Cautery selection for oculofacial plastic surgery in patients with implantable electronic devices

2018 ◽  
Vol 29 (3) ◽  
pp. 315-322
Author(s):  
Alexander D Blandford ◽  
Newton B Wiggins ◽  
Waseem Ansari ◽  
Catherine J Hwang ◽  
Bruce L Wilkoff ◽  
...  
Keyword(s):  
Plastic Surgery ◽  
Practice Patterns ◽  
Electronic Device ◽  
Statistical Significance ◽  
Electronic Devices ◽  
Comfort Level ◽  
Cardiac Implantable Electronic Device ◽  
Chi Square ◽  
Web Based ◽  
American Society

Purpose: To discover oculofacial plastic surgeon practice patterns for cautery selection in the setting of implantable electronic devices and present guidelines based on a review of current literature. Methods: A 10-Question web-based survey was sent to the email list serve of the American Society of Ophthalmic Plastic and Reconstructive Surgery to determine surgeon cautery preference in the setting of various implantable electronic devices and comfort level with the guidelines for cautery selection in their practice or institution. The relationship between survey questions was assessed for statistical significance using Pearson’s Chi-square tests. Results: Two hundred ninety-three (41% response rate) surveys were completed and included for analysis. Greater than half of respondents either had no policy (36%) or were unaware of a policy (19%) in their practice or institution regarding cautery selection in patients with a cardiac implantable electronic device. Bipolar cautery was favored for use in patients with a cardiac implantable electronic device (79%–80%) and this number dropped in patients with implantable neurostimulators (30%). Overall, one-third of respondents did not feel comfortable with their practice/institution policy. Conclusion: Choices and comfort level among oculofacial plastic surgeons for cautery selection in patients with implantable electronic devices vary considerably, and some choices may increase the risk for interference-related complications. Practice patterns vary significantly in the setting of a neurostimulator or cochlear implant, where interference can cause thermal injury to the brain and implant damage, respectively. Guidelines are proposed for cautery selection in patients with implantable electronic devices undergoing oculofacial plastic surgery.

scholarly journals Autopsy Utilization in Medicolegal Defense of Anesthesiologists

2011 ◽  
Vol 115 (4) ◽  
pp. 713-717 ◽  
Author(s):  
Lorri A. Lee ◽  
Linda S. Stephens ◽  
Corinne L. Fligner ◽  
Karen L. Posner ◽  
Frederick W. Cheney ◽  
...  
Keyword(s):  
Cause Of Death ◽  
Statistical Significance ◽  
Chi Square ◽  
Autopsy Findings ◽  
New Information ◽  
Malpractice Claims ◽  
Hospital Deaths ◽  
American Society ◽  
Chi Square Analysis ◽  
Closed Claims

Background The rate of autopsy in hospital deaths has declined from more than 50% to 2.4% over the past 50 yr. To understand the role of autopsies in anesthesia malpractice claims, we examined 980 closed claims for deaths that occurred in 1990 or later in the American Society of Anesthesiologists Closed Claims Project Database. Methods Deaths with autopsy were compared with deaths without autopsy. Deaths with autopsy were evaluated to answer the following four questions: Did autopsy findings establish a cause of death? Did autopsy provide new information? Did autopsy identify a significant nonanesthetic contribution to death? Did autopsy help or hurt the defense of the anesthesiologist? Reliability was assessed by κ scores. Differences between groups were compared with chi-square analysis and Kolmogorov-Smirnov test with P < 0.05 for statistical significance. Results Autopsies were performed in 551 (56%) of 980 claims for death. Evaluable autopsy information was available in 288 (52%) of 551 claims with autopsy. Patients in these 288 claims were younger and healthier than those in claims for death without autopsy (P < 0.01). Autopsy provided pathologic diagnoses and an unequivocal cause of death in 21% of these 288 claims (κ= 0.71). An unexpected pathologic diagnosis was found in 50% of claims with evaluable autopsy information (κ = 0.59). Autopsy identified a significant nonanesthetic contribution in 61% (κ = 0.64) of these 288 claims. Autopsy helped in the defense of the anesthesiologist in 55% of claims and harmed the defense in 27% (κ = 0.58) of claims with evaluable autopsy information. Conclusions Autopsy findings were more often helpful than harmful in the medicolegal defense of anesthesiologists. Autopsy identified a significant nonanesthetic contribution to death in two thirds of claims with evaluable autopsy information.

