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At least 1,063 records · Page 59Linked to original sources
PubMed1995

Diagnostic value of programmed ventricular stimulation in patients with bifascicular block: a prospective study of patients with and without syncope.

OBJECTIVES: The aim of this study was to examine the inducibility of ventricular arrhythmias in patients with bifascicular block both with and without a history of syncope and to relate the findings to clinical events during follow-up. BACKGROUND: Patients with bifascicular block have an increased risk of sudden death that is not reduced by pacemaker treatment. This risk could be related to a high incidence of ventricular arrhythmias. METHOD: Programmed ventricular stimulation was performed in 101 patients with bifascicular block: 41 had a history of unexplained syncope, and 60 were asymptomatic. RESULTS: Programmed ventricular stimulation resulted in a sustained ventricular arrhythmia in 18 patients (18%), 8 in the syncope group and 10 in the nonsyncope group (p = NS). Three patients in each group had an inducible sustained monomorphic ventricular tachycardia. During a mean follow-up of 21 months, 10 patients experienced a clinical event defined as sudden death (n = 4), syncope (n = 5) or appropriate discharges from an implantable cardioverter-defibrillator (n = 1). Only one of these patients had an inducible ventricular arrhythmia at baseline. CONCLUSIONS: The inducibility of ventricular arrhythmias is high in patients with bifascicular block and of the same magnitude in patients with and without a history of syncope. Clinical events during follow-up were not predicted by programmed ventricular stimulation in either of the two groups. The finding of inducible ventricular arrhythmia in patients with bifascicular block should therefore be interpreted with caution.

Adolescent↗
PubMed1992

Two different reentrant circuits of ventricular tachycardia in a patient with an extensive anterior infarction: evaluation using electrical catheter ablation techniques.

Two morphologically distinct sustained ventricular tachycardias were initiated by programmed stimulation during attempted catheter ablation in a patient with an old anterior myocardial infarction. Right bundle branch block configuration of ventricular tachycardia, which was identical to the spontaneously occurring tachycardia, was initiated and displayed fragmented mid-diastolic potential at the apicolateral left ventricular site. Evidence of a critical slow conduction area was observed during delivery of electrical stimuli to this area. Following a 150-joule electrical shock delivered to this area, right bundle branch block pattern of ventricular tachycardia was no longer inducible but a new sustained monomorphic ventricular tachycardia with left bundle branch block pattern was initiated. The mid-diastolic fragmented activity at the ablation site became electrical activation of bystander area that was not participating in the left bundle branch block type of the ventricular tachycardia circuit. The critical slow conduction area was identified at the apicoseptal left ventricular site that was separated more than 5 cm from the ablation site. We speculate that two morphologically distinct sustained monomorphic ventricular tachycardias may be due to two different reentrant circuits and not the different expression of the same circuit.

Aged↗
PubMed1986

Electrophysiologic and clinical factors influencing response to class IA antiarrhythmic agents in patients with inducible sustained monomorphic ventricular tachycardia.

Clinical and electrophysiologic data from 51 consecutive patients with sustained monomorphic ventricular tachycardia inducible during programmed ventricular stimulation were evaluated to determine what variables predict the response to intravenous class IA antiarrhythmic agents. All patients received acute drug testing in the electrophysiologic laboratory with either intravenous procainamide or intravenous quinidine. Ventricular tachycardia suppression was achieved in 9 out of 51 patients (18%). The age, gender, left ventricular ejection fraction, baseline right ventricular effective refractory period, baseline HV interval, and baseline ventricular tachycardia cycle length were not predictive of ventricular tachycardia suppression with intravenous procainamide or quinidine during programmed ventricular stimulation. The degree of prolongation of the right ventricular effective refractory period after drug administration did not predict success or failure to suppress inducible ventricular tachycardia. The degree of prolongation of the HV interval was also not predictive. In addition, the degree of prolongation of the right ventricular effective refractory period or the HV interval did not predict the change in the ventricular tachycardia cycle length after drug administration in patients who remained inducible. These data indicate that the response to class IA antiarrhythmic agents in patients with inducible sustained monomorphic ventricular tachycardia cannot be predicted on the basis of various clinical and electrophysiologic parameters.

Arrhythmias, Cardiac↗
PubMed2006

Long-term reductions in mortality among children under age 5 in rural Haiti: effects of a comprehensive health system in an impoverished setting.

OBJECTIVES: Evidence regarding the long-term impact of health and other community development programs on under-5 mortality (the risk of death from birth until the fifth birthday) is limited. We compared mortality in a population served by health and other community development programs at the Hôpital Albert Schweitzer (HAS) with national mortality rates among children younger than 5 years for Haiti between 1958 and 1999. METHODS: We collected information on births and deaths in the HAS service area between 1995 and 1999 and assembled previously published under-5 mortality rates at HAS. Published national rates for Haiti served as a comparison. RESULTS: In the early 1970s, the under-5 mortality rate at HAS declined to a level three fourths lower than that in Haiti nationwide. More recently, HAS rates have remained at one half those for Haiti nationwide. Child survival interventions in the HAS service area were substantially higher than in Haiti nationwide although socioeconomic characteristics and levels of childhood malnutrition were similar in both areas. CONCLUSIONS: HAS's programs have been responsible for long-term sustained reduction in mortality among children aged less than 5 years. Integrated systems for health and other community development programs could be an effective strategy for achieving the United Nations Millennium Goal to reduce under-5 mortality two thirds by 2015.

Benchmarking↗
PubMed1992

Prospective detection of vulnerability to sustained ventricular tachycardia in patients awaiting cardiac transplantation.

This prospective study tested the hypothesis that abnormal signal-averaged electrocardiograms (ECGs) and inducible ventricular arrhythmias identify patients awaiting cardiac transplantation who are prone to sustained ventricular tachycardia (VT) or ventricular fibrillation (VF). Thirty-seven patients with advanced symptoms of heart failure and a mean left ventricular ejection fraction of 20 +/- 7 were studied. In response to programmed ventricular stimulation using up to 3 extrastimuli, sustained monomorphic VT was induced in 8 (22%) and polymorphic VT or VF was induced in 5 patients (13%). Patients with inducible arrhythmias underwent drug therapy guided by results of programmed ventricular stimulation or implantation of a defibrillator. Patients in whom ventricular arrhythmias could not be induced were not treated for arrhythmias. The signal-averaged ECG was abnormal and sustained VT or VF was induced in 10 patients (27%). Follow-up ranged from 1 to 33 months (mean 12). Four patients (11%) died suddenly and 4 (11%) had nonfatal sustained VT or VF. The positive predictive value for sudden death or nonfatal VT/VF was 27% for the signal-averaged ECG, 38% for programmed ventricular stimulation, and 50% if both tests were abnormal. The negative predictive values for these tests were 87, 88 and 88%, respectively. The actuarial incidence of arrhythmic events was significantