We report our experience with a modified mini-maze procedure and pulmonary vein isolation using radiofrequency energy for treating persistent atrial fibrillation during coronary artery bypass grafting (CABG).
Ninety-five patients with persistent atrial fibrillation and coronary heart disease underwent open heart surgery combined with intraoperative irrigated radiofrequency ablation. Patients were randomized into the following three groups: CABG and irrigated radiofrequency pulmonary vein isolation (CABG+PVI, n = 31); CABG and an irrigated radiofrequency modified mini-maze procedure (CABG+MM, n = 30); and isolated CABG (CABG alone, n = 34). All patients received implantable loop recorders.
No reoperation and no hospital mortality were recorded. Mean follow-up was 14.4 ± 9.7 months. The implantable loop recorder-determined freedom from atrial fibrillation was 80% in the CABG+PVI group, 86.2% in the CABG+MM group and 44.1% in the CABG alone group.
Patients with concomitant atrial fibrillation and coronary heart disease may benefit from intraoperative ablation to prevent relapse of arrhythmia.
(1) The PillCam Colon capsule is an ingestible miniature camera that captures images of the colon's inner lining. (2) There is limited evidence on the use of this technology in imaging the colon. Two small, methodologically flawed pilot studies found that for patients with positive findings (i.e., abnormalities detected), the rates of detection with the PillCam Colon capsule were similar to those obtained with conventional colonoscopy. (3) No serious adverse events were reported in the pilot studies, although some patients had delayed excretion of the capsule. (4) A challenge for clinicians using this technology will be the time required to read the large quantity of video images produced. Further enhancements to the software system used to view the images may address this issue.
Ultrasound (US) has an ever increasing scope in the evaluation of trauma, but relies greatly on operator experience. NASA has refined telesongraphy (TS) protocols for traumatic injury, especially in reference to mentoring inexperienced users. We hypothesized that such TS might benefit remote terrestrial caregivers. We thus explored using real-time US and video communication between a remote (Banff) and central (Calgary) site during acute trauma resuscitations.
A existing internet link, allowing bidirectional videoconferencing and unidirectional US transmission was used between the Banff and Calgary ERs. Protocols to direct or observe an extended focused assessment with sonography for trauma (EFAST) were adapted from NASA algorithms. A call rota was established. Technical feasibility was ascertained through review of completed checklists. Involved personnel were interviewed with a semistructured interview.
In addition to three normal volunteers, 20 acute clinical examinations were completed. Technical challenges requiring solution included initiating US; audio and video communications; image freezing; and US transmission delays. FAST exams were completed in all cases and EFASTs in 14. The critical anatomic features of a diagnostic examination were identified in 98% of all FAST exams and a 100% of all EFASTs that were attempted. Enhancement of clinical care included confirmation of five cases of hemoperitoneum and two pneumothoraces (PTXs), as well as educational benefits. Remote personnel were appreciative of the remote direction particularly when instructions were given sequentially in simple, nontechnical language.
The remote real-time guidance or observation of an EFAST using TS appears feasible. Most technical problems were quickly overcome. Further evaluation of this approach and technology is warranted in more remote settings with less experienced personnel.
We developed an off-the-shelf system to transfer DICOM-compliant ultrasound images from a small rural hospital in northern Alberta to an urban radiology clinic in Calgary. The transfer time was less than 30 s per image. The radiologist could then review the case and release the patient. The radiologist could also switch to realtime videoconferencing mode and direct the rural ultrasound technician to obtain additional images of the patient.
Large numbers of harbor seals (Phoca vitulina) use habitat in tidewater glaciers in Alaska for pupping, breeding, and molting. Glacial fjords are also popular tourist destinations; however, visitation by numerous vessels can result in disturbance of seals during critical life-history phases. We explored factors affecting haul-out behavior of harbor seals at a glacial site frequented by tourism vessels. In 2008-10, we deployed VHF transmitters on 107 seals in Endicott Arm, Alaska. We remotely monitored presence and haul-out behavior of tagged seals and documented vessel presence with time-lapse cameras. We evaluated the influence of environmental and physical factors on the probability of being hauled out, duration of haul-out bouts, and as factors associated with the start and end of a haulout. Location, season, hour, and interactions of location by year, season, hour, and sex significantly influenced haul-out probability, as did ice, weather, and vessels. Seals were more likely to be hauled out with greater ice availability during the middle of the day, and less likely to be hauled out if vessels were present. Cruise ships had the strongest negative effect; however, most vessel types negatively affected haul-out probability. Haul-out duration was longest in association with starting on incoming tides, clear skies, no precipitation, occurring in the middle of the day, and ending in the late afternoon or evening. End of haulouts was associated with increasing cloud cover, low ice availability, and vessel presence; large-sized tourism vessels or all-vessel-types combined were significant predictors of ending a haul-out bout. Probability of being hauled out was highest in June, during pupping season. Potential disturbances of harbor seals could be reduced, enabling longer resting times for seals and fewer interruptions for nursing pups, if vessels focused the majority of visits to glacial habitat to before or after the hours of 08:00-17:00 or, less optimally, 09:00-16:00.
