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At least 973 records · Page 54Linked to original sources
PubMed2005

Predictive characteristics of holter-based postinfarction risk stratifiers appear superior to electrophysiological testing.

Prevalent low-frequency (PLF) oscillation of heart rate and turbulence slope (TS) are both powerful postmyocardial infarction (MI) risk factors. Abnormal composite risk stratifier (CRS) was defined as abnormal PLF or abnormal TS when PLF was not analyzable. We compared the predictive power of CRS with the previously published predictive value of conventional electrophysiological (EP) testing based on the presence of nonsustained ventricular tachycardia (NSVT) and inducibility of sustained ventricular tachycardia/fibrillation (VT/VF) during programmed ventricular stimulation (PVS). PLF and TS were calculated from baseline Holter recordings in the placebo population of European Amiodarone Infarction Myocardial Infarction Trial (EMIAT trial) (n = 633; LVEF </= 40%; 87 deaths; 22-month follow-up). Previously established cut-off values of PLF >/= 0.1 Hz and TS </= 2.5 ms/RR were used. The clinical characteristics of the EMIAT population were similar to those of the Multicenter Unsustained Tachycardia Trial (MUSTT trial). Therefore, we compared the predictive power of CRS and conventional PVS using the values of 35% VT/VF inducibility during PVS in NSVT patients, and a 33% and 50% increase in all-cause and arrhythmic mortality, respectively, associated with VT/VF inducibility in MUSTT. Projecting the predictive power of PVS in MUSTT into the EMIAT population yielded a sensitivity of 13.8% and 14.0% and positive predictive value (PPV) of 27.9% and 14.0% for all-cause and arrhythmic mortality, respectively, whereas an abnormal CRS was associated with sensitivities of 46.0% and 46.5% and PPV of 37.4% and 18.7%. Compared with the noninvasive Holter-based CRS, invasive PVS appears inferior in the identification of high-risk post-MI patients with left ventricular dysfunction.

Electrocardiography, Ambulatory↗
PubMed2006

Improving SVT discrimination in single-chamber ICDs: a new electrogram morphology-based algorithm.

INTRODUCTION: Wide-spread adoption of ICD therapy has focused efforts on improving the quality of life for patients by reducing "inappropriate" shock therapies. To this end, distinguishing supraventricular tachycardia from ventricular tachycardia remains a major challenge for ICDs. More sophisticated discrimination algorithms based on ventricular electrogram morphology have been made practicable by the increased computational ability of modern ICDs. METHODS AND RESULTS: We report results from a large prospective study (1,122 pts) of a new ventricular electrogram morphology tachycardia discrimination algorithm (Wavelet Dynamic Discrimination, Medtronic, Minneapolis, MN, USA) operating at minimal algorithm setting (RV coil-can electrogram, match threshold of 70%). This is a nonrandomized cohort study of ICD patients using the morphology discrimination of the Wavelet algorithm to distinguish SVT and VT/VF. The Wavelet criterion was required ON in all patients and all other supraventricular tachycardia discriminators were required to be OFF. Spontaneous episodes (N = 2,235) eligible for ICD therapy were adjudicated for detection algorithm performance. The generalized estimating equations method was used to remove bias introduced when an individual patient contributes multiple episodes. Inappropriate therapies for supraventricular tachycardia were reduced by 78% (90% CI: 72.8-82.9%) for episodes within the range of rates where Wavelet was programmed to discriminate. Sensitivity for sustained ventricular tachycardia was 98.6% (90% CI: 97-99.3%) without the use of high-rate time out. CONCLUSIONS: Results from this prospective study of the Wavelet electrogram morphology discrimination algorithm operating as the sole discriminator in the ON mode demonstrate that inappropriate therapy for supraventricular tachycardia in a single-chamber ICD can be dramatically reduced compared to rate detection alone.

Algorithms↗
PubMed1992

Comparative electrophysiological effects of captopril or hydralazine combined with nitrate in patients with left ventricular dysfunction and inducible ventricular tachycardia.

