P5281Synthetic extracellular volume quantification by cardiac magnetic resonance imaging - a reliable tool in clinical practice?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Unbehaun ◽  
S Nunn ◽  
J Vietheer ◽  
J S Wolter ◽  
L Zipse ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Blood Sample ◽  
Linear Regression Analysis ◽  
Tertiary Care ◽  
Extracellular Volume ◽  
Patient Characteristics ◽  
Blood Pool ◽  
Tertiary Care Centre ◽  
Post Contrast ◽  
Myocardial Diseases

Abstract Background Extracellular volume (ECV) quantification by CMR imaging allows the measurement of changes in the extracellular space indicating diffuse edema and fibrosis, especially in early stages of myocardial disease. Usually venous hematocrit (Hct) is needed in order to calculate standard ECV. Recent findings suggest the alternative use of the blood pool T1-relaxation time (T1blood) instead of the venous Hct to generate “synthetic Hct ” and furthermore “synthetic ECV”, allowing a more routine and user-friendly application without the need of a current blood sample. Purpose Purpose of this study is to re-evaluate whether the connection between venous Hct and T1blood can be used to generate a synthetic ECV in a large number of volunteers and patients with various myocardial diseases from a tertiary care centre. Methods 945 volunteers and patients were divided into a derivation (n=490) and a validation group (n=455). Standard ECV was calculated using T1-relaxtion times acquisitioned in the septal myocardium and blood pool, each on pre- and post-contrast Images using a modified look-locker sequence at a 3 Tesla MR-scanner. In addition venous Hct was measured in a blood sample drawn prior to the scan. Synthetic Hct was derived through linear regression analysis between venous Hct and 1/T1blood and was then compared to venous Hct. Also we derived standard ECV and synthetic ECV and examined these using Lin's rho and Bland-Altman comparison. Results In the derivation group venous Hct and 1/T1blood showed a linear relationship (R2=0,22; p=ehz746.02521). This was used to calculate synthetic Hct and synthetic ECV. Synthetic ECV correlated well with standard ECV (Lin's rho= 0,903; p<0,0001). Mean difference 0,004, limits of agreement −0,038 and 0,047. See table 1 for patient characteristics and figure 1 for Bland-Altman plot on standard and synthetic ECV. Table 1. Patient characteristics Sex female (%) 312 (33%) Age, yrs 60±15 EDVi, ml/m2 86±31 ESVi, ml/m2 43±30 LVEF, % 54±16 Hematocrit, % 43±5 Figure 1 Conclusion Despite only weak correlation of synthetic and venous Hct we found excellent correlation in synthetic and standard ECV. Therefore we could confirm the value of synthetic ECV in a large cohort of volunteers and patients, providing a feasible and non-invasive marker for extracellular myocardial alterations in everyday clinical practice.

scholarly journals P107: Understanding the sensory experience of performing a rare, high-stakes clinical procedure: a qualitative study of clinicians with lived experience

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S102-S103
Author(s):  
J. Riggs ◽  
M. McGowan ◽  
C. Hicks
Keyword(s):  
Clinical Practice ◽  
Data Collection ◽  
Lived Experience ◽  
Skill Acquisition ◽  
Qualitative Content Analysis ◽  
Tertiary Care ◽  
Mental Practice ◽  
Tertiary Care Centre ◽  
High Stakes ◽  
Qualitative Interview Study

Introduction: Emergency physicians (EP) are expected to be competent in a variety of uncommon but life-saving procedures, including the bougie assisted cricothyrotomy (BAC). Given the rarity and high-stakes nature of the BAC, simulation is often used as the primary learning and training modality. However, mental practice (MP), defined as the “cognitive rehearsal of a skill in the absence of overt physical movement”, has been shown to be as effective as physical practice in several areas, including athletics, music, team-based resuscitation and surgical skill acquisition. MP scripts incorporate cues from different sensory modalities to supplement instructions of how to complete the skill. We sought to explore EPs perspectives on the kinesthetic, visual and cognitive aspects of performing a BAC to inform the development of a MP BAC script. Methods: We undertook a qualitative interview study of EPs at a single tertiary care centre who had done a BAC in clinical practice. Participants were recruited using purposive sampling. The primary method for data collection was in-depth semi-structured qualitative interviews, which were recorded and transcribed verbatim. Data collection and analysis were concurrent; transcripts were coded independently by two researchers using qualitative content analysis on a coding framework based on the previously developed BAC checklist. At each procedural step, the kinesthetic, visual and cognitive cues that enhance MP were identified. Results: Eight EPs (5 staff; 3 Royal College residents) participated in the interviews. All participants had completed at least one BAC in their clinical practice. Data analysis revealed recurrent themes signifying successful completion of each procedural step. These include visual (ie. seeing a spray of blood upon entry into the airway) and kinesthetic (ie. feel of the tracheal rings on a finger) cues that describe aspects of the procedure not found in traditional teaching modalities, such as textbooks. Conclusion: Knowledge gleaned from the interviews of EPs with lived experience gives us a deeper insight into the sensory aspects of performing a BAC in clinical practice. We expect that using these experientially derived cues to inform the development of a MP script will increase its validity and applicability to learners and for skill maintenance. Future work includes evaluating the utility of the developed script in acquiring and maintaining competence performing the BAC.

