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Heart Rhythm Jun 2018The decision to abandon or extract superfluous sterile leads is controversial.
BACKGROUND
The decision to abandon or extract superfluous sterile leads is controversial.
OBJECTIVE
The purpose of this study was to compare procedural outcomes and long-term survival of patients with and those without abandoned leads undergoing lead extraction (LE).
METHODS
Retrospective review of all patients who had undergone transvenous LE at our institution from January 2007 to May 2016 was performed. Patients were stratified into 2 groups based on the presence (group 1) or absence (group 2) of abandoned leads.
RESULTS
Among 774 patients who had undergone LE procedures, 38 (4.9%) had abandoned leads (group 1). Dwell time of the oldest extracted lead was longer in group 1 vs group 2 (7.6 ± 4.9 years vs 5.6 ± 4.4 years; P = .017), as was infection as an indication for LE (76% vs 33%; P <.001). A bailout femoral approach was more commonly required in group 1 than in group 2 (18.4% vs 6%; P = .007). Complete procedural success rates were similar (92.1% in group 1 vs 95.0% in group 2; P = .439), but there was a trend toward lower clinical success in group 1 (92.1% vs 97.4%; P = .088), primarily due to failure to remove all hardware in the setting of infection. Major procedural complication rates were similar (2.6% in group 1 vs 1.2% in group 2; P = .397), as was long-term survival (mean follow-up 2.3 ± 2.2 years).
CONCLUSION
Abandoned leads at the time of LE were associated with increased procedural complexity, including a higher rate of bailout femoral extraction, and may be associated with lower clinical success. Among appropriately selected patients, consideration should be given to LE instead of abandonment.
Topics: Arrhythmias, Cardiac; Defibrillators, Implantable; Device Removal; Equipment Failure; Female; Follow-Up Studies; Forecasting; Georgia; Humans; Male; Middle Aged; Pacemaker, Artificial; Retrospective Studies; Risk Factors; Survival Rate; Treatment Outcome
PubMed: 29325975
DOI: 10.1016/j.hrthm.2018.01.018 -
Journal of Biological Rhythms Jun 2022The chronobiology community advocates ending the biannual practice in many countries of adjusting their clocks to observe Daylight Saving Time (DST). Many governments...
The chronobiology community advocates ending the biannual practice in many countries of adjusting their clocks to observe Daylight Saving Time (DST). Many governments are actively considering abandoning this practice. While sleep and circadian experts advocate the adoption of year-round standard time, most jurisdictions are instead considering permanent DST. In guiding advocacy, it is useful to understand the factors that lead governments and citizens to prefer the various options. In October 2021, the Canadian province of Alberta conducted a province-wide referendum on adopting year-round DST, in which more than 1 million valid votes were cast. As this referendum was tied to province-wide municipal elections, the results of the referendum were reported at the community level, allowing a geospatial analysis of preference for permanent DST. While the referendum proposal was narrowly defeated (49.8% in favor), a community-level analysis demonstrated a significant East-West gradient, with eastern communities more strongly in favor and western communities more strongly opposed to the year-round DST. Community size and latitudinal position also contributed to preference, with smaller and more northern communities showing more preference for year-round DST. These findings help identify how geospatial location can influence how citizens feel about the various time options and can further help guide public advocacy efforts by the sleep and circadian communities.
Topics: Canada; Circadian Rhythm; Emotions; Seasons; Sleep
PubMed: 35382618
DOI: 10.1177/07487304221089401 -
International Journal of Health... Apr 2017Twenty years ago, many of Canada's provinces began to introduce regional health authorities to address problems with their health care systems. With this action, the...
Twenty years ago, many of Canada's provinces began to introduce regional health authorities to address problems with their health care systems. With this action, the provinces sought to achieve advances in community decision-making, the integration of health services, and the provision of care in the home and community. The authorities were also to help restrict health care costs. An assessment of the authorities indicates, however, that over the past two decades they have been unable to meet their objectives. Community representatives continue to play little role in determining the appropriate health services for their regions. Gains have been made towards integrating health services, but the plan for a near seamless set of health services has not been realized. Funding for health services remains focused on hospital and physician care, and health care expenditures have until very recently been little affected by regional authorities. This disappointing performance has caused some provinces to abandon their regional authorities, but this article argues that the provision of greater autonomy and a better public appreciation of their role and potential may lead to more successful regional authorities. Accordingly, the objective of this article is to reveal the shortcomings of regional health authorities in Canada while at the same time arguing that changes can be made to increase the chances of more workable authorities.
Topics: Canada; Efficiency, Organizational; Health Plan Implementation; Humans; Organizational Objectives; Regional Health Planning
PubMed: 28292228
DOI: 10.1177/0020731416681229 -
Ecotoxicology and Environmental Safety Jun 2016Lead-acid battery sites have contributed enormous amounts of lead to the environment, significantly affecting its global biogeochemical cycle and leaving the potential...