OBJECTIVE: To assess the electrophysiological and antiarrhythmic effects of pharmacological load manipulation by an angiotensin converting enzyme (ACE) inhibitor (captopril) and a direct vasodilator (hydralazine plus isosorbide mononitrate) in patients with inducible ventricular tachycardia and impaired left ventricular function. DESIGN: Randomised open label cross-over comparison of three regimens. SETTING: Tertiary arrhythmia referral centre. SUBJECTS: Eight patients with reduced left ventricular function and sustained ventricular tachycardia inducible by programmed stimulation. INTERVENTIONS: Three treatment regimens each of 48 hours duration: captopril, hydralazine plus isosorbide mononitrate, and control (no vasodilator). MAIN OUTCOME MEASURES: Changes in central haemodynamics, electrophysiological parameters, and induction of ventricular tachycardia during treatment with captopril, or hydralazine combined with nitrate, compared with a control period. RESULTS: Both vasodilator treatments produced similar balanced reductions in peak systolic pressures and filling pressures compared with controls. Captopril had no effect on sinus cycle length, atrial refractoriness, or intraventricular conduction, but prolonged ventricular effective and functional refractory periods and QT interval during constant rate atrial pacing. Hydralazine combined with nitrate did not significantly alter any electrophysiological variable. Ventricular tachycardia was similarly inducible during all three periods. CONCLUSIONS: Load manipulation by captopril but not hydralazine combined with nitrate prolonged ventricular refractoriness and repolarisation, possibly reflecting a combination of mechano-electrical effect with the restraining influence of ACE inhibitors on reflex sympathetic stimulation.

Aged↗
PubMedDate not supplied

Electropharmacologic characteristics and radiofrequency catheter ablation of sustained ventricular tachycardia in patients without structural heart disease.

Twenty-six patients (mean age 39 +/- 17 years) with idiopathic sustained ventricular tachycardia (VT) were included for study. The patients were divided into two groups: group I: 14 patients with VT originating from the right ventricular outflow tract (wide QRS tachycardia with complete left bundle branch block pattern), and group II: 12 patients with VT originating from the left ventricle (wide QRS tachycardia with complete right bundle branch block pattern). Most of the group I patients (11/14) needed isoproterenol to facilitate induction of VT, and were sensitive to both verapamil and adenosine. Eight patients had successful radio-frequency (RF) ablation and were free of VT without any antiarrhythmic drugs. In group II, sustained VT was induced by programmed ventricular stimulation in all the patients (only 3 patients needed isoproterenol for facilitation); verapamil could terminate all the VT but none of the patients responded to adenosine. Eight patients received RF ablation and 6 patients had successful ablation without recurrent tachycardia on a long-term basis. Different sensitivity to adenosine and isoproterenol between right and left ventricular idiopathic VT suggested different underlying mechanisms for both types of VT. The patients who did not receive catheter ablation still had attacks of VT despite antiarrhythmic drug treatment; however, none of these patients had sudden death since the first attack of VT (mean 95 +/- 51 months), suggesting a benign prognosis in idiopathic VT.

Adolescent↗
PubMed1989

Reversal of proarrhythmic effects of flecainide acetate and encainide hydrochloride by propranolol.

The use of membrane-active antiarrhythmic agents may be complicated by aggravation of existing arrhythmias or development of new drug-induced arrhythmias. Four patients, referred because of out-of-hospital cardiac arrest or symptomatic sustained ventricular tachycardia, were receiving class IC antiarrhythmic agents in an attempt to prevent inducibility of sustained ventricular tachycardia. New or worsening spontaneous arrhythmias developed while they were on flecainide acetate (n = 3) or encainide hydrochloride (n = 1) therapy. Spontaneous runs of rapid nonsustained and sustained ventricular tachycardia developed in two. Increased frequency of premature ventricular contractions and repetitive forms of ventricular ectopic activity developed in one, despite the fact that inducibility of sustained ventricular tachycardia had been prevented. Salvos and nonsustained ventricular tachycardia developed in the fourth patient. Propranolol had failed to prevent inducibility of sustained ventricular tachycardia during previous programmed stimulation studies in three of the four patients, but it reproducibly suppressed drug-induced arrhythmias that appeared only after administration of the IC agents in each patient. Suppression of the proarrhythmic effects by beta-adrenergic blockade suggests a possible interaction of these drugs with autonomic function in the genesis of the observed proarrhythmic effects. Direct pharmacologic control of proarrhythmic drug effects has not previously been reported.

Aged↗
PubMed1998

Characteristics of the temporal and spatial excitable gap in anisotropic reentrant circuits causing sustained ventricular tachycardia.

