Clinical Implementation of TG-203 for Patients With Implanted Cardiac Devices at One Institution

The use of implantable electronic cardiac devices is increasing. Post-implantation follow-up is important for monitoring both device function and patient condition; however, clinical practice is inconsistent. For example, implantable cardioverter–defibrillator follow-up schedules vary from every three months to yearly according to facility and physician preference and the availability of resources. Importantly, no surveillance occurs between follow-up visits. By contrast, implantable devices with automatic remote monitoring capability provide a means for performing constant surveillance, with the ability to identify salient problems rapidly. The Lumos-T Reduces Routine Office Device Follow-up Study (TRUST) demonstrated that remote home monitoring reduced clinic burden and allowed early detection of patient and/or system problems, enabling efficient monitoring and an opportunity to enhance patient safety. The results of the trial have significant implications for the management of patients receiving all forms of implantable electronic cardiac device.

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Clinicians’ Knowledge and Attitudes About Delirium Detection and Management

Innovation in Aging ◽

10.1093/geroni/igaa057.1676 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 519-520

Author(s):

Priyanka Shrestha ◽

Erica Husser ◽

Diane Berish ◽

Long Ngo ◽

Marie Boltz ◽

...

Keyword(s):

Rating Scale ◽

P Value ◽

Clinical Implementation ◽

Chi Square ◽

Response Options ◽

Knowledge And Attitudes ◽

Point Rating Scale ◽

Life Threatening ◽

Strongly Agree ◽

High Level

Abstract Delirium is a serious and potentially life-threatening problem, but it remains clinically under-recognized. Various factors contribute to this under-recognition, including limited understanding of delirium, insufficient training and application of delirium assessments, potential stigma for the patient and increased workload for the clinician. As a part of an NIH funded study testing a rapid two-step delirium identification protocol at two hospitals in the U.S. (one urban and one rural), clinicians completed a 12-item survey to assess their knowledge and attitudes about delirium and their confidence in preventing and managing delirium. Survey response options followed a 5-point rating scale (strongly disagree, disagree, undecided, agree, strongly agree). The sample for this analysis included 399 clinicians (MDs=53; RNs=235; CNAs=111). Chi-square was used to test for group differences between clinician types. Less than half of the clinicians reported agreeing with the statement, “delirium is largely preventable” (MDs: 47%; RN: 44%; CNA: 41%, p-value=0.021). MDs and RNs indicated a high level of confidence in recognizing delirium while CNAs endorsed lower levels of confidence (MDs: 87%; RN: 81%; CNA: 65%, p-value=0.001). All types of clinicians reported lower confidence in managing delirium (MDs: 29%; RN: 36%; CNA: 44%, p-value=0.117). 47% of CNAs and 37% of RNs agreed there is a need for additional training in caring for persons with delirium while only 21% of MDs agreed (p = 0.031). Understanding how different types of clinicians think and feel about delirium will inform training and communication initiatives, clinical implementation, and research on best practices for delirium identification and management.

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Theory-based approach to developing an implementation plan to support the adoption of a patient decision aid for Down syndrome prenatal screening

Implementation Science ◽

10.1186/s13012-021-01103-5 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Titilayo Tatiana Agbadjé ◽

Matthew Menear ◽

Marie-Pierre Gagnon ◽

France Légaré

Keyword(s):

