Increased risk of ventricular fibrillation associated with RYTHMIQ™: lessons learned

2016 ◽  
Vol 48 (1) ◽  
pp. 111-112
Author(s):  
Thomas Nguyen ◽  
Juan Sieira ◽  
Ruben Casado-Arroyo
Keyword(s):  
Ventricular Fibrillation ◽  
Lessons Learned ◽  
Increased Risk

scholarly journals Safer primary healthcare facilities are needed to protect healthcare workers and maintain essential services: lessons learned from a multicountry COVID-19 emergency response initiative

2021 ◽  
Vol 6 (6) ◽  
pp. e005833
Author(s):  
Leena N Patel ◽  
Samantha Kozikott ◽  
Rodrigue Ilboudo ◽  
Moreen Kamateeka ◽  
Mohammed Lamorde ◽  
...  
Keyword(s):  
Health Facility ◽  
Healthcare Workers ◽  
National Level ◽  
Lessons Learned ◽  
Health Facilities ◽  
Infection Prevention And Control ◽  
Health Facility Level ◽  
Ensure Patient Safety ◽  
Increased Risk ◽  
Facility Level

Healthcare workers (HCWs) are at increased risk of infection from SARS-CoV-2 and other disease pathogens, which take a disproportionate toll on HCWs, with substantial cost to health systems. Improved infection prevention and control (IPC) programmes can protect HCWs, especially in resource-limited settings where the health workforce is scarcest, and ensure patient safety and continuity of essential health services. In response to the COVID-19 pandemic, we collaborated with ministries of health and development partners to implement an emergency initiative for HCWs at the primary health facility level in 22 African countries. Between April 2020 and January 2021, the initiative trained 42 058 front-line HCWs from 8444 health facilities, supported longitudinal supervision and monitoring visits guided by a standardised monitoring tool, and provided resources including personal protective equipment (PPE). We documented significant short-term improvements in IPC performance, but gaps remain. Suspected HCW infections peaked at 41.5% among HCWs screened at monitored facilities in July 2020 during the first wave of the pandemic in Africa. Disease-specific emergency responses are not the optimal approach. Comprehensive, sustainable IPC programmes are needed. IPC needs to be incorporated into all HCW training programmes and combined with supportive supervision and mentorship. Strengthened data systems on IPC are needed to guide improvements at the health facility level and to inform policy development at the national level, along with investments in infrastructure and sustainable supplies of PPE. Multimodal strategies to improve IPC are critical to make health facilities safer and to protect HCWs and the communities they serve.

scholarly journals The ACHIEVE Trial: Lessons Learned From Nesting a Randomized Controlled Trial Within an Observational Cohort Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 811-811
Author(s):  
Jennifer Deal ◽  
Nicholas Reed ◽  
David Couper ◽  
Kathleen Hayden ◽  
Thomas Mosley ◽  
...  
Keyword(s):  
Older Adults ◽  
Randomized Controlled Trial ◽  
Observational Study ◽  
Cognitive Decline ◽  
Controlled Trial ◽  
Lessons Learned ◽  
Community Dwelling ◽  
Randomized Controlled ◽  
Study Staff ◽  
Increased Risk

Abstract Hearing impairment in older adults is linked to accelerated cognitive decline and a 94% increased risk of incident dementia in population-based observational studies. Whether hearing treatment can delay cognitive decline is unknown but could have substantial clinical and public health impact. The NIH-funded ACHIEVE randomized controlled trial of 977 older adults aged 70-84 years with untreated mild-to-moderate hearing loss, is testing the efficacy of hearing treatment versus health education on cognitive decline over 3 years in community-dwelling older adults (Clinicaltrials.gov Identifier: NCT03243422.) This presentation will describe lessons learned from ACHIEVE’s unique study design. ACHIEVE is nested within a large, well-characterized multicenter observational study, the Atherosclerosis Risk in Communities Study. Such nesting within an observational study maximizes both operational and scientific efficiency. With trial results expected in 2022, this presentation will focus on the benefits gained in design and recruitment/retention, including dedicated study staff, well-established protocols, and established study staff-participant relationships. Part of a symposium sponsored by Sensory Health Interest Group.