The excitable gap of a reentrant circuit has both temporal (time during the cycle length that the circuit is excitable) and spatial (length of the circuit that is excitable at a given time) properties. We determined the temporal and spatial properties of the excitable gap in reentrant circuits caused by nonuniform anisotropy. Myocardial infarction was produced in canine hearts by ligation of the left anterior descending coronary artery. Four days later, reentrant circuits were mapped in the epicardial border zone of the infarcts with a multielectrode array during sustained ventricular tachycardia induced by programmed stimulation. During tachycardia, premature impulses were initiated by stimulation at sites around and in the reentrant circuits, and their conduction characteristics in the circuit were mapped. All circuits had a temporal excitable gap in at least part of the circuit, which allowed premature impulses to enter the circuit. Completely and partially excitable segments of the temporal gap were identified by measuring conduction velocity of the premature impulses; conduction was equal to the native reentrant wave front in completely excitable regions and slower than the reentrant wave front in partially excitable regions. In some circuits, a temporal gap existed throughout the circuit, permitting the entire circuit to be reset over a range of premature coupling intervals, although the size of the gap varied at different sites. In other circuits, the gap became so small at local sites that even though premature impulses could enter the circuit, the circuit could not be reset. Premature impulses could terminate reentry in circuits that could be reset or not. We also found a significant spatial gap, which was identified by determining the distance between the head of the circulating wave front, which could be located on the activation map, and its tail, which was the site most distal from the head as located by the site of entry of the premature wave front into the circuit. The spatial gap could also vary in different parts of the circuit. Therefore, nonuniform anisotropic reentrant circuits have both a temporal and spatial excitable gap with fully and partially excitable components that change in different parts of the circuit.

Animals↗
PubMed1998

The growing influence of non governmental organisations (NGOs) in international health: challenges and opportunities.

The growing influence of non governmental organizations (NGOs) in international health is occurring in the face of major challenges and opportunities. These challenges include the continued increases in global poverty status, the growing influence of private-funded health systems, the need for sustainability of external-funded programs, and the clamour for community participation in the planning and management of external-funded programs. Opportunities include the near universal recognition of the indispensable roles of NGOs by bilateral institutions and governments, the current emphasis on global trade by developed countries, and the need to develop political and economic systems that are equitable and promote social development. This article is an overview of these challenges and how these challenges can become excellent opportunities for NGOs to improve the health and social development of target communities in developing countries.

Commerce↗
PubMed1997

Commitment to the underserved: evaluating the effect of an extracurricular medical student program on career choice.

BACKGROUND: This study was conducted to compare the practice locations and characteristics of physicians who participated as medical students in an extracurricular program to foster interest in careers of service to medically underserved populations with those of their classmates who did not participate in the program. METHODS: Using a mailed questionnaire, we conducted a cross-sectional study of graduates from the classes of 1983-1987 at one southwestern, public medical school. All Commitment to Underserved People (CUP) participants (n = 94) and a random sample of nonparticipating classmates (n = 188) were surveyed. CUP is an extracurricular project with components in each of 4 years of medical school that provides peer and faculty support, curriculum enrichment, and direct service to medically underserved populations. Outcome measures included the size of community of practice, practice type, and practice patient characteristics. RESULTS: Sixty seven (71%) of CUP participants and 126 (67%) of nonparticipants responded. CUP participants were more likely to be women, to specialize in family practice, to practice in the Indian Health Service (IHS) or overseas, to be located in a community of 25,000 or less, and to have participated in the state, service-payback loan program. In multiple regression, the specialty of family practice was associated with practice in a small community, the IHS, and a community health center; CUP participation was correlated with practice in small communities, the IHS, and a foreign country. CONCLUSIONS: Participation in the CUP program was associated with the specialty choice of family practice and with practice in settings associated with medically underserved populations. The CUP program has been successful in sustaining entering medical students' interests in underserved practice.

Journal Article↗
PubMed1991

Ventricular tachycardia with congenital ventricular diverticulum.

A 24-year-old man presented with symptomatic, recurrent, sustained ventricular tachycardia (VT). He was found to have a basal inferior left ventricular diverticulum. His sustained VT was reproduced by programmed electrical stimulation and was unresponsive to procainamide, tocainide, propafenone, and flecainide. Endocardial mapping followed by resection and cryoablative surgery was performed. The patient had only one recurrence after 18 months, with subsequent control with procainamide for over 14 months.

Adult↗
PubMed2006

Stream fish, water and habitat quality in a pasture dominated basin, southeastern Brazil.