Prenatal Care ◽

Knowledge Translation ◽

Pregnant Women ◽

Decision Aid ◽

Prenatal Screening ◽

Clinical Implementation ◽

Implementation Plan ◽

Translation Strategies ◽

Knowledge To Action ◽

Knowledge Translation Strategies

Abstract Background Our team has developed a decision aid to help pregnant women and their partners make informed decisions about Down syndrome prenatal screening. However, the decision aid is not yet widely available in Quebec’s prenatal care pathways. Objective We sought to identify knowledge translation strategies and develop an implementation plan to promote the use of the decision aid in prenatal care services in Quebec, Canada. Methods Guided by the Knowledge-to-Action Framework and the Theoretical Domains Framework, we performed a synthesis of our research (11 publications) on prenatal screening in Quebec and on the decision aid. Two authors independently reviewed the 11 articles, extracted information, and mapped it onto the Knowledge-to-Action framework. Using participatory action research methods, we then recruited pregnant women, health professionals, managers of three prenatal care services, and researchers to (a) identify the different clinical pathways followed by pregnant women and (b) select knowledge translation strategies for a clinical implementation plan. Then, based on all the information gathered, the authors established a consensus on strategies to include in the plan. Results Our knowledge synthesis showed that pregnant women and their partners are not sufficiently involved in the decision-making process about prenatal screening and that there are numerous barriers and facilitators of the use of the decision aid in clinical practice (e.g., low intention to use it among health providers). Using a participatory action approach, we met with five pregnant women, three managers, and six health professionals. They informed us about three of Quebec’s prenatal care pathways and helped us identify 20 knowledge translation strategies (e.g., nurse discusses decision aid with women before they meet the doctor) to include in a clinical implementation plan. The research team reached a consensus about the clinical plan and also about broader organizational strategies, such as training healthcare providers in the use of the decision aid, monitoring its impact (e.g., measure decisional conflict) and sustaining its use (e.g., engage key stakeholders in the implementation process). Conclusion Next steps are to pilot our implementation plan while further identifying global strategies that target institutional, policy, and systemic supports for implementation.

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649. Clinical Implementation of a Rapid Susceptibility Testing Procedure, Directly From a Positive Blood Culture Using the Vitek®2 System on Gram Negative Rods

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.843 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S383-S383

Author(s):

Charma Henry ◽

Dustin Evans ◽

Daniel Navas ◽

Arleen Barker ◽

Chonnapat Somyos ◽

...

Keyword(s):

Blood Culture ◽

Positive Blood Culture ◽

Susceptibility Testing ◽

Testing Procedure ◽

Turnaround Time ◽

National Average ◽

Major Error ◽

Clinical Implementation ◽

Salmonella Spp ◽

Gram Negative

Abstract Background The national average of identification and susceptibility for organisms isolated from positive blood culture to final susceptibility based on growth on solid media is 48 hours. The goal of this research was to prove that the Vitek®2 (bioMérieux, Inc.) system can provide an accurate and reliable susceptibility result directly from positive blood culture for Gram negative rods and reduce the turnaround time (TAT) from positive blood culture to the final susceptibility. Methods An FDA-modified validation procedure was performed on positive blood cultures directly from the bottle to the VITEK®2 System for susceptibility testing. The protocol tested and validated an aliquot of 50uL of blood directly from the positive bottle into 10 mL of saline (1:200). The solution was vortexed and 3mL were placed in the VITEK®2 test tube. This protocol was intended only for Gram negative rods using the AST-GN70, AST-GN81 & AST-GN801 cards. This protocol followed the CLSI M52 and M100 guidelines. Results 515 organisms from clinical blood culture samples from July 2018 to October 2019 were evaluated. Organisms included, but were not limited to: E. coli, K. pneumoniae, Enterobacter spp., and P. aeruginosa, Proteus spp., Salmonella spp., Acinetobacter spp., and S. maltophilia. There were 5,201 drug/bug combinations. AdventHealth Orlando achieved an essential agreement of 99.32% (n=5,166), minor error 0.74% (n=39) major error 0.02% (n=1) and very major error 0.49% (n=2). A 100% agreement was achieved on detection of ESBL, CRE, and MDR organisms. Conclusion Rapid direct blood culture protocol using the VITEK®2 System and the AST-GN cards is accurate, reliable and can be performed with less than 1 minute hands-on time. The protocol can be implemented in any laboratory at no additional costs or modification where the current VITEK®2 AST-GN panels are in use. This protocol was clinically implemented at AdventHealth Orlando on July 15, 2019. Compared with the national average of 72 hours, the TAT obtained during this study was 23 hours from positive blood culture to final susceptibility, a significant reduction of 25 hours. The authors encourage bioMérieux Inc. to evaluate and explore the opportunity to expand the use of the VITEK®2 system for this application with the appropriate clinical trial. Disclosures All Authors: No reported disclosures

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Leadless and Wireless Cardiac Devices: The Next Frontier in Remote Patient Monitoring

Current Problems in Cardiology ◽

10.1016/j.cpcardiol.2021.100800 ◽

2021 ◽

Vol 46 (5) ◽

pp. 100800

Author(s):

Abdulaziz Joury ◽

Tamunoinemi Bob-Manuel ◽

Alexandra Sanchez ◽

Fnu Srinithya ◽

Amber Sleem ◽

...