Graves’-induced prothrombotic state and the risk of early-onset myocardial infarction

2021 ◽  
Vol 14 (6) ◽  
pp. e243446
Author(s):  
Meilyr Dixey ◽  
Alice Barnes ◽  
Fiqry Fadhlillah
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Ventricular Fibrillation ◽  
Cardiopulmonary Resuscitation ◽  
Plaque Rupture ◽  
Graves Disease ◽  
Thyroid Function Tests ◽  
Prothrombotic State ◽  
Thrombotic Occlusion ◽  
Increased Risk

Hyperthyroidism represents a state of hypercoagulability and hypofibrinolysis, which predisposes an individual to the increased risk of thromboembolism. We present a case of a 25-year-old patient presenting with an acute myocardial infarction secondary to plaque rupture with thrombotic occlusion of proximal left anterior descending artery, in a patient known to have Graves’ disease. She had a sudden ventricular fibrillation arrest and a precordial thump given and cardiopulmonary resuscitation started. She successfully underwent cardiac catheterisation. Subsequent thyroid function tests showed she was in active thyrotoxicosis.

Anomaly Criteria for General Visual Inspection of Subsea Flexible Pipes

2020 ◽  
Author(s):  
Damir Tadjiev
Keyword(s):  
Visual Inspection ◽  
Service Failure ◽  
Lessons Learned ◽  
Inspection Method ◽  
Deep Waters ◽  
Flexible Pipes ◽  
Increased Risk ◽  
Competent Person ◽  
Routine Basis ◽  
Areas Of Concern

Abstract For flexible pipes in subsea applications, General Visual Inspection (GVI) by Remotely Operated Vehicles (ROV) remains the most common inspection method that is used on a routine basis. It enables verification of pipe configuration or layout and also helps to identify any areas of concern indicative of an increased risk of in-service failure. The success of ROV GVI chiefly relies on the anomaly criteria used, these help inspectors to identify any areas of concern, which can then be assessed by a competent person to ensure any threat to the integrity of an inspected component is identified and addressed. Currently there are no commonly accepted anomaly criteria for ROV GVI of flexible pipes. As a result there is no consistent approach between different operators and experience shows that the inspection approach and anomaly criteria are often adopted from what has traditionally been used for rigid pipes. Since flexible pipes have different design and associated failure threats and mechanisms to rigid pipe, use of this approach may result in under or over inspection of flexible pipes. This paper presents a set of anomaly criteria for ROV GVI of flexible pipes. The criteria were developed using the experience and lessons learned from a population of approximately 350 flexible pipes from two different manufactures operating in deep waters of the UKCS for over a period of 20 years. The criteria cover dynamic flexible risers and associated ancillary equipment, seabed flexible flowlines and jumpers. The applicability of the proposed anomaly criteria to other systems, the benefits of having commonly accepted anomaly criteria, the anomaly detection capability of ROV GVI and the reporting of anomalies are also discussed.

Connected Vehicle Training Framework and Lessons Learned to Improve Safety of Highway Patrol Troopers

2020 ◽  
Vol 2674 (12) ◽  
pp. 447-463
Author(s):  
Biraj Subedi ◽  
Sherif M. Gaweesh ◽  
Guangchuan Yang ◽  
Mohamed M. Ahmed
Keyword(s):  
Training Program ◽  
New Technologies ◽  
Driving Simulator ◽  
Real Life ◽  
Lessons Learned ◽  
Simulator Training ◽  
Connected Vehicle ◽  
Training Module ◽  
Increased Risk ◽  
Highway Patrol

The Wyoming Highway Patrol (WHP) investigates more than 7,000 vehicle crashes yearly, often as first-hand responders. They often drive at high speeds through difficult road/weather conditions and under enormous secondary workloads, leading to an increased risk of crash. Connected vehicle (CV) technology can communicate timely road and traveler information messages (TIMs) to troopers, which could significantly reduce the frequency, severity, or both, of these crashes. The majority of the troopers, however, might not be familiar with driving a CV. This paper developed a “first responder-specific” training program on safe interaction with the technology and an in-depth assessment of how these new technologies are perceived by the troopers. The training program contains an E-training module and a hands-on driving simulator training module. The E-training presents concept of various CV warnings and notifications, including forward collision warning (FCW), spot weather warnings, work zone warnings, and other TIMs. Two scenarios were developed to familiarize troopers to simulated driving, two single-alert scenarios to help mastering the two most important warnings (FCW and variable speed limit), and two multiple-alert scenarios to train the troopers to drive in a comprehensive connected environment. A quiz section in the E-training module and comprehensive pre- and post-training questionnaire surveys were performed to evaluate the effectiveness of the developed CV training program. According to the trainees from the WHP, the driving simulator provided impressively realistic real-life-like scenarios for the troopers to practice the CV warnings they learned during the E-training.

Lifting Operation Safety Management in AP1000 Nuclear Plant Project

2013 ◽  
Author(s):  
Xiaogang He ◽  
Shell Shortes
Keyword(s):  
Power Plant ◽  
Nuclear Power Plant ◽  
Nuclear Power ◽  
Management Practices ◽  
Safety Management ◽  
Lessons Learned ◽  
Plant Design ◽  
Modular Construction ◽  
Increased Risk ◽  
Culture Development

As a third-generation nuclear power plant design, construction of the Westinghouse AP1000 incorporates the characteristics of modular construction and the “Open-Top” lifting method, which results in many kinds of lifting operations, whose potential failure creates increased risk to key equipment and construction personnel. Lifting by its very nature is high risk. Based on traditional safety management practices utilized at the project, lift operation characteristics were analyzed, and procedures and processes developed to manage the risk. These developed aspects included: lifting operation procedures; a construction scheme review/approval process; work planning/risk mitigation; equipment inspections; personnel certification requirements; training; crew management; special inspections; lessons learned utilization; discipline management; emergency management; and safety culture development. The authors believe that the safety management approaches discussed in this paper can provide guidance in conducting safe lift operations in other nuclear power plant projects.

Inland Oiled Wildlife Response: It’s a Different Animal

2017 ◽  
Vol 2017 (1) ◽  
pp. 1795-1805
Author(s):  
Curtis Clumpner ◽  
Michael Ziccardi
Keyword(s):  
At Risk ◽  
Oil Spills ◽  
Geographical Area ◽  
State Legislature ◽  
Lessons Learned ◽  
California Department ◽  
Increased Risk ◽  
Available Technology ◽  
Transport Patterns ◽  
High Level

ABSTRACT 2017-311 The Oiled Wildlife Care Network (OWCN) was established in 1994 to address the need for timely, consistent, and professional science-based preparedness and response for wildlife at risk from oil spills occurring in the marine waters of California. Its mission focused on providing a high level of professional care based on the best available technology and science combined with the experience of many organizations that were pioneers in the field of wildlife rehabilitation. Since that time, the OWCN and its now more than 35 members have responded to over 100 spills while caring for more than 8,200 impacted animals. In 2014, in response to the increased risk due to changing sources and transport patterns in oil coming to refineries in California, the State legislature expanded the OWCN’s responsibility to include responding to oiled wildlife impacted during oil spills in all surface waters of California. Since then, the OWCN has worked to expand its plan and resources to ensure readiness to provide best achievable capture and care to a host of new species in the myriad of habitats and locations found in a large and ecologically diverse state. The biggest challenges to this expansion are the increased diversity of species and their habitats (California has 233 species and subspecies of reptiles and amphibians), and the increase in geographical scope. Working with the California Department of Fish and Wildlife (specifically the Office of Spill Prevention and Response, or OSPR), the OWCN staff have identified species at risk and response challenges unique to an inland environment and terrestrial species and the appropriate resources meet those challenges and fill current gaps. We have incorporated lessons learned by colleagues during wildlife responses to inland spills including CNR Lake Wabamun (2005), Enbridge Kalamazoo River (2010), Silvertip Pipeline Yellowstone River (2011), and CNRL Cold Lake (2013). We have repurposed and redesigned existing equipment as well as acquiring additional mobile equipment to increase capacity and decrease response time. We have identified and trained first responders over a wide geographical area focusing on regions with increased risk of incident and impacts while leveraging our current primary care facilities with field stabilization and wildlife transportation plans to achieve maximum flexibility and cost effectiveness. We detail both the process that was used to develop this expansion and the resulting additions to the wildlife plan aimed to provide best achievable care to all wildlife species impacted by an inland oil spill in California.

