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https://www.readbyqxmd.com/read/28528621/using-lean-to-rapidly-and-sustainably-transform-a-behavioral-health-crisis-program-impact-on-throughput-and-safety
#1
Margaret E Balfour, Kathleen Tanner, Paul J Jurica, Dawn Llewellyn, Robert G Williamson, Chris A Carson
BACKGROUND: Lean has been increasingly applied in health care to reduce waste and improve quality, particularly in fast-paced and high-acuity clinical settings such as emergency departments. In addition, Lean's focus on engagement of frontline staff in problem solving can be a catalyst for organizational change. In this study, ConnectionsAZ demonstrates how they applied Lean principles to rapidly and sustainably transform clinical operations in a behavioral health crisis facility. METHODS: A multidisciplinary team of management and frontline staff defined values-based outcome measures, mapped the current and ideal processes, and developed new processes to achieve the ideal...
June 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28525920/torsade-de-pointes-arrhythmias-arise-at-the-site-of-maximal-heterogeneity-of-repolarization-in-the-chronic-complete-atrioventricular-block-dog
#2
Albert Dunnink, Thom R G Stams, Alexandre Bossu, Veronique M F Meijborg, Jet D M Beekman, Sofieke C Wijers, Jacques M T De Bakker, Marc A Vos
Aims: The chronic complete atrioventricular block (CAVB) dog is highly sensitive for drug-induced torsade de pointes (TdP) arrhythmias. Focal mechanisms have been suggested as trigger for TdP onset; however, its exact mechanism remains unclear. In this study, detailed mapping of the ventricles was performed to assess intraventricular heterogeneity of repolarization in relation to the initiation of TdP. Methods and results: In 8 CAVB animals, 56 needles, each containing 4 electrodes, were inserted in the ventricles...
May 1, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28522367/qrs-t-wave-and-calcium-alternans-in-a-type-i-diabetic-mouse-model-for-spontaneous-post-myocardial-infarction-ventricular-tachycardia-a-mechanism-for-the-antiarrhythmic-effect-of-statins
#3
Hongwei Jin, Charles M Welzig, Mark Aronovitz, Farzad Noubary, Robert Blanton, Bo Wang, Mohammad Rajab, Alfred Albano, Mark S Link, Sami F Noujaim, Ho-Jin Park, Jonas B Galper
BACKGROUND: The incidence of sudden arrhythmic death is markedly increased in diabetics. OBJECTIVE: Develop a mouse model for Post MI VT in the diabetic heart and determine the mechanism of an antiarrhythmic effect of statins. METHODS: EKG transmitters were implanted in wild type (WT), placebo and pravastatin treated Type I diabetic Akita mice, MIs induced by coronary ligation, Ca(2+) transients studied by optical mapping, Ca(2+) transients and sparks in left VM (VM) by the Ionoptix system and confocal microscopy...
May 15, 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/28515824/cardiogenic-shock-acute-severe-mitral-regurgitation-and-complete-heart-block-after-cavo-tricuspid-isthmus-atrial-flutter-ablation
#4
Thein Tun Aung, Edward Samuel Roberto, Kevin D Kravitz
Radiofrequency (RF) ablation is the first-line management of cavo-tricuspid isthmus dependent atrial flutter. It has been performed with 95% success rate. Adverse events are very rare. We report the first case of acute severe mitral regurgitation (MR) and complete heart block developed after successful atrial flutter ablation. A 62-year-old female with mild MR presented with palpitations. Surface electrocardiogram was suggestive of isthmus dependent atrial flutter. A duodecapolar mapping catheter showed an atrial flutter with cycle length of 280 ms...
April 2017: Cardiology Research
https://www.readbyqxmd.com/read/28484842/conventional-mapping-and-ablation-of-focal-ventricular-tachycardias-in-the-healthy-heart
#5
REVIEW
Sonia Busch, Johannes Brachmann, Ahmed Saleh, Mathias Forkmann
Ventricular tachycardias (VT) in the healthy heart, also known as idiopathic VTs, often have a focal origin. Triggered activity due to delayed after-depolarization is the most likely mechanism of focal VTs. Localization of the site of origin of focal VTs is based on activation mapping with or without combination with pace mapping. The characteristic anatomic site of origin of idiopathic VTs is the right and left outflow tract. Other sites include the tricuspid and mitral annulus, the papillary muscles, and Purkinje fibers...