Cites: J Comp Physiol B. 1991;160(6):637-442045544
We conducted a feasibility study of teleconsultation in dermatology using low-cost equipment. Patients and their general practitioners took part in consultations from the Primary Health Care Centre in Ikaalinen with a dermatologist 55 km away at the Tampere University Hospital (TAUH). Consultations were performed using standard commercial videoconferencing equipment, a modified document camera and a dermatoscope. A single ISDN line (128 kbit/s) was used for the connection. During the eight months of the study, 25 patients participated in a teledermatology consultation. Their mean age was 45 years (range 4-92). The average time the patient spent in travelling to the videoconsultation (i.e. one way) was 24 min (range 5-65 min). The mean time spent in the teleconsultation was 15 min (range 5-30 min). After the teleconsultation, patients' treatments changed in 19 cases (76%), diagnoses were changed in 13 cases (52%) and 18 patients (72%) did not need to go to the TAUH. The equipment was generally reliable and easy to use. However, the dermatoscope was not very useful and only one of the consultations relied mainly on it. The cost of the teleconsultations for the 18 patients who avoided travel to the TAUH was FM18,627. The total costs for the 18 conventional consultations in the TAUH would have been FM18,034. The main economic benefits of the videoconferencing were attributable to the reduced travelling and hospital costs. The economic benefits of medical education were more difficult to quantify.
A hospital-managed project for the advanced care of children in their homes (SABH) has been established in Sweden. The aim was to provide an alternative to inpatient paediatric care by providing hospital-at-home care to stable infants and children using mobile units based on advanced information and communication technology. The Karolinska Hospital children's ward and emergency room referred children to SABH care. A medical care plan was drawn up by the physicians and nurses responsible for the patient while in hospital, in conjunction with the parents and the patient. In one year, 350 episodes of care requiring 3000 bed-days were managed by SABH in the children's homes rather than at hospital. Forty-two per cent of the patients were aged less than one year, 41% were between one and six years old, and 17% were older than six years. SABH care was at least 30% cheaper than conventional hospital care and patient satisfaction with the service was high. At the conclusion of the two-year project, the SABH became a permanent unit at the Karolinska Hospital.
Decompensation is frequent in heart failure (HF) patients and predicts poor prognosis.
Volume-overload events in HF patients are preceded by changes in intrathoracic impedance (Z) and body weight (BW); monitoring these parameters may be useful to predict decompensation.
Forty-three HF patients (LVEF 25%?±?12%) with a recent HF event and an implantable cardioverter-defibrillator providing daily Z were equipped with telemonitoring scales submitting daily BW. Changes in BW and Z 30 days prior to major (HF hospitalization) and minor (ambulatory adjustment of diuretics) were analyzed.
During median of 427 days follow-up 25 major and 41 minor events occurred. Z decreased by -4.8 (95% confidence interval [CI]: CI -6.7 to -3.0) and -4.3 (95% CI: -5.5 to -3.2) within 30 days prior to major and minor events respectively (P?
A low-cost, general-purpose telemetry system was developed for use in rural health centres, hospitals, ambulances and clinics. It was designed to transmit a range of analogue biomedical signals using various communications media. The system was tested using different telephone systems, including mobile telephony. The results showed a maximum sample rate of 1.6 kHz using the public telephone network. With three data channels the system produced sample rates of 500 Hz at 8 bit/sample. Typical overall delay times were below 100 ms. Mobile tests showed that the GSM telephone was superior to the Nordic mobile telephone (NMT 900). In field tests, sample rates of 990 Hz were obtained using GSM telephony. Bit error rates were less than 10(-7) for all applications and high-fidelity regeneration was obtained at the receiver. The tests showed that the system was well suited for telemetry of analogue biomedical signals in a broad range of telemedicine applications.
Floating passive-integrated transponder (PIT) antennae and smolt traps were used to study the time of sea entry and relative recapture of wild and hatchery-reared Atlantic salmon Salmo salar smolt released below and above a lake formed in the Vosso River. In total, 8.4 and 4.1% of the tagged wild and hatchery fish, respectively, were detected leaving the river (i.e. sea entry). Wild smolts released below the lake were detected leaving the river 16 days before smolts released above the lake, which also showed a 52% lower probability of detection during out-migration. Hatchery smolts were out of sync with the wild smolts and were detected approximately 2 months later than the wild smolts from both release locations, with an 84% lower likelihood of detection than wild fish. Size selection was evident for wild fish released above the lake, but not below the lake, with an overall likelihood of detection increasing by 2.6% per cm total length (LT ). Wild fish caught in the tributaries and transported to the main river had a 64% lower likelihood of detection than fish caught and released in the main river. This study demonstrates that floating PIT antennae out-performed the traditional rotary screw trap in the ability to detect tagged smolts and that it is an efficient tool for evaluating the time of sea entry of S. salar smolts in a large river system.