scholarly journals Resistance to ventricular fibrillation predicted by the QRS/QTc - ratio in an intact rat model of hypothermia/rewarming

2020 ◽  
Author(s):  
Erik Sveberg Dietrichs ◽  
Timofey Kondratiev ◽  
Karen McGlynn ◽  
Godfrey Smith ◽  
Torkjel Tveita
Keyword(s):  
Ventricular Fibrillation ◽  
Rat Model ◽  
Ventricular Arrhythmias ◽  
Accidental Hypothermia ◽  
Moderate Hypothermia ◽  
Experimental Protocol ◽  
Cooling Period ◽  
Increased Risk ◽  
High Incidence ◽  
Lethal Hypothermia

Abstract Background Accidental hypothermia is associated with increased risk for arrhythmias, including ventricular fibrillation and cardiac arrest. Recently QRS/QTc was proposed as an ECG-marker, where decreasing QRS/QTc ratio could predict ventricular arrhythmias in such patients. If reliable it should also predict nonappearance of arrhythmias, observed in species like rat that regularly tolerate prolonged hypothermia, during sustained sinus rhythm. Methods A rat model designed for studying cardiovascular function during cooling, 4 h experimental hypothermia (15 °C core temperature) and subsequent rewarming was used, and ECG recorded throughout the experimental protocol. Results No ventricular arrhythmias occured and there was no sign of a hypothermia-induced reduction of QRS/QTc values during moderate hypothermia. The ratio steadily increased throughout the entire cooling period and remained above normothermic baseline until rewarmed. Conclusion Different from the high incidence of hypothermia-induced ventricular arrhythmias in accidental hypothermia patients, where QRS/QTc ratio is decreased in moderate hypothermia, hypothermia and rewarming of rats is not associated with increased risk for ventricular fibrillation. This resistance to lethal hypothermia-induced arrhythmias was predicted by the QRS/QTc ratio.

scholarly journals Patients’ thoughts on their falls in a rehabilitation hospital: a qualitative study of patients with stroke

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Saika Aihara ◽  
Shin Kitamura ◽  
Masayuki Dogan ◽  
Sachiko Sakata ◽  
Kunitsugu Kondo ◽  
...  
Keyword(s):  
Fear Of Falling ◽  
Lessons Learned ◽  
Positive Thinking ◽  
Risk Of Falling ◽  
Comprehensive Information ◽  
Increased Risk ◽  
Before And After ◽  
Risky Behaviours ◽  
Past Experiences ◽  
Need For Rehabilitation