Keyword(s):

Patient Monitoring ◽

Remote Patient Monitoring ◽

Cardiac Devices ◽

Remote Patient

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The Effects of Compression on the Detection of Atrial Fibrillation in ECG Signals

Applied Sciences ◽

10.3390/app11135908 ◽

2021 ◽

Vol 11 (13) ◽

pp. 5908

Author(s):

Raquel Cervigón ◽

Brian McGinley ◽

Darren Craven ◽

Martin Glavin ◽

Edward Jones

Keyword(s):

Atrial Fibrillation ◽

Characteristic Curve ◽

Set Partitioning ◽

Constrained Systems ◽

Battery Life ◽

Detection Accuracy ◽

Ecg Signal ◽

Signal Compression ◽

Ecg Signals ◽

Cardiac Devices

Although Atrial Fibrillation (AF) is the most frequent cause of cardioembolic stroke, the arrhythmia remains underdiagnosed, as it is often asymptomatic or intermittent. Automated detection of AF in ECG signals is important for patients with implantable cardiac devices, pacemakers or Holter systems. Such resource-constrained systems often operate by transmitting signals to a central server where diagnostic decisions are made. In this context, ECG signal compression is being increasingly investigated and employed to increase battery life, and hence the storage and transmission efficiency of these devices. At the same time, the diagnostic accuracy of AF detection must be preserved. This paper investigates the effects of ECG signal compression on an entropy-based AF detection algorithm that monitors R-R interval regularity. The compression and AF detection algorithms were applied to signals from the MIT-BIH AF database. The accuracy of AF detection on reconstructed signals is evaluated under varying degrees of compression using the state-of-the-art Set Partitioning In Hierarchical Trees (SPIHT) compression algorithm. Results demonstrate that compression ratios (CR) of up to 90 can be obtained while maintaining a detection accuracy, expressed in terms of the area under the receiver operating characteristic curve, of at least 0.9. This highlights the potential for significant energy savings on devices that transmit/store ECG signals for AF detection applications, while preserving the diagnostic integrity of the signals, and hence the detection performance.

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Gut Microbiota and Host Metabolism: From Proof of Concept to Therapeutic Intervention

Microorganisms ◽

10.3390/microorganisms9061302 ◽

2021 ◽

Vol 9 (6) ◽

pp. 1302

Author(s):

Patrice D. Cani ◽

Emilie Moens de Hase ◽

Matthias Van Hul

Keyword(s):

Gut Microbiota ◽

Research Field ◽

Proof Of Concept ◽

Clinical Implementation ◽

Science Area ◽

Microbiome Research ◽

Fast Pace ◽

Health And Disease ◽

Underlying Mechanisms ◽

Host Metabolism

The field of the gut microbiota is still a relatively young science area, yet many studies have already highlighted the translational potential of microbiome research in the context of human health and disease. However, like in many new fields, discoveries are occurring at a fast pace and have provided new hope for the development of novel clinical applications in many different medical conditions, not in the least in metabolic disorders. This rapid progress has left the field vulnerable to premature claims, misconceptions and criticism, both from within and outside the sector. Tackling these issues requires a broad collaborative effort within the research field and is only possible by acknowledging the difficulties and challenges that are faced and that are currently hindering clinical implementation. These issues include: the primarily descriptive nature of evidence, methodological concerns, disagreements in analysis techniques, lack of causality, and a rather limited molecular-based understanding of underlying mechanisms. In this review, we discuss various studies and models that helped identifying the microbiota as an attractive tool or target for developing various translational applications. We also discuss some of the limitations and try to clarify some common misconceptions that are still prevalent in the field.

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