trials have assessed the outcome and reliability of the HeartWare HVAD (HW) and HeartMate 3 (HM3) left ventricular assist devices. A direct comparison of clinical outcomes and of the complication profile of these 2 left ventricular assist devices is lacking. We present a retrospective analysis of patients supported with HM3 and HW as a left ventricular assist device. METHODS: Preoperative data, complications and outcomes including a 1-year follow-up of patients supported with the HM3 and HW in a single centre were retrospectively analysed. Both pumps were implanted on- or off-pump, employing standard and minimally invasive techniques. For logistic reasons, the 2 device types were implanted in an alternating manner, thereby reducing the systematic bias for pump selection. We considered this to be an appropriate approach, as no differences in respect of survival or the complication profile of the two device types have been demonstrated. Anticoagulation was similar in patients with both pumps according to our anticoagulation protocol, with a target international normalized ratio of 2.5-3.0, a home monitoring system and blood pressure management with a mean arterial target pressure of 70-80 mmHg. RESULTS: Between October 2015 and April 2017, 100 patients underwent implantation of the HW and 100 patients underwent implantation of the HM3. The median time on the device was 0.98 years (range 0-2.23 years). The median age was 58.5 (51-65) versus 57 (49-64) years (P = 0.456); the number of male patients was 87 versus 88 (P = 0.831). Of the HW patients, 73% were rated as having an INTERMACS level I or II, compared to 57% of the HM3 patients (P = 0.018). There were no further differences in preoperative data. A total of 14 patients had pre-, intra- or post-pump blood flow obstruction in the HW group versus 4 in the HM3 group [hazard ratio (HR) 2.5 (0.7-8.8), P = 0.103]. There were no differences regarding gastrointestinal bleeding [HR 1.25 (0.56-2.64), P = 0.624] or driveline infection (0.68 vs 0.8 events per patient-year, P = 0.0789). The incidence of ischaemic stroke was similar in both groups [HR 0.72 (0.25-2.09), P = 0.550]. Cerebral bleeding was more frequent in patients supported with HW [HR 6.79 (1.43-32.20), P = 0.016]. The incidence of cerebrovascular accidents, on the other hand, was similar in both groups [HR 1.85 (0.83-4.19), P = 0.13]. The incidence of haemocompatibility-related adverse events, however, was significantly higher in the HW group (113 points corresponding to 1.28 events per patient-year versus 69 points corresponding to 0.7 events per patient-year, P < 0.001). The 1-year survival was similar in both groups [62.2%, 95% confidence interval (CI) (0.53-0.73) vs 66.7%, 95% CI (0.58­0.767) [corrected]. CONCLUSIONS: Our data show that the complication profile differs between the 2 pumps, but that early survival is comparable.


Subject(s)
Brain Ischemia , Heart Failure , Heart-Assist Devices , Stroke , Follow-Up Studies , Heart-Assist Devices/adverse effects , Humans , Male , Middle Aged , Reproducibility of Results , Retrospective Studies , Treatment Outcome
16.
J Crit Care ; 56: 106-112, 2020 04.
Article in English | MEDLINE | ID: mdl-31896443

ABSTRACT

Mechanical circulatory support (MCS) using left ventricular assist devices (LVAD) have considerably improved the quality of life and survival rate of patients with end-stage heart failure. Despite substantial technological progress, major challenges with regard to VAD-specific and VAD-related infections have hitherto hindered the broader application of this promising therapy approach. Driveline infections (DLI) range among the main adverse events experienced in LVAD patients. However, many centers still apply their own protocol for driveline exit site (DLES) care and an international standard on prevention, reduction and early treatment of DLI after the perioperative period has not yet been defined. In March 2019, VAD coordinators and cardiac surgeons from Germany and Austria met to develop a standard of care procedure (SOP) as well as a new staging approach with recommended actions for treatment of VAD carriers. In this Driveline Expert STagINg and carE (DESTINE) study group we developed a 10-step SOP for DLES care with emphasis on essentials such as clean and save preparation, sterile dressing change and secure driveline immobilization. An advanced wound staging approach was defined with recommended actions for prevention, early detection and stage-related management of DLI. Broad consensus was reached on the fact that an interdisciplinary approach both in DLES care and DLES healing disorder awareness is required to prolong infect-free survival times on MCS as well as to ensure high patient compliance and quality of life. In conclusion, a new detailed SOP for appropriate DLES care and an advanced wound staging approach for prevention and management of DLI were defined on an expert level applicable for VAD clinicians, practitioners and care givers in Central Europe.


Subject(s)
Heart Failure/physiopathology , Heart-Assist Devices/adverse effects , Prosthesis-Related Infections/prevention & control , Skin Diseases/prevention & control , Austria , Cardiology/standards , Female , Germany , Humans , International Cooperation , Male , Middle Aged , Outpatients , Prosthesis-Related Infections/diagnosis , Quality of Life , Skin Diseases/diagnosis , Standard of Care , Survival Rate
17.
Eur J Cardiothorac Surg ; 55(4): 773-779, 2019 Apr 01.
Article in English | MEDLINE | ID: mdl-30445489