May 8, 2017: Herzschrittmachertherapie & Elektrophysiologie
https://www.readbyqxmd.com/read/28484220/electrophysiological-properties-and-viability-of-neonatal-rat-ventricular-myocyte-cultures-with-inducible-chr2-expression
#6
Qince Li, Rong Ruby Ni, Huixian Hong, Kah Yong Goh, Michael Rossi, Vladimir G Fast, Lufang Zhou
Channelrhodopsin-2 (ChR2)-based optogenetic technique has been increasingly applied to cardiovascular research. However, the potential effects of ChR2 protein overexpression on cardiomyocytes are not completely understood. The present work aimed to examine how the doxycycline-inducible lentiviral-mediated ChR2 expression may affect cell viability and electrophysiological property of neonatal rat ventricular myocyte (NRVM) cultures. Primary NVRMs were infected with lentivirus containing ChR2 or YFP gene and subjected to cytotoxicity analysis...
May 8, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28479514/comprehensive-use-of-cardiac-computed-tomography-to-guide-left-ventricular-lead-placement-in-cardiac-resynchronization-therapy
#7
Jonathan M Behar, Ronak Rajani, Amir Pourmorteza, Rebecca Preston, Orod Razeghi, Steve Niederer, Shaumik Adhya, Simon Claridge, Tom Jackson, Ben Sieniewicz, Justin Gould, Gerry Carr-White, Reza Razavi, Elliot McVeigh, Christopher Aldo Rinaldi
BACKGROUND: Optimal lead positioning is an important determinant of cardiac resynchronization therapy (CRT) response. OBJECTIVE: Evaluation of cardiac computed tomography (CT) selection of the optimal epicardial vein for LV lead placement by targeting regions of late mechanical activation (LMA) and avoiding myocardial scar. METHODS: 18 patients undergoing CRT upgrade with existing pacing systems, underwent pre-implant ECG-gated cardiac CT to assess wall thickness, hypoperfusion, LMA and regions of myocardial scar by the derivation of the Stretch Quantifier of Endocardial Engraved Zones (SQUEEZ) algorithm...
May 4, 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/28479513/epicardial-endocardial-breakthrough-during-stable-atrial-macro-reentry-evidence-from-ultra-high-resolution-three-dimensional-mapping-epicardial-endocardial-breakthrough-in-atrial-macro-reentry
#8
Bhupesh Pathik, Geoffrey Lee, Frédéric Sacher, Michel Haïssaguerre, Pierre Jaïs, Grégoire Massoullié, Nicolas Derval, Prashanthan Sanders, Peter Kistler, Jonathan M Kalman
BACKGROUND: Evidence for epicardial-endocardial breakthrough(EEB) is derived from mapping inferences in patients with AF who may also have focal activations. OBJECTIVES: We investigated whether EEB could be discerned during stable right atrial macro-reentry using high-density high-spatial resolution 3D mapping. METHODS: Macro-reentry was diagnosed using 3D mapping and entrainment. Bipolar maps were reviewed for EEB defined as (i)focal endocardial activation with radial spread unaccounted for by an endocardial wavefront and (ii)present with the same timing on every tachycardia cycle...
May 4, 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/28472409/gait-rather-than-cognition-predicts-decline-in-specific-cognitive-domains-in-early-parkinson-s-disease
#9
Rosie Morris, Sue Lord, Rachael A Lawson, Shirley Coleman, Brook Galna, Gordon W Duncan, Tien K Khoo, Alison J Yarnall, David J Burn, Lynn Rochester
Background: Dementia is significant in Parkinson's disease (PD) with personal and socioeconomic impact. Early identification of risk is of upmost importance to optimize management. Gait precedes and predicts cognitive decline and dementia in older adults. We aimed to evaluate gait characteristics as predictors of cognitive decline in newly diagnosed PD. Methods: One hundred and nineteen participants recruited at diagnosis were assessed at baseline, 18 and 36 months...
May 3, 2017: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
https://www.readbyqxmd.com/read/28467972/mitral-isthmus-ablation-using-a-circular-mapping-catheter-positioned-in-the-left-atrial-appendage-as-a-reference-for-conduction-block
#10
Takahiko Nishiyama, Takehiro Kimura, Taishi Fujisawa, Kazuaki Nakajima, Akira Kunitomi, Shin Kashimura, Yoshinori Katsumata, Nobuhiro Nishiyama, Yoshiyasu Aizawa, Keiichi Fukuda, Seiji Takatsuki
BACKGROUND: For perimitral atrial flutter (PMFL) developing after catheter ablation of atrial fibrillation (AF), to create a complete conduction block at the mitral isthmus (MI) is mandatory to terminate it, however, it is still challenging. METHODS: This study consisted of 80 patients (74 male, 61 ± 8.1 years) undergoing MI ablation. After a circular mapping catheter was positioned at the neck of the left atrial appendage (LAA), the MI ablation was performed on the MI line just below the LAA neck targeting the earliest activation recording site of the LAA catheter during pacing from the coronary sinus (CS)...