A fish survey in 35 stream reaches (from 1st to 3rd order) with physicochemical and habitat assessment in the São José dos Dourados system, southeastern Brazil, was conducted. Most of the basin land cover (77.4%) is used for pasture. From the sampled stream reaches, 24 were of good physicochemical quality, 10 of fair quality, and only one of poor quality. A habitat assessment showed that 10 stream reaches were considered fair, 22 were poor, and 3 were very poor. Fifty species were collected and their abundances showed strong correlation with habitat descriptors. In addition to the correlation between fish abundance and habitat, some species also showed optimal distribution related to the degree of physical habitat conservation. Streams located in this region experience organic pollution, but the most important aspect is the decline of the instream physical habitat condition, especially in first order streams, which negatively affects coarse substrates and water column dependent fish species. Effluent control, riparian vegetation restoration programs, siltation control and adequate sustainable soil use are practices which could mitigate such impacts.

Animals↗
PubMed1997

Ethical dilemmas in current planning for polio eradication.

Intensification of polio eradication efforts worldwide raises concerns about costs and benefits for poor countries. A major argument for global funding is the high benefit-cost ratio of eradication; however, financial benefits are greatest for rich countries. By contrast, the greatest costs are borne by poor countries; the Pan American Health Organization has estimated that host countries bore 80% of costs for polio eradication in the Americas. The 1988 World Health Assembly resolution setting up the Polio Eradication Initiative carried the proviso that programs should strengthen health infrastructures. Drastic cuts in donor funding for health make this commitment even more important. Two international evaluations have reported both positive and negative effects of polio and Expanded Programme on Immunization programs on the functioning and sustainability of primary health care. Negative effects were greatest in poor countries with many other diseases of public health importance. If poor countries are expected to divert funds from their own urgent priorities, donors should make solid commitments to long-term support for sustainable health development.

Developed Countries↗
PubMed2000

Competency development in public health leadership.

The professional development of public health leaders requires competency-based instruction to increase their ability to address complex and changing demands for critical services. This article reviews the development of the Leadership Competency Framework by the National Public Health Leadership Development Network and discusses its significance. After reviewing pertinent literature and existing practice-based competency frameworks, network members developed the framework through sequential use of workgroup assignments and nominal group process. The framework is being used by network members to develop and refine program competency lists and content; to compare programs; to develop needs assessments, baseline measures, and performance standards; and to evaluate educational outcomes. It is a working document, to be continually refined and evaluated to ensure its continued relevance to performance in practice. Understanding both the applications and the limits of competency frameworks is important in individual, program, and organizational assessment. Benefits of using defined competencies in designing leadership programs include the integrated and sustained development of leadership capacity and the use of technology for increased access and quality control.

Curriculum↗
PubMed2001

Preemptive biopreparedness: can we learn anything from history?

The treat of bioterrorism is in the public eye again, and major public health agencies are urging preparedness efforts and special federal funding. In a sense, we have seen this all before. The Centers for Disease Control and Prevention grew substantially during the Cold War era in large part because Alexander Langmuir, Chief Epidemiologist of the CDC, used an earlier generation's anxieties to revitalize the CDC, create an Epidemic Intelligence Service, and promote epidemiologic "surveillance" as part of the nation's defense. Retrospective investigation suggests that, while Langmuir contributed to efforts promoted by the Department of Defense and the Federal Civil Defense Administration, the United States did not have real cause to fear Communist biological warfare aggression. Given clear historical parallels, it is appropriate to ask, What was gained and what was lost by Langmuir's central role in that first instance of American biopreparedness? Among the conclusions drawn is that biopreparedness efforts fed the Cold War climate, narrowed the scope of public health activities, and failed to achieve sustained benefits for public health programs across the country.

Biological Warfare↗
PubMed2002

Prospects for a schistosome vaccine.

After some 20 years experience it is generally agreed that chemotherapy against schistosomiasis, a parasitic disease which should be considered a consequence of a chronic infection, does have significant limitations. In particular, chemotherapy does not affect transmission of the infection or the high re-infection rates and so limits the success by demanding frequently re-scheduled mass treatments. For this reason, a complementary approach that can be integrated and could sustain chemotherapy-based control programs, i.e. vaccination, is very much needed. The rationale is that drug treatment would provide short-term reduction of worm burdens and vaccination, long-term protective immune response. Vaccination can either be targeted towards the prevention of infection or to the reduction of parasite fecundity. A reduction in worm numbers is the "gold standard" for anti-schistosome vaccine development but, as schistosome eggs are responsible for both pathology and transmission, a vaccine targeted on parasite fecundity and egg viability also appears to be entirely relevant. This review considers various aspects of anti-schistosome protective immunity that are important in the context of vaccine development. The current status in the development of vaccines against the African (Schistosoma mansoni and S. haematobium) and Asian (S. japonicum) schistosomes is then discussed as the new approaches that may improve on the efficacy of the available vaccines and aid in the identification of new targets for immune attack.