ABSTRACT

OBJECTIVES: Extracorporeal life support (ECLS) can be applied as a bridge to diagnosis and decision-making for further treatment with long-term left ventricular assist devices (LVADs). METHODS: From January 2012 to January 2018, 714 adult patients were treated with ECLS in our institution. During the same period, 618 patients received an LVAD for long-term support. Of them, 100 patients were further supported with a long-term LVAD. We retrospectively analysed the datasets of these 100 consecutive patients with the goal of developing an algorithm to predict outcomes for a rational use of long-term ventricular assist device therapy in this setting. RESULTS: The mean age of the 100 patients was 54.1 ± 11.6 years, and 72 were men. Twenty-nine patients had a BMI of >30 kg/m2. In 33 patients, a temporary right ventricular assist device was necessary postoperatively. The 30-day, 1-year and 2-year survival after ventricular assist device implantation was 62.0% [95% confidence interval (CI) 53.2-72.3], 43.0% (95% CI 34.3-53.9) and 37.1% (95% CI 28.2-48.7%), respectively. Penalized multivariable logistic regression analysis showed following predictors for 1-year mortality: bilirubin increase per mg/dl [odds ratio (OR) 1.41, 95% CI 1.12-1.77], C-reactive protein increase per mg/dl (OR 1.11, 95% CI 1.05-1.19), ECLS duration >7 days (OR 4.90, 95% CI 1.66-14.41), BMI >30 kg/m2 (OR 1.41, 95% CI 1.05-8.52) and female gender (OR 3.06, 95% CI 1.02-9.23). On the basis of these data, a nomogram to estimate 1-year mortality after LVAD implantation was created. CONCLUSIONS: After stabilization of patients experiencing cardiogenic shock using ECLS, LVAD implantation can be performed with elevated mortality in an otherwise futile situation. Liver dysfunction, inflammatory status and obesity increase the risk for mid-term mortality.


Subject(s)
Extracorporeal Circulation , Heart-Assist Devices , Prosthesis Implantation , Extracorporeal Circulation/methods , Extracorporeal Circulation/mortality , Extracorporeal Membrane Oxygenation/methods , Extracorporeal Membrane Oxygenation/mortality , Female , Heart-Assist Devices/adverse effects , Humans , Male , Middle Aged , Prosthesis Implantation/methods , Prosthesis Implantation/mortality , Retrospective Studies , Survival Analysis , Treatment Outcome
19.
PLoS One ; 13(1): e0190971, 2018.
Article in English | MEDLINE | ID: mdl-29364916

ABSTRACT

Urban environments are increasing worldwide and are inherently different than their rural counterparts, with a variety of effects on wildlife due to human presence, increased habitat fragmentation, movement barriers, and access to anthropogenic food sources. Effective management of urban wildlife requires an understanding of how urbanization affects their behavior and ecology. The spatial activity and interactions of urban wildlife, however, have not been as rigorously researched as in rural areas. From January 2015 to December 2016, we captured, radio-collared, and tracked 11 coyotes and 12 red foxes in Madison, WI. Within our study area, coyotes strongly selected home ranges with high proportions of natural areas; conversely, red foxes selected home ranges with open space and moderately developed areas. Use of highly developed areas best explained variation among individual home range sizes and inversely affected home range size for coyotes and red foxes. Coyote and red fox home ranges showed some degree of spatial and temporal overlap, but generally appeared partitioned by habitat type within our study area. Coyotes and red foxes were both active at similar times of the day, but their movement patterns differed based on species-specific habitat use. This spatial partitioning may promote positive co-existence between these sympatric canids in urban areas, and our findings of spatial activity and interactions will better inform wildlife managers working in urban areas.


Subject(s)
Coyotes/physiology , Foxes/physiology , Animals , Ecosystem , Seasons , Urbanization
20.
Exp Neurol ; 297: 25-35, 2017 11.
Article in English | MEDLINE | ID: mdl-28734788

ABSTRACT

Guillain-Barré syndrome (GBS) is an acute, immune-mediated polyradiculoneuropathy characterized by rapidly progressive paresis and sensory disturbances. Moderate to severe and often intractable neuropathic pain is a common symptom of GBS, but its underlying mechanisms are unknown. Pathology of GBS is classically attributed to demyelination of large, myelinated peripheral fibers. However, there is increasing evidence that neuropathic pain in GBS is associated with impaired function of small, unmyelinated, nociceptive fibers. We therefore examined the functional properties of small DRG neurons, the somata of nociceptive fibers, in a rat model of GBS (experimental autoimmune neuritis=EAN). EAN rats developed behavioral signs of neuropathic pain. This was accompanied by a significant shortening of action potentials due to a more rapid repolarization and an increase in repetitive firing in a subgroup of capsaicin-responsive DRG neurons. Na+ current measurements revealed a significant increase of the fast TTX-sensitive current and a reduction of the persistent TTX-sensitive current component. These changes of Na+ currents may account for the significant decrease in AP duration leading to an overall increase in excitability and are therefore possibly directly linked to pathological pain behavior. Thus, like in other animal models of neuropathic and inflammatory pain, Na+ channels seem to be crucially involved in the pathology of GBS and may constitute promising targets for pain modulating pharmaceuticals.


Subject(s)
Ganglia, Spinal/physiopathology , Neuralgia/physiopathology , Neuritis, Autoimmune, Experimental/physiopathology , Nociceptors/physiology , Animals , Cells, Cultured , Electrophysiological Phenomena/physiology , Ganglia, Spinal/pathology , Male , Neuralgia/pathology , Neuritis, Autoimmune, Experimental/pathology , Nociceptors/pathology , Pain Measurement/methods , Rats , Rats, Inbred Lew
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