Abstract Background Patients with stroke in rehabilitation wards are at an increased risk of falling. Although patients’ participation in establishing medical safety is considered crucial, there is limited evidence on their perspectives of falls. This study aims to comprehensively elucidate the subjective falling experience of patients with stroke who have been admitted to rehabilitation wards. Methods Twenty-three consecutive patients with stroke (44 to 90 years) who experienced a fall during hospitalisation were interviewed within 1 week after the fall, and thematic analysis was used to analyse the data. Results Five themes surrounding fall events were extracted from the narratives: ‘Psychological background before the action’, ‘Support for the action’, ‘Direct causes of the fall’, ‘Patients’ awareness after the fall’, and ‘Changes in attitudes and behaviours after the fall’. ‘Psychological background before the action’ comprised hastiness or hesitation to call for help. Participants often took an action based on ‘Support for the action’ derived from their past experiences of moving safely, their confidence, and/or motivation to challenge themselves to move. ‘Direct causes of the fall’ consisted of unfamiliar actions, training fatigue, the surrounding environment, reduced physical function due to paralysis, lack of attention, overconfidence in their ability, and insufficient prediction of falls. ‘Patients’ awareness after the fall’ consisted of re-affirming difficult movements, the need for rehabilitation, a reduced ability to move, an increased risk of falling, the need for attention while moving, a fear of falling, and a lack of lessons learned from falling. Finally, patients demonstrated ‘Changes in attitudes and behaviours after the fall’ such as embodying a positive attitude to cope with the risk of falling or behavioural changes to reduce the risk of falling. Conclusions Comprehensive information on patients’ perspectives before and after the fall was elucidated, uncovering many aspects including the psychological background for why patients engaged in risky behaviours resulting in falls, presence of positive thinking, and behaviour after the fall. By incorporating the patients’ views on fall incidences and their assessment, we can develop appropriate prevention strategies against falls.

scholarly journals Lessons Learned from Inherited Metabolic Disorders of Sulfur-Containing Amino Acids Metabolism

2020 ◽  
Vol 150 (Supplement_1) ◽  
pp. 2506S-2517S ◽  
Author(s):  
Viktor Kožich ◽  
Sally Stabler
Keyword(s):  
Amino Acids ◽  
Megaloblastic Anemia ◽  
Genetic Disorders ◽  
Lessons Learned ◽  
Metabolic Changes ◽  
B Vitamins ◽  
Enzyme Replacement ◽  
Increased Risk ◽  
Biallelic Mutations ◽  
Sulfur Containing

ABSTRACT The metabolism of sulfur-containing amino acids (SAAs) requires an orchestrated interplay among several dozen enzymes and transporters, and an adequate dietary intake of methionine (Met), cysteine (Cys), and B vitamins. Known human genetic disorders are due to defects in Met demethylation, homocysteine (Hcy) remethylation, or cobalamin and folate metabolism, in Hcy transsulfuration, and Cys and hydrogen sulfide (H2S) catabolism. These disorders may manifest between the newborn period and late adulthood by a combination of neuropsychiatric abnormalities, thromboembolism, megaloblastic anemia, hepatopathy, myopathy, and bone and connective tissue abnormalities. Biochemical features include metabolite deficiencies (e.g. Met, S-adenosylmethionine (AdoMet), intermediates in 1-carbon metabolism, Cys, or glutathione) and/or their accumulation (e.g. S-adenosylhomocysteine, Hcy, H2S, or sulfite). Treatment should be started as early as possible and may include a low-protein/low-Met diet with Cys-enriched amino acid supplements, pharmacological doses of B vitamins, betaine to stimulate Hcy remethylation, the provision of N-acetylcysteine or AdoMet, or experimental approaches such as liver transplantation or enzyme replacement therapy. In several disorders, patients are exposed to long-term markedly elevated Met concentrations. Although these conditions may inform on Met toxicity, interpretation is difficult due to the presence of additional metabolic changes. Two disorders seem to exhibit Met-associated toxicity in the brain. An increased risk of demyelination in patients with Met adenosyltransferase I/III (MATI/III) deficiency due to biallelic mutations in the MATIA gene has been attributed to very high blood Met concentrations (typically >800 μmol/L) and possibly also to decreased liver AdoMet synthesis. An excessively high Met concentration in some patients with cystathionine β-synthase deficiency has been associated with encephalopathy and brain edema, and direct toxicity of Met has been postulated. In summary, studies in patients with various disorders of SAA metabolism showed complex metabolic changes with distant cellular consequences, most of which are not attributable to direct Met toxicity.

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