Lead-acid battery sites have contributed enormous amounts of lead to the environment, significantly affecting its global biogeochemical cycle and leaving the potential risks to human health. An abandoned lead-acid battery site prepared for redevelopment was selected in order to study the distribution of lead in soils, plants, rhizosphere soils and soil solutions. In total, 197 samples from 77 boreholes were collected and analyzed. Single extractions by acetic acid (HOAc) were conducted to assess the bioavailability and speciation of lead in soils for comparison with the parts of the plants that are aboveground. Health risks for future residential development were evaluated by the integrated exposure uptake biokinetic (IEUBK) model. The results indicated that lead concentrations in 83% of the soil samples exceeded the Chinese Environmental Quality Standard for soil (350 mg/kg for Pb) and mainly occurred at depths between 0 and 1.5 m while accumulating at the surface of demolished construction waste and miscellaneous fill. Lead concentrations in soil solutions and HOAc extraction leachates were linked closely to the contents of aboveground Broussonetia papyrifera and Artemisia annua, two main types of local plants that were found at the site. The probability density of lead in blood (PbB) in excess of 10 µg/dL could overtake the 99% mark in the residential scenario. The findings provided a relatively integrated method to illustrate the onsite investigations and assessment for similar sites before remediation and future development from more comprehensive aspects.
Topics: Biological Availability; China; Electric Power Supplies; Environmental Restoration and Remediation; Humans; Lead; Models, Theoretical; Refuse Disposal; Soil; Soil Pollutants
PubMed: 26921546
DOI: 10.1016/j.ecoenv.2016.02.017 -
Hematology. American Society of... Dec 2016Chemotherapy combinations have been the backbone of therapy for follicular lymphoma, and are associated with high initial response rates. Unfortunately, toxicity and... (Review)
Review
Chemotherapy combinations have been the backbone of therapy for follicular lymphoma, and are associated with high initial response rates. Unfortunately, toxicity and secondary malignancies remain concerns, and most advanced-stage patients still relapse within 5 years, regardless of the regimen. Advances in the understanding of lymphoma biology have resulted in a new generation of noncytotoxic therapeutics with significant activity in follicular lymphoma. Recent studies exploring biological and targeted combinations in the frontline have shown promise, with response rates similar to chemotherapy. However, these regimens are also associated with significant cost as well as a unique toxicity profile. Large randomized studies are underway to compare noncytotoxic regimens with chemotherapy in the frontline, and several new combinations are being tested in the phase 2 setting. Ongoing work to identify predictive biomarkers and investment in mechanistic studies will ultimately lead to the personalization of therapy in the frontline setting for follicular lymphoma.
Topics: Antineoplastic Combined Chemotherapy Protocols; Clinical Trials, Phase II as Topic; Humans; Lymphoma, Follicular; Randomized Controlled Trials as Topic
PubMed: 27913492
DOI: 10.1182/asheducation-2016.1.277 -
Journal of Cardiovascular... Nov 2020
Topics: Defibrillators, Implantable; Device Removal; Electrodes, Implanted; Equipment Failure; Humans; Pacemaker, Artificial; Retrospective Studies; Treatment Outcome; Veins
PubMed: 32955129
DOI: 10.1111/jce.14752 -
Ecotoxicology and Environmental Safety Mar 2017Abandoned hard rock mines and the resulting acid mine drainage (AMD) are a source of vast, environmental degradation that are toxic threats to plants, animals, and...
Abandoned hard rock mines and the resulting acid mine drainage (AMD) are a source of vast, environmental degradation that are toxic threats to plants, animals, and humans. Cadmium (Cd) and lead (Pb) are metal contaminants often found in AMD. In our mine outwash water samples, Cd and Pb concentrations were 300 and 40 times greater than EPA Aquatic Life Use water quality standards, respectively. We tested the phytoremediation characteristics, accumulation and tolerance of Cd and Pb contamination, for annual aboveground biomass harvest of three montane willows native to the Rocky Mountains: Salix drummondiana, S. monticola, and S. planifolia. We found S. monticola best suited for Pb remediation based on greater growth and tolerance in response to the low Pb treatment compared to the high Pb treatment. Salix monticola stems also contained higher Pb concentrations in control treatment compared to S. planifolia. We found S. planifolia and S. drummondiana best suited for Cd remediation. Salix drummondiana accumulated higher concentrations of Cd in stems than both S. monticola and S. planifolia. Salix planifolia accumulated nearly 2.5 times greater concentrations of Cd in stems in control treatment than did S. drummondiana. Salix planifolia also contained more total Cd in stems than did S. monticola in Cd treatments. Based on our results, S. drummondiana and S. planifolia could aid in reduction of Cd in watersheds, and S. monticola is better suited than is S. planifolia for aboveground accumulation and tolerance of Pb pollution.
Topics: Biodegradation, Environmental; Biomass; Cadmium; Lead; Mining; Rivers; Salix; Soil Pollutants; Water Pollutants, Chemical
PubMed: 27951422
DOI: 10.1016/j.ecoenv.2016.12.001 -
Heart Rhythm Apr 2023Current methods to identify cardiovascular implantable electronic device lead failure include postapproval studies, which may be limited in scope, participant numbers,...