Animals↗
PubMed1981

Counselor training as a treatment method for alcohol and drug abuse.

Based on the "helper-therapy" principle, a group of predominantly chronic alcohol- and drug-dependent individuals were trained for new careers in alcohol-drug counseling. A 2-month preinternship in alcohol or drug treatment centers served as a screening procedure for motivation and sobriety. Prior to training, measures of personality and self-concept were taken as well as demographic information. A 4-month training course covered broad educational and technical areas, including counseling procedures with participation, and physical conditioning. The 13% who dropped out were compared to the completers and found to differ only in extent of past antisocial history and less certainty about social drinking and abstinence. The pre-post measures of the completers indicated significant improvement in all areas of self-concept and on most of the MMPI scales. A 1-year post follow-up self-report questionnaire revealed that 74% of the respondents were employed, 59% in counseling or related areas. Less than 10% reported moderate regular use of drugs of alcohol, less than 2% heavy usage or addiction. Overall the program appears to have had sustained positive effects.

Alcoholism↗
PubMed2006

Veterinary medicine educational requirements to meet the needs of the US Agency for International Development.

The US Agency for International Development (USAID) works within the overall purpose of US foreign assistance to improve the lives of the citizens of the developing world. Through partnerships with other agencies, organizations, and governments, and using its field offices around the world, USAID strives to develop local capacity and thus build sustainable development. Two specific USAID programs pertinent to veterinary medicine are global health and agriculture. In the area of global health, veterinarians can aid USAID's work to improve the quality, availability, and use of essential health services that specifically target maternal and child health, HIV/AIDS, family planning and reproductive health, infectious diseases, environmental health, nutrition, and other life-saving areas. The challenge of making the agricultural sector in a developing country more productive is a critical one for USAID and a clear area for input from the veterinary profession. Animal agriculture is the largest single sector of agricultural economies in most developing countries, and livestock remains a critical component of poverty alleviation. There are educational requirements that benefit anyone working at USAID and can be met prior to admittance to a DVM program, as part of a DVM curriculum, or in post-graduate training/employment, such as proficiency in a foreign language; environmental sciences background; familiarity with accounting and management techniques; expertise in foreign animal diseases, zoonotic diseases, epidemiology, food safety, and nutrition, as well as the application to human health of those areas; an advanced degree such as an MPH; and management experience. Appropriately trained veterinarians can make enormous contributions to USAID's global efforts to improve the health and agriculture sectors of developing nations.

Agriculture↗
PubMed1996

Ivermectin distribution and the cultural context of forest onchocerciasis in South Province, Cameroon.

This investigation examined the cultural context of forest onchocerciasis in several communities in the Dja-Lobo Division of southern Cameroon. The study sought to elucidate behaviors that would enhance or diminish health status relative to forest onchocerciasis and other filarial infections, and to make culturally sensitive and appropriate recommendations regarding the development of health education materials and the long-term sustainability of the ivermectin distribution program in Dja-Lobo. The study consisted of two sequential components; the first was a qualitative study of a few severely affected villages and the second was a quantitative study of 212 randomly selected heads of households from eight villages. The Boulou and Baka peoples in these communities defined general filariasis (minak) as small worms under the skin, identified flies as important transmitters of the illness, and indicated that blindness and other skin and ocular problems were a consequence of the illness. Illness of the Dja (referring to an illness found near the Dja River) was another illness that was closely linked to onchocerciasis; local people indicated it was transmitted by the black flies found near the Dja River, resulting in severe itching and leopard skin. These and other cultural-behavioral data on filariasis were used to implement a health education and distribution program.

Antinematodal Agents↗
PubMed1989

Developing a service-oriented health care culture.

To remain competitive and respond to consumer expectations for high-quality service, organizations in the health care industry must develop a service-oriented culture. This article describes a series of program steps to increase an organization's responsiveness to both internal and external customers. Of fundamental importance is understanding that employees' capacity to provide high-quality service to other employees and customers is directly related to the quality service they receive as internal customers of their organization's day-to-day management. Prior to summarizing specific program steps to develop and sustain commitment to a service-oriented culture, recommendations are provided for managing top-level support.

Consumer Behavior↗