Frequency of Adverse Event Monitoring in Ambulatory Patients on Amiodarone or Dofetilide.

BACKGROUND: Published studies state that adherence to regular laboratory assessments for anti-arrhythmic drugs is as low as 20%. Monitoring adherence is important as other studies have shown that up to 93% of patients on amiodarone experience an adverse drug event leading to a potentially lethal event. OBJECTIVE: To determine whether patients prescribed amiodarone or dofetilide are being monitored according to package labeling and guideline recommendations for adverse events. METHODS: Patients prescribed amiodarone or dofetilide from a 2-year period were eligible for inclusion. Patients with ventricular arrhythmias, prescribed more than 1 anti-arrhythmic agent, or received anti-arrhythmic monitoring outside the health-care system were excluded. Adherence to monitoring parameters was assessed according to labeled recommendations and published guidelines. The primary objective was to determine the frequency of baseline and follow-up monitoring recommendations for patients receiving amiodarone or dofetilide. The secondary objective was to determine rates of adverse drug events. RESULTS: One hundred patients were evaluated (amiodarone n = 50, dofetilide n = 50). Average rates of baseline and follow-up amiodarone monitoring parameters were 55% and 57%, respectively. Average rates of baseline and follow-up dofetilide monitoring were 99.6% and 85%, respectively. There was a statistically significant difference in abnormally elevated thyroid-stimulating hormone levels (8%-30%, P ≤ .005) after patients were prescribed amiodarone. Twelve percent of patients taking dofetilide had an increase in QTc interval by >15%. CONCLUSIONS: Amiodarone adverse event monitoring was lower than dofetilide in this cohort. Improving the monitoring of these agents may decrease morbidity risk in this population.

Long-term evaluation of air sensor technology under ambient conditions in Denver, Colorado.

Air pollution sensors are quickly proliferating for use in a wide variety of applications, with a low price point that supports use in high-density networks, citizen science, and individual consumer use. This emerging technology motivates the assessment under real-world conditions, including varying pollution levels and environmental conditions. A seven-month, systematic field evaluation of low-cost air pollution sensors was performed in Denver, Colorado, over 2015-2016; the location was chosen to evaluate the sensors in a high-altitude, cool, and dry climate. A suite of particulate matter (PM), ozone (O3), and nitrogen dioxide (NO2) sensors were deployed in triplicate and were collocated with federal equivalent method (FEM) monitors at an urban regulatory site. Sensors were evaluated for their data completeness, correlation with reference monitors, and ability to reproduce trends in pollution data, such as daily concentration values and wind-direction patterns. Most sensors showed high data completeness when data loggers were functioning properly. The sensors displayed a range of correlations with reference instruments, from poor to very high (e.g., hourly-average PM Pearson correlations with reference measurements varied from 0.01 to 0.86). Some sensors showed a change in response to laboratory audits/testing from before the sampling campaign to afterwards, such as Aeroqual, where the O3 response slope changed from about 1.2 to 0.6. Some PM sensors measured wind-direction and time-of-day trends similar to those measured by reference monitors, while others did not. This study showed different results for sensor performance than previous studies performed by the U.S. EPA and others, which could be due to different geographic location, meteorology, and aerosol properties. These results imply that continued field testing is necessary to understand emerging air sensing technology.

Systemic Intravenous Lidocaine for the Treatment of Complex Regional Pain Syndrome: A Case Report and Literature Review.

Complex regional pain syndrome (CRPS) was described in 1864 by Mitchell et al as a condition characterized by many unique symptoms. Although symptoms may differ from patient to patient, the most common complaints are painful swelling in upper or lower extremities or changes in the skin. CRPS has been given many different names since it was first mentioned in the literature in 1851. The most common alternative names include causalgia, aglodystrophy, and sympathetic dystrophy syndrome. This condition is generally diagnosed in older adults because of trauma, nerve damage, and coronary artery disease; however, there are cases of CRPS affecting the pediatric and young adult population. The fourth edition of the diagnostic and treatment guidelines of CRPS published by Harden et al in 2013 suggest many different pharmacologic treatment options for these patients. Intravenous lidocaine is used to block the sodium channels in neuronal membranes, thus stopping initiation and conduction of impulses associated with neuropathic and inflammatory pain. The use of regional intravenous lidocaine (by applying a tourniquet on the affected extremity) has been well-documented in the literature with a successful decrease in pain symptoms. A unique case of the use of systemic intravenous lidocaine will be presented.

Community Air Sensor Network (CAIRSENSE) project: evaluation of low-cost sensor performance in a suburban environment in the southeastern United States.

Advances in air pollution sensor technology have enabled the development of small and low-cost systems to measure outdoor air pollution. The deployment of a large number of sensors across a small geographic area would have potential benefits to supplement traditional monitoring networks with additional geographic and temporal measurement resolution, if the data quality were sufficient. To understand the capability of emerging air sensor technology, the Community Air Sensor Network (CAIRSENSE) project deployed low-cost, continuous, and commercially available air pollution sensors at a regulatory air monitoring site and as a local sensor network over a surrounding ∼ 2 km area in the southeastern United States. Collocation of sensors measuring oxides of nitrogen, ozone, carbon monoxide, sulfur dioxide, and particles revealed highly variable performance, both in terms of comparison to a reference monitor as well as the degree to which multiple identical sensors produced the same signal. Multiple ozone, nitrogen dioxide, and carbon monoxide sensors revealed low to very high correlation with a reference monitor, with Pearson sample correlation coefficient (r) ranging from 0.39 to 0.97, 0.25 to 0.76, and 0.40 to 0.82, respectively. The only sulfur dioxide sensor tested revealed no correlation (r < 0.5) with a reference monitor and erroneously high concentration values. A wide variety of particulate matter (PM) sensors were tested with variable results - some sensors had very high agreement (e.g., r = 0.99) between identical sensors but moderate agreement with a reference PM2.5 monitor (e.g., r = 0.65). For select sensors that had moderate to strong correlation with reference monitors (r > 0.5), step-wise multiple linear regression was performed to determine if ambient temperature, relative humidity (RH), or age of the sensor in number of sampling days could be used in a correction algorithm to improve the agreement. Maximum improvement in agreement with a reference, incorporating all factors, was observed for an NO2 sensor (multiple correlation coefficient R2 adj-orig = 0.57, R2 adj-final = 0.81); however, other sensors showed no apparent improvement in agreement. A four-node sensor network was successfully able to capture ozone (two nodes) and PM (four nodes) data for an 8-month period of time and show expected diurnal concentration patterns, as well as potential ozone titration due to nearby traffic emissions. Overall, this study demonstrates the performance of emerging air quality sensor technologies in a real-world setting; the variable agreement between sensors and reference monitors indicates that in situ testing of sensors against benchmark monitors should be a critical aspect of all field studies.