ABSTRACT
OBJECTIVES: This study sought to synthesize the available evidence on the use of the wearable cardioverter-defibrillator (WCD). BACKGROUND: Observational WCD studies for the prevention of sudden cardiac death have provided conflicting data. The VEST (Vest Prevention of Early Sudden Death) trial was the first randomized controlled trial (RCT) showing no reduction in sudden cardiac death as compared to medical therapy only. METHODS: We searched PubMed, EMBASE, and Google Scholar for studies reporting on the outcomes of patients wearing WCDs from January 1, 2001, through March 20, 2018. Rates of appropriate and inappropriate WCD therapies were pooled. Estimates were derived using DerSimonian and Laird's method. RESULTS: Twenty-eight studies were included (N = 33,242; 27 observational, 1 RCT-WCD arm). The incidence of appropriate WCD therapy was 5 per 100 persons over 3 months (95% confidence interval [CI]: 3.0 to 6.0, I2 = 93%). In studies on ischemic cardiomyopathy, the appropriate WCD therapy incidence was lower in the VEST trial (1 per 100 persons over 3 months; 95% CI: 1.0 to 2.0) as compared with observational studies (11 per 100 persons over 3 months; 95% CI: 11.0 to 20.0; I2 = 93%). The incidence of inappropriate therapy was 2 per 100 persons over 3 months (95% CI: 1.0 to 3.0; I2 = 93%). Mortality while wearing WCD was rare at 0.7 per 100 persons over 3 months (95% CI: 0.3 to 1.7; I2 = 94%). CONCLUSIONS: The rate of appropriately treated WCD patients over 3 months of follow-up was substantial; higher in-observational studies as compared with the VEST trial. There was significant heterogeneity. More RCTs are needed to justify continued use of WCD in primary prevention.
Subject(s)
Death, Sudden, Cardiac , Defibrillators, Implantable , Electric Countershock , Adult , Aged , Death, Sudden, Cardiac/epidemiology , Death, Sudden, Cardiac/prevention & control , Defibrillators, Implantable/adverse effects , Defibrillators, Implantable/statistics & numerical data , Electric Countershock/adverse effects , Electric Countershock/mortality , Electric Countershock/statistics & numerical data , Female , Humans , Incidence , Male , Middle AgedABSTRACT
BACKGROUND: Concerns have been raised over the integrity of gloves and the longevity of their protective barrier function. AIMS: This study aimed to assess the effect of clinicians' fingernail length as a predisposing factor for perforation of latex gloves. METHODS: We assessed 2006 latex examination gloves for perforations using the water inflation method after being used by 6 senior dental students who had fingernail lengths ranging from 0 to 3 mm. Four simulated clinical procedures representing a variety of hand movements were used for this purpose and were repeated 30 times, followed by a water leakage assessment test. Data were analysed using the χ2 test, analysis of variance and logistic regression. RESULTS: Leakage was detected in 222 (11.1%) gloves, and was most frequent with longer fingernails (odds ratio =1.431, 95% confidence interval 1.249-1.640; P < 0.001). This was independent from the simulated clinical procedure. Most perforations were over the index fingers and thumbs (63.5% and 24.3%, respectively; P < 0.001). The simulated procedures with most perforations were wiping the scaler tip with gauze (20.8%) and placing the chamfer bur (15.3%). The procedure with the fewest perforations was placing the triple way syringe (3.5%). CONCLUSION: The length of the clinicians' fingernails significantly compromises the integrity of latex gloves. Maintaining short fingernails is important in reducing the risk of damaging latex gloves intraoperatively, and hence maintaining the barrier function of the gloves.