April 13, 2017: Oncotarget
https://www.readbyqxmd.com/read/28461795/prolonged-sinus-pauses-upon-termination-of-paroxysmal-atrial-fibrillation-abnormal-right-atrial-electrophysiologic-and-electroanatomic-findings
#11
Zhengyu Bao, Hongwu Chen, Bing Yang, Michael Shehata, Weizhu Ju, Fengxiang Zhang, Gang Yang, Kai Gu, Mingfang Li, Kejiang Cao, Xunzhang Wang, Minglong Chen
The efficacy of pulmonary vein antral isolation for patients with prolonged sinus pauses (PSP) on termination of atrial fibrillation has been reported. We studied the right atrial (RA) electrophysiologic and electroanatomic characteristics in such patients. Forty patients underwent electroanatomic mapping of the RA: 13 had PSP (group A), 13 had no PSP (group B), and 14 had paroxysmal supraventricular tachycardia (control group C). Group A had longer P-wave durations in lead II than did groups B and C (115.5 ± 15...
April 2017: Texas Heart Institute Journal
https://www.readbyqxmd.com/read/28454882/new-frontiers-for-environmental-epidemiology-in-a-changing-world
#12
Cathryn Tonne, Xavier Basagaña, Basile Chaix, Maud Huynen, Perry Hystad, Tim S Nawrot, Remy Slama, Roel Vermeulen, Jennifer Weuve, Mark Nieuwenhuijsen
BACKGROUND: In the next 25years, transformative changes, in particular the rapid pace of technological development and data availability, will require environmental epidemiologists to prioritize what should (rather than could) be done to most effectively improve population health. OBJECTIVES: In this essay, we map out key driving forces that will shape environmental epidemiology in the next 25years. We also identify how the field should adapt to best take advantage of coming opportunities and prepare for challenges...
April 25, 2017: Environment International
https://www.readbyqxmd.com/read/28443992/educational-interventions-for-knowledge-on-the-disease-treatment-adherence-and-control-of-diabetes-mellitus
#13
Ana Laura Galhardo Figueira, Lilian Cristiane Gomes Villas Boas, Anna Claudia Martins Coelho, Maria Cristina Foss de Freitas, Ana Emilia Pace
OBJECTIVE: to assess the effect of educational interventions for knowledge on the disease, medication treatment adherence and glycemic control of diabetes mellitus patients. METHOD: evaluation research with "before and after" design, developed in a sample of 82 type 2 diabetes mellitus patients. To collect the data, the Brazilian version of the Diabetes Knowledge Scale (DKN-A), the Measure of Adherence to Treatments and the electronic system at the place of study were used...
April 20, 2017: Revista Latino-americana de Enfermagem
https://www.readbyqxmd.com/read/28434449/electrical-superior-vena-cava-isolation-using-a-novel-pace-and-ablate-technique-under-diaphragmatic-electromyography-monitoring
#14
Shinsuke Miyazaki, Shigeki Kusa, Hitoshi Hachiya, Hiroshi Taniguchi, Takayuki Niida, Sadamitsu Ichijo, Kenzo Hirao, Yoshito Iesaka
BACKGROUND: Diaphragmatic compound motor action potential (CMAP) amplitude monitoring is a standard technique to anticipate phrenic nerve injury during cryoballoon ablation. OBJECTIVE: The purpose of this study was to evaluate the feasibility of a novel superior vena cava isolation (SVCI) technique using simultaneous pacing and ablation through the tip of a single mapping/ablation catheter. METHODS: Fifty-four patients with atrial fibrillation were included...
May 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/28423777/data-driven-quality-improvement-of-health-professions-education-design-and-development-of-clue-an-interactive-curriculum-data-visualization-tool
#15
Claire Ann Canning, Alan Loe, Kathryn Jane Cockett, Paul Gagnon, Nabil Zary
Curriculum Mapping and dynamic visualization is quickly becoming an integral aspect of quality improvement in support of innovations which drive curriculum quality assurance processes in medical education. CLUE (Curriculum Explorer) a highly interactive, engaging and independent platform was developed to support curriculum transparency, enhance student engagement, and enable granular search and display. Reflecting a design based approach to meet the needs of the school's varied stakeholders, CLUE employs an iterative and reflective approach to drive the evolution of its platform, as it seeks to accommodate the ever-changing needs of our stakeholders in the fast pace world of medicine and medical education today...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28422337/in-vivo-validation-of-a-novel-algorithm-for-automatic-premature-ventricular-contractions-recognition
#16
Jedrzej Kosiuk, Guilherme Portugal, Sebastian Hilbert, Silke John, Mario Oliveira, Gerhard Hindricks, Andreas Bollmann
INTRODUCTION: Template-matching algorithms are routinely used in the catheter ablation of patients with premature ventricular contractions (PVCs). However, systematic analysis of the accuracy and spatial resolution of such systems is lacking. Therefore, the aim of this evaluation was to perform a systematic in-vivo validation of performance of a novel automated template-matching algorithm. METHODS AND RESULTS: In a porcine model, paced beats simulating PVCs from different origins were investigated...