scholarly journals The impact of the COVID-19 pandemic on microbial keratitis presentation patterns

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256240
Author(s):  
Gibran F. Butt ◽  
Alberto Recchioni ◽  
George Moussa ◽  
James Hodson ◽  
Graham R. Wallace ◽  
...  
Keyword(s):  
Time Windows ◽  
Tertiary Care ◽  
Patient Characteristics ◽  
Microbial Keratitis ◽  
Tertiary Care Centre ◽  
Culture Positivity ◽  
Equivalent Time ◽  
Sight Loss ◽  
The Difference ◽  
The Impact

Background Microbial keratitis (MK) is the most common non-surgical ophthalmic emergency, and can rapidly progress, causing irreversible sight-loss. This study explored whether the COVID-19 (C19) national lockdown impacted upon the clinical presentation and outcomes of MK at a UK tertiary-care centre. Methods Medical records were retrospectively reviewed for all patients with presumed MK requiring corneal scrapes, presenting between 23rd March and 30th June in 2020 (Y2020), and the equivalent time windows in 2017, 2018 and 2019 (pre-C19). Results In total, 181 and 49 patients presented during the pre-C19 and Y2020 periods, respectively. In Y2020, concurrent ocular trauma (16.3% vs. 5.5%, p = 0.030) and immunosuppression use (12.2% vs 1.7%, p = 0.004) were more prevalent. Despite proportionately fewer ward admissions during the pandemic (8.2% vs 32.6%, p<0.001), no differences were observed in baseline demographics; presenting visual acuity (VA; median 0.6 vs 0.6 LogMAR, p = 0.785); ulcer area (4.0 vs 3.0mm2, p = 0.520); or final VA (0.30 vs 0.30 LogMAR, p = 0.990). Whilst the overall rates of culture positivity were similar in Y2020 and pre-C19 (49.0% vs. 54.7%, p = 0.520), there were differences in the cultures isolated, with a lower rate of poly-microbial cultures in Y2020 (8.3% vs. 31.3%, p = 0.022). Conclusions Patient characteristics, MK severity and final visual outcomes did not appear to be affected in the first UK lockdown, despite fewer patients being admitted for care. Concurrent trauma and systemic immunosuppression use were greater than in previous years. The difference in spectra of isolated organisms may relate to behavioural changes, such as increased hand hygiene.

LIMBERG FLAP A BETTER METHOD OF CLOSURE OF LUMBAR MYELOMENINGOCELE DEFECTS: A PROSPECTIVE STUDY

2021 ◽  
pp. 3-4
Author(s):  
Prem Shanker ◽  
Raghavendra Gupta ◽  
Rajesh Kumar ◽  
Adiveeth Deb
Keyword(s):  
Tertiary Care ◽  
Wound Dehiscence ◽  
Patient Characteristics ◽  
Csf Leak ◽  
Controlled Study ◽  
Limberg Flap ◽  
Tertiary Care Centre ◽  
Direct Repair ◽  
Group B ◽  
A Prospective Study

Background: Myelomeningocele is the most common and complex congenital malformation of the central nervous system with an incidence of approximately 1 in 1000 live births. The lumbosacral area is the commonest site for defect. Early closure of a myelomeningocele defect is advocated because it reduces infection rates even though it is not associated with an improved neurological outcome. Aims & objectives: The aim of this study was to evaluate the effectiveness and outcome of direct repair and a Limberg ap repair for skin defects that occur in myelomeningocele. Settings and Design: This was a prospective, randomized controlled study. Material and methods: A tertiary care centre based, non-randomized, prospective, comparative study was conducted in the Department of Neurosurgery, GSVM Medical College, Kanpur, from January 2018 to October 2019, in 22 patients with lumbar myelomeningocele. 7 patients who underwent Limberg ap repair constituted Group A and 15 patients who underwent direct repair constituted Group B. Post operatively the outcomes were compared at 6 months, on the basis of cosmetic appearance and complications such as wound dehiscence, CSF leak, neurological decit, hydrocephalus, necrosis and wound infection. Results : Lesser complications and a better cosmetic outcome were seen post operatively at 6 months with Limberg ap technique compared to direct repair. Our study show better result with Limberg ap over direct repair of myelomeningocele defect closure up to the follow up period of 6 months. Conclusion: Because of various defect sizes and patient characteristics, no single protocol exists for the reconstruction of myelomeningocele defects. Most lumbar myelomeningocele defects can be managed by direct skin repair alone. In cases of large defects, in which direct repair is not possible, local aps may be used to cover the defect. Overall, Limberg ap is a better technique for closure in these patients.