Avoiding implant complications in cardiac implantable electronic devices: what works?

EP Europace ◽  
2020 ◽  
Author(s):  
Maria Hee Jung Park Frausing ◽  
Mads Brix Kronborg ◽  
Jens Brock Johansen ◽  
Jens Cosedis Nielsen
Keyword(s):  
Primary Prevention ◽  
Electronic Device ◽  
Electronic Devices ◽  
Evidence Base ◽  
Cardiac Implantable Electronic Device ◽  
Cardiac Implantable Electronic Devices ◽  
What Works ◽  
Preventive Actions ◽  
Implant Complications ◽  
Patients Experience

Abstract Nearly one in ten patients experience complications in relation to cardiac implantable electronic device (CIED) implantations. CIED complications have serious implications for the patients and for the healthcare system. In light of the rising rates of new implants and consistent rate of complications, primary prevention remains a major concern. To guide future efforts, we sought to review the evidence base underlying common preventive actions made during a primary CIED implantation.

scholarly journals Education in plastic surgery: Are we headed in the right direction?

2014 ◽  
Vol 47 (01) ◽  
pp. 109-115 ◽  
Author(s):  
Nishant Khare ◽  
Vinita Puri
Keyword(s):  
Plastic Surgery ◽  
Statistical Significance ◽  
Maxillofacial Surgery ◽  
Aesthetic Surgery ◽  
Microvascular Surgery ◽  
Chi Square ◽  
Surgery Group ◽  
Group I ◽  
Group Ii ◽  
And Training

ABSTRACT Introduction: Plastic surgery in India is in an era of transition. The speciality faces many challenges as it grows. The present study attempts to identify these challenges and the prevalent mood among the teachers and the trainees. Materials and Methods: The study was conducted from September 2011 to June 2012. In an E-mail based survey a questionnaire was mailed to professionals actively involved in teaching and training of residents in plastic surgery in many institutes running MCh courses in plastic surgery (Group I) [Appendix 1]. Another questionnaire was mailed to residents undergoing training in plastic surgery and those who had completed their training within past 2 years (Group II) [Appendix 2]. Chi-square test was applied to test for statistical significance. Observations: 29 Group I and 33 Group II subjects responded to the questionnaire. While 72.4% teachers believed that the current system is producing plastic surgeons with enough skill level, only 9.1% of the respondents in Group II thought the same (Chi-square = 28.1; df = 2; P < 0.001). Whereas 58.6% Group I respondents thought that their student is sufficiently equipped to compete in today’s scenario [Figure 1], only 18.2% Group II respondents thought that their training is enough [Figure 2]. (Chi-square = 16.4; df = 2; P < 0.001). Nearly 28% respondents in Group I and only 3% in Group II thought that scientific research and publications should be made mandatory for successful completion of plastic surgery training (Chi-square = 9.4; df = 2; P = 0.009). Adequate exposure was thought to be available in general plastic surgery (Group I: 92% Group II: 81%), maxillofacial surgery (Group I: 72% Group II: 68%) and hand surgery (Group I: 84% Group II: 69%). Both groups agreed that exposure is lacking in craniofacial surgery, aesthetic surgery and microvascular surgery. Aesthetic surgery (38.7%) and microvascular surgery (32.6%) were the most frequent response when the Group II respondents were enquired about the subspeciality they would like to focus on in their practice. Inter-departmental exchange of students for limited period of time was favoured by 86.2% of Group I respondents and 93.9% Group II respondents (Chi-square = 1.3; df = 2; P = 0.49). Conclusion: The current training programme is differently perceived by teachers and the trainees. We recommend that constant deliberations at national and regional forums should take place regarding our education and training programmes.