April 19, 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28422050/k-mer-content-correlation-and-position-analysis-of-genome-dna-sequences-for-the-identification-of-function-and-evolutionary-features
#17
Aaron Sievers, Katharina Bosiek, Marc Bisch, Chris Dreessen, Jascha Riedel, Patrick Froß, Michael Hausmann, Georg Hildenbrand
In genome analysis, k-mer-based comparison methods have become standard tools. However, even though they are able to deliver reliable results, other algorithms seem to work better in some cases. To improve k-mer-based DNA sequence analysis and comparison, we successfully checked whether adding positional resolution is beneficial for finding and/or comparing interesting organizational structures. A simple but efficient algorithm for extracting and saving local k-mer spectra (frequency distribution of k-mers) was developed and used...
April 19, 2017: Genes
https://www.readbyqxmd.com/read/28416973/the-utility-of-atrial-pacing-for-identifying-the-electrical-breakthrough-sites-between-the-left-atrium-and-pulmonary-veins
#18
Shinya Sugiura, Koji Matsuoka, Hideki Noda, Naoya Kurata, Misa Uemori, Hirokazu Shioji, Akihiro Takasaki, Takafumi Koji, Takashi Tanigawa, Masaaki Ito
BACKGROUND: Circumferential pulmonary vein (PV) isolation for atrial fibrillation (AF) is occasionally difficult to achieve because electrical breakthrough sites (EBSs) between the left atrium (LA) and PVs cannot be identified during ablation especially in the carina regions. METHODS: The left PVs (Lt.PVs) of 60 AF patients and the right PVs (Rt.PVs) of 37 patients undergoing PV isolation were studied. When PV isolation was not achieved after the initial circumferential PV isolation, atrial pacing was repeatedly performed from the distal coronary sinus (CSd) and high right atrium (HRA), and the time interval from the stimulus to the earliest PV potential (stimulus-PV interval) was measured using circular mapping catheters at each PV until PV isolation was achieved...
April 2017: Journal of Arrhythmia
https://www.readbyqxmd.com/read/28416514/optical-mapping-approaches-on-muscleblind-like-compound-knockout-mice-for-understanding-mechanistic-insights-into-ventricular-arrhythmias-in-myotonic-dystrophy
#19
Chung-Chuan Chou, Po-Cheng Chang, Yi-Chia Wei, Kuang-Yung Lee
BACKGROUND: Cardiac arrhythmias are common causes of death in patients with myotonic dystrophy (dystrophia myotonica [DM]). Evidence shows that atrial tachyarrhythmia is an independent risk factor for sudden death; however, the relationship is unclear. METHODS AND RESULTS: Control wild-type (Mbnl1(+/+); Mbnl2(+/+) ) and DM mutant (Mbnl1(-/-); Mbnl2(+/-) ) mice were generated by crossing double heterozygous knockout (Mbnl1(+/-); Mbnl2(+/-) ) mice. In vivo electrophysiological study and optical mapping technique were performed to investigate mechanisms of ventricular tachyarrhythmias...
April 17, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28412166/palliative-care-development-in-european-care-homes-and-nursing-homes-application-of-a-typology-of-implementation
#20
Katherine Froggatt, Sheila Payne, Hazel Morbey, Michaela Edwards, Harriet Finne-Soveri, Giovanni Gambassi, H Roeline Pasman, Katarzyna Szczerbińska, Lieve Van den Block
BACKGROUND: The provision of institutional long-term care for older people varies across Europe reflecting different models of health care delivery. Care for dying residents requires integration of palliative care into current care work, but little is known internationally of the different ways in which palliative care is being implemented in the care home setting. OBJECTIVES: To identify and classify, using a new typology, the variety of different strategic, operational, and organizational activities related to palliative care implementation in care homes across Europe...
April 12, 2017: Journal of the American Medical Directors Association
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