scholarly journals Rivaroxaban Experience at Tertiary Care Centre in Saudi Arabia:A Retrospective Observational Study

2020 ◽  
Vol 9 ◽  
pp. 1882
Author(s):  
Muhammad Riazuddin ◽  
Mohamed Ahmed Mpharm ◽  
Muhammad Imran Butt ◽  
Muhammad Abufarhaneh ◽  
Shahid Masud Khan ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Major Bleeding ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Tertiary Care ◽  
Tertiary Referral ◽  
Bleeding Events ◽  
Tertiary Referral Hospital ◽  
Tertiary Care Centre

Background: Atrial fibrillation (AF) and Venous Thromboembolism (VTE) are significant causes of morbidity and mortality. Direct oral anticoagulants (DOACs) are as effective as vitamin K antagonists (VKAs) with a propensity to cause less major bleeding. This study aimed to assess the safety and effectiveness of rivaroxaban in routine clinical practice in a large tertiary referral center in Saudi Arabia. Methods and Materials: In this study, patients who received rivaroxaban at a tertiary referral hospital were included in this study. All adverse events were recorded, including major bleeding, non-major bleeding events, symptomatic thromboembolic events (deep vein thrombosis, pulmonary embolism) and all-cause death. Results: A total of 509 patients were prescribed rivaroxaban during the study period. The most common indication for rivaroxaban was non-valvular AF (65.3%) and VTE (34.7%). The mean age was 60.4 ± 16.4 years, and 50.8% were female. The median CHA2DS2-Vasc score was 2.1 in patients on rivaroxaban for non-valvular AF. Bleeding occurred in 72 (14.1%) patients, of which 20 (3.9%) had major bleeds. Thrombosis events occurred in 13 (2.5%) patients in the overall cohort. Fourteen (2.7%) patients died during the study, including a case of fatal bleeding secondary to rivaroxaban. Conclusion: This study describes the use of rivaroxaban in a broad patient population in clinical practice in the Middle East. The overall bleeding and thrombosis rates in this study were comparable to those seen in major clinical trials.  [GMJ.2020;9:e1882] DOI:10.31661/gmj.v9i0.1882 

scholarly journals Observational study of the epidemiology and outcomes of vancomycin-resistant Enterococcus bacteraemia treated with newer antimicrobial agents

2010 ◽  
Vol 139 (9) ◽  
pp. 1342-1350 ◽  
Author(s):  
J. A. McKINNELL ◽  
M. PATEL ◽  
R. M. SHIRLEY ◽  
D. F. KUNZ ◽  
S. A. MOSER ◽  
...  
Keyword(s):  
Antimicrobial Agents ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Patient Characteristics ◽  
Tertiary Care Centre ◽  
Multivariable Analyses ◽  
Vancomycin Resistant ◽  
Poor Outcomes ◽  
Relationship Of ◽  
The Relationship

SUMMARYVancomycin-resistant Enterococcus bloodstream infections (VRE-BSI) are a growing problem with few clinical trials to guide therapy. We conducted a retrospective study of management and predictors of mortality for VRE-BSI at a tertiary-care centre from January 2005 to August 2008. Univariate and multivariable analyses examined the relationship of patient characteristics and antibiotic therapy with 30-day all-cause mortality. Rates of VRE-BSI increased from 0·06 to 0·17 infections/1000 patient-days (P=0·03). For 235 patients, 30-day mortality was 34·9%. Patients were primarily treated with linezolid (44·2%) or daptomycin (36·5%). Factors associated with mortality were haemodialysis [odds ratio (OR) 3·2, 95% confidence interval (CI) 1·6–6·3, P=0·007], mechanical ventilation (OR 3·7, 95% CI 1·3–10·4, P=0·01), and malnutrition (OR 2·0, 95% CI 1·0–4·0, P=0·046). Use of linezolid, but not daptomycin (P=0·052) showed a trend towards an association with survival. In conclusion, VRE-BSI is a growing problem, associated with significant 30-day mortality. Multiple factors were associated with poor outcomes at our hospital.