Cardiac implantable electronic device remote monitoring in a large cohort of patients and the need for planning

2020 ◽  
Vol 16 (5) ◽  
pp. 447-456
Author(s):  
Franco Zoppo ◽  
Antonio Lupo ◽  
Giacomo Mugnai ◽  
Francesca Zerbo
Keyword(s):  
Atrial Fibrillation ◽  
Remote Monitoring ◽  
Electronic Device ◽  
Descriptive Analysis ◽  
Electronic Devices ◽  
Standard Of Care ◽  
Large Cohort ◽  
Cardiac Implantable Electronic Device ◽  
Cardiac Implantable Electronic Devices

Aim: The remote monitoring (RM) of cardiac implantable electronic devices (CIED) is standard of care. We describe an organizational and projection RM workload model. Methods: At the time of the analysis (2015), 3995 CIED patients were followed-up; 1582 (40.5%) with RM. All RM transmissions (Tx) have been gathered in five event types. Results: We received 10,406 Tx, classified as: 128 (1.2%) red alerts, 141 (1.3%) atrial fibrillation episodes, 1944 (18.6%) yellow alerts, 403 (3.9%) lost Tx (disconnected/noncompliant patients) and 7790 (75.0%) Tx ‘OK' (un-eventful Tx). At the time of 100% of remote CIED managed, we can expect a total of 25,990 Tx/year. Conclusion: We provide a descriptive analysis of remote monitoring management and workload estimation in a large cohort of CIED patients.

Abstract 103: A Meta Analysis of Antibiotic Envelope Use to Prevent Cardiac Implantable Electronic Device Infections

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Muhammad U Khan ◽  
Ahmad Naeem Lone ◽  
Muhammad Khan ◽  
shahul valavoor ◽  
Muhammad Munir ◽  
...  
Keyword(s):  
Infection Prevention ◽  
Electronic Device ◽  
Meta Analysis ◽  
Electronic Devices ◽  
Control Group ◽  
Preventive Strategy ◽  
Cardiac Implantable Electronic Device ◽  
Cardiac Implantable Electronic Devices ◽  
Device Infection ◽  
Effective Preventive Strategy

Introduction: Cardiac Implantable Electronic Device (CIED) infections are a major source of morbidity, mortality and increased healthcare cost. There are several well established risk factors associated with increased infection. An antibiotic coated envelope has been developed as an infection prevention intervention. Hypothesis: Whether antibiotic coated envelope is an effective preventive strategy against Cardiac Implantable Electronic Device Infections. Methods: 6 trials comparing use of antibiotic envelope to control, including 1 randomized trial and 5 cohort studies were selected using PubMed and Embase data bases through May 2019. The efficacy end point was prevention of CIED Infection. Outcomes were combined using random effects model and estimated by odds ratio with 95% confidence intervals (CI). Results: In our analysis of total 12,024 patients undergoing CIED implantation, 5,844 patients received antibiotic envelope while 6,180 patients were included in the control group. Antibiotic envelope was superior to control in reducing the risk of device infection (OR 0.40 CI [0.17-0.95], p=0.04). Conclusions: The use of antibiotic envelope in Cardiac Implantable Electronic Devices (CIED) is associated with reduced incidence of CIED infection.

scholarly journals Upper extremity dysfunctions in patients with cardiac implantable electronic devices: a systematic review

2021 ◽  
Vol 28 (7) ◽  
pp. 1-18
Author(s):  
Praveen Jayaprabha Surendran ◽  
Prasobh Jacob ◽  
Dineshkumar Selvamani ◽  
Theodoros Papasavvas ◽  
Narasimman Swaminathan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Range Of Motion ◽  
Upper Extremity ◽  
Electronic Device ◽  
Electronic Devices ◽  
Cochrane Central Register ◽  
Cardiac Implantable Electronic Device ◽  
Cardiac Implantable Electronic Devices ◽  
Shoulder Range Of Motion