BACKGROUND
Current methods to identify cardiovascular implantable electronic device lead failure include postapproval studies, which may be limited in scope, participant numbers, and attrition; studies relying on administrative codes, which lack specificity; and voluntary adverse event reporting, which cannot determine incidence or attribution to the lead.
OBJECTIVE
The purpose of this study was to determine whether adjudicated remote monitoring (RM) data can address these limitations and augment lead safety evaluation.
METHODS
Among 48,191 actively monitored patients with a cardiovascular implantable electronic device, we identified RM transmissions signifying incident lead abnormalities and, separately, identified all leads abandoned or extracted between April 1, 2019, and April 1, 2021. We queried electronic health record and Medicare fee-for-service claims data to determine whether patients had administrative codes for lead failure. We verified lead failure through manual electronic health record review.
RESULTS
Of the 48,191 patients, 1170 (2.4%) had incident lead abnormalities detected by RM. Of these, 409 patients had administrative codes for lead failure, and 233 of these 409 patients (57.0%) had structural lead failure verified through chart review. Of the 761 patients without administrative codes, 167 (21.9%) had structural lead failure verified through chart review. Thus, 400 patients with RM transmissions suggestive of lead abnormalities (34.2%) had structural lead failure. In addition, 200 patients without preceding abnormal RM transmissions had leads abandoned or extracted for structural failure, making the total lead failure cohort 600 patients (66.7% with RM abnormalities, 33.3% without). Patients with isolated right atrial or left ventricular lead failure were less likely to have lead replacement and administrative codes reflective of lead failure.
CONCLUSION
RM may strengthen real-world assessment of lead failure, particularly for leads where patients do not undergo replacement.
Topics: Aged; Humans; United States; Defibrillators, Implantable; Medicare; Heart Failure; Monitoring, Physiologic
PubMed: 36586706
DOI: 10.1016/j.hrthm.2022.12.033 -
Techniques in Orthopaedics (Rockville,... Dec 2018In the anterior cruciate ligament (ACL) deficient knee, excellent outcomes are achieved in many patients with an isolated, intra-articular ACL reconstruction. Some...
In the anterior cruciate ligament (ACL) deficient knee, excellent outcomes are achieved in many patients with an isolated, intra-articular ACL reconstruction. Some patients, however, have ongoing instability or suffer graft rupture. Failure after ACL reconstruction is multifactorial, but residual anterolateral rotatory laxity is 1 potential contributing factor. Lateral extra-articular procedures are a heterogenous group of operations that were initially described as isolated treatments for the ACL deficient knee, and subsequently used in combination with intra-articular reconstructions. Initial observational studies were encouraging, however, comparative studies were less flattering and lead to a general abandonment of these procedures. With improved understanding of the anatomy and biomechanics of the anterolateral capsuloligamentous complex there has been a renewed interest in these procedures. Recent systematic reviews suggest efficacy of these procedures in improving rotational control, though data showing improved patient reported outcomes or reduced graft rupture rates are lacking. Preliminary results from ongoing clinical trials are supportive for lateral extra-articular tenodesis when used as an augment to modern, intra-articular ACL reconstructions in targeted, high-risk patients.
PubMed: 30542222
DOI: 10.1097/BTO.0000000000000309 -
Europace : European Pacing,... Mar 2021FRench Attitude reGistry in case of ICD LEad replacement (FRAGILE) registry was set-up to describe the attitude in different French institutions in case of implantable... (Observational Study)
Observational Study
AIMS
FRench Attitude reGistry in case of ICD LEad replacement (FRAGILE) registry was set-up to describe the attitude in different French institutions in case of implantable cardioverter-defibrillator (ICD) lead replacement, extraction, or abandonment and to compare outcomes in both groups.
METHODS AND RESULTS
Prospective observational study comparing two attitudes in case of ICD lead replacement, extraction, or abandonment. Primary endpoint describes the attitude in different French centres, collect parameters that may influence the decision. Secondary endpoint compares early and mid-term (2 years) complications in both groups.Between April 2013 and April 2017, 552 patients were included in 32 centres. 434 (78.6%) were male, mean patient's age was 60.3 ± 14.4 years. In 56.9% of the cases, the decision was to explant the lead. Patients in the extraction group were younger than in the abandonment group (56.7 ± 14.5 vs. 65 ± 12.7 P < 0.0001) and less likely to have comorbidities (46.5% vs. 58.3% of the patients P = 0.022). The mean lead dwelling time was significantly longer in the abandonment group as compared with the extraction group (7.6 ± 3.9 vs. 5.2 ± 3.1 years, P < 0.0001). There was no statistical difference between both groups concerning early and 2 years complications.
CONCLUSION
In this registry, the strategy in case of non-infected ICD lead replacement was mainly influenced by patient's age and comorbidities and lead dwelling time. No difference was observed in outcomes in both strategies.
Topics: Aged; Attitude; Defibrillators, Implantable; Device Removal; Electric Countershock; Humans; Male; Middle Aged; Registries
PubMed: 33257986
DOI: 10.1093/europace/euaa290