scholarly journals Extracellular volume quantification using synthetic haematocrit assessed from native and post-contrast longitudinal relaxation T1 times of a blood pool

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lukas Opatril ◽  
Roman Panovsky ◽  
Jan Machal ◽  
Tomas Holecek ◽  
Lucia Masarova ◽  
...  
Keyword(s):  
Relaxation Time ◽  
Volume Fraction ◽  
Extracellular Volume ◽  
Relaxation Times ◽  
Extracellular Volume Fraction ◽  
Blood Pool ◽  
Coefficient Of Determination ◽  
Post Contrast ◽  
T1 Relaxation ◽  
Before And After

Abstract Background In terms of cardiovascular magnetic resonance are haematocrit values required for calculation of extracellular volume fraction (ECV). Previously published studies have hypothesized that haematocrit could be calculated from T1 blood pool relaxation time, however only native T1 relaxation time values have been used and the resulting formulae had been both in reciprocal and linear proportion. The aim of the study was to generate a synthetic haematocrit formula from only native relaxation time values first, calculate whether linear or reciprocal model is more precise in haematocrit estimation and then determine whether adding post-contrast values further improve its precision. Methods One hundred thirty-nine subjects underwent CMR examination. Haematocrit was measured using standard laboratory methods. Afterwards T1 relaxation times before and after the application of a contrast agent were measured and a statistical relationship between these values was calculated. Results Different linear and reciprocal models were created to estimate the value of synthetic haematocrit and ECV. The highest coefficient of determination was observed in the combined reciprocal model “− 0.047 + (779/ blood native) − (11.36/ blood post-contrast)”. Conclusions This study provides more evidence that assessing synthetic haematocrit and synthetic ECV is feasible and statistically most accurate model to use is reciprocal. Adding post-contrast values to the calculation was proved to improve the precision of the formula statistically significantly.

scholarly journals Adherence to coronary artery disease secondary prevention medicines: exploring modifiable barriers

Open Heart ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. e000997 ◽  
Author(s):  
Rani Khatib ◽  
Kay Marshall ◽  
Jon Silcock ◽  
Claire Forrest ◽  
Alistair S Hall
Keyword(s):  
Coronary Artery Disease ◽  
Clinical Practice ◽  
Coronary Artery ◽  
Secondary Prevention ◽  
Tertiary Care ◽  
Self Report ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Modifiable Factors ◽  
Artery Disease

BackgroundNon-adherence to secondary prevention medicines (SPMs) among patients with coronary artery disease (CAD) remains a challenge in clinical practice. This study attempted to identify actual and potential modifiable barriers to adherence that can be addressed in cardiology clinical practice.MethodsThis was a cross-sectional, postal survey-based study of the medicines-taking experience of patients with CAD treated at a secondary/tertiary care centre. All participants had been on SPM for ≥3 months.ResultsIn total, 696 eligible patients were sent the survey and 503 responded (72.3%). The median age was 70 years, and 403 (80.1%) were male; the median number of individual daily doses of all medicines was 6. The rate of non-adherence to at least one SPM was 43.5% (n=219), but 53.3% of reported non-adherence was to only one SPM. Statins contributed to 66.7% and aspirin to 61.7% of overall non-adherence identified by the Single Question (SQ) tool. In 30.8% of non-adherent patients (n=65), this was at least partly intentional. Barriers included forgetfulness (84.9%; n=186), worry that medicines will do more harm than good (33.8%; n=74), feeling hassled about medicines taking (18.7%; n=41), feeling worse when taking medicines (14.2%; n=31) and not being convinced of the benefit of medicines (9.1%; n=20). In a multivariate analysis, modifiable factors associated with overall non-adherence included being prescribed aspirin (OR: 2.22; 95% CI: 1.18 to 4.17), having specific concern about SPM (OR: 1.12; 95% CI: 1.07 to 1.18) and issues with repeat prescriptions (OR: 2.48; 95% CI: 1.26 to 4.90). Different factors were often associated with intentional versus unintentional non-adherence.ConclusionsUsing appropriate self-report tools, patients share actual and potential modifiable barriers to adherence that can be addressed in clinical practice. Non-adherence behaviour was selective. Most non-adherence was driven by forgetfulness, concern about the harm caused by SPM and practical barriers.

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