Background/Aims The prevalence of cardiac implantable electronic devices has risen considerably during recent years. This has revolutionised the treatment of cardiac arrhythmias, which in turn reduced the incidence of sudden cardiac death. There are several complications associated with cardiac implantable electronic device implantation. Upper extremity dysfunction is one of the complications associated with this procedure and it should be addressed, since it can affect activities of daily living. This systematic review analysed the prevailing evidence pertaining to the common upper extremity dysfunctions associated with receiving a cardiac implantable electronic device. Methods A comprehensive literature search was conducted using PubMed, Cochrane Central Register of Controlled Trials, EMBASE (through Cochrane) and Google Scholar for original research published in the English language. The Rayyan QCRI web application was used for study selection and the decision-making process. PRISMA guidelines were used to conduct and report this review. The methodological quality of the included studies was appraised using the Newcastle–Ottawa Scale and Joanna Briggs Institute critical appraisal tool for analytic cross-sectional studies and case reports. Results This systematic review included eight studies with a total of 696 participants. The most common upper extremity dysfunctions associated with receiving a cardiac implantable electronic device were pain and limitation of shoulder range of motion. Limitation of range of motion could be persisted even in the long term after having a cardiac implantable electronic device implanted. Conclusions Contributing factors of upper extremity dysfunctions included size of the device, pectoral site of implantation and upper extremity immobilisation practices. Upper extremity dysfunction is an overlooked complication, as it received a relatively low priority, although it may negatively impact quality of life.

scholarly journals Cardiac Implantable Electronic Device Infections—Decision-Making Process in Complex Patients: Report of 3 Cases

2019 ◽  
Vol 7 ◽  
pp. 232470961983132
Author(s):  
Assad Mohammedzein ◽  
Aaisha Mozumder ◽  
Scott Milton
Keyword(s):  
Decision Making ◽  
Electronic Device ◽  
Early Recognition ◽  
Electronic Devices ◽  
Decision Making Process ◽  
High Morbidity ◽  
Entire System ◽  
Cardiac Implantable Electronic Device ◽  
Cardiac Implantable Electronic Devices ◽  
Complex Patients

Cardiac implantable electronic devices infections are becoming increasingly frequent with more of these devices being implanted in elderly patients with multiple comorbidities. They carry high morbidity and mortality if not treated promptly, which often entails removal of the entire system. Early recognition is paramount, and a multidisciplinary team is required. In this case report, we go through unique and challenging presentations of such patients with cardiac implantable electronic devices–related issues who presented to our institution, and we describe individual approaches to management and review the literature.

scholarly journals Customized Mobile App for Residents Rotating Through Pediatric Critical Care Unit

2022 ◽  
Author(s):  
Yu-shan Tseng ◽  
Ronald Thomas ◽  
Ajit Sarnaik
Keyword(s):  
Critical Care ◽  
Mobile Apps ◽  
Statistical Significance ◽  
Pediatric Intensive Care ◽  
Study Groups ◽  
Mobile App ◽  
Comfort Level ◽  
Control Group ◽  
Chi Square ◽  
Pediatric Critical Care

Abstract Introduction: Physicians use mobile apps for patient care, but few are dedicated to pediatric critical care medicine (PCCM). We developed an easy-to-use customized mobile app for PCCM residents. Our objectives were to evaluate whether this mobile app will improve residents' confidence in PCCM knowledge and comfort level in the pediatric intensive care unit (PICU).Methods: We recruited 90 residents from March 2020 to April 2021 for this prospective survey-based, block-randomized, single-center study with a pre-post study design. Participants completed 20-question quizzes at the beginning and end of the rotation. T-test was used to compare the pre-post quiz score difference between the two groups of residents (those with and without the app). At the end of the rotation, subjects also completed a survey with 5-point Likert scale items to compare their comfort level in PICU and confidence in PCCM knowledge pre- and post-rotation.Results: There was a significantly increased improvement in the post-block quiz from the pre-block quiz in the mobile app group compared to the control group (an increase of 0.23 questions vs 1.67, p=0.045). There was a trend of increased improvement in confidence in pediatric critical care knowledge for the App group; however, the difference did not reach statistical significance by Pearson's Chi-square test (p=0.246). Similarly, there was no statistical difference between the two study groups for change in Comfort Level in PICU from the baseline level.Conclusion: Implementation of a service-specific mobile app may enhance residents' clinical experience and improve self-efficacy. Further investigation is warranted.

scholarly journals Knowledge, attitude and practice study on awareness and preventing cyber threats among the electronic devices used by the doctors of government medical college Vellore, Tamil Nadu, India

2019 ◽  
Vol 7 (1) ◽  
pp. 283
Author(s):  
Balaji J. ◽  
Ganesh G.
Keyword(s):  
Logistic Regression ◽  
Cyber Security ◽  
Tamil Nadu ◽  
Statistical Significance ◽  
Electronic Devices ◽  
Government Medical College ◽  
Chi Square ◽  
Cross Sectional ◽  
External Resources ◽  
Medical College

Background: Now a days the whole World is submerged with digital electronics devices round the clock for all utilities. Even the doctor community also is not spared by these digital gadgets. Almost every doctor in India is permanently having and operating a smart phone and laptops or desktops plus vide computer applications.Methods: This cross-sectional study was conducted among 45 doctors across 7 departments of Government Medical College, Vellore. Mean, median, mode, standard deviation was used for quantitative data and Pearson chi square test and logistic regression was used for qualitative data using trial version of SPSS 22.Results: The mean score was 11.2±2.8 with mean scoring percentile of 38.8±6.5. There was Pearsons Chi square significance for Variables like exposure to external resources and, Books related to cyber security, age less than 34 years and average spending time with electronic devices >2.5 hours per day, designation MD versus MBBS, gender difference.Conclusions: On running logistic regression the multivariate analysis for study variables with statistical significance was seen for four variables- exposure to external resources, and books related to cyber security, age <34 years, average spending time with electronic devices >2.5 hours per day. Designation and gender variables lost their significance on logistic regression analysis.

scholarly journals Identifying At‐Risk Patients for Sustained Atrial High‐Rate Episodes Using the C 2 HEST Score: The West Birmingham Atrial Fibrillation Project

2021 ◽  
Vol 10 (6) ◽  
Author(s):  
Yan‐Guang Li ◽  
Daniele Pastori ◽  
Kazuo Miyazawa ◽  
Farhan Shahid ◽  
Gregory Y. H. Lip
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Electronic Device ◽  
Electronic Devices ◽  
Systolic Heart Failure ◽  
High Rate ◽  
Cardiac Implantable Electronic Device ◽  
The West ◽  
Cardiac Implantable Electronic Devices ◽  
Increased Risk

Background Sustained atrial high‐rate episodes (SAHREs) among individuals with a cardiac implantable electronic device are associated with an increased risk of adverse outcomes. Risk stratification for the development of SAHREs has never been investigated. We aimed to assess the performance of the C 2 HEST (coronary artery disease or chronic obstructive pulmonary disease [1 point each], hypertension [1 point], elderly [age ≥75 years, 2 points], systolic heart failure [2 points], thyroid disease [1 point]) score in predicting SAHREs in patients with cardiac implantable electronic devices without atrial fibrillation. Methods and Results Five Hundred consecutive patients with cardiac implantable electronic devices in the West Birmingham Atrial Fibrillation Project in the United Kingdom were followed since the procedure to observe the development of SAHREs, defined by atrial high‐rate episodes lasting >24 hours. Risk factors and incidence of SAHREs were analyzed. The predictive value of the C 2 HEST score for SAHRE prediction was evaluated. Over a mean follow‐up of 53.1 months, 44 (8.8%) patients developed SAHREs. SAHREs were associated with higher all‐cause mortality ( P <0.001) and ischemic stroke ( P =0.001). Age and heart failure were associated with SAHRE occurrence. The incidence of SAHREs increased by the C 2 HEST score (39% higher risk per point increase). Among patients with a C 2 HEST score ≥4, the incidence of SAHREs was 3.62% per year (95% CI, 2.14–5.16). The C 2 HEST score had moderate predictive capability (area under the curve, 0.73; 95% CI, 0.64–0.81) and discriminative ability (log‐rank P =0.003), which was better than other clinical scores (CHA 2 DS 2 ‐VASc, CHADS 2 , HATCH). Conclusions The C 2 HEST score predicted SAHRE incidence in patients without atrial fibrillation who had an cardiac implantable electronic device, with the highest risk seen in patients with a C 2 HEST score ≥4 The benefit of using the C 2 HEST score in clinical practice in this patient population needs further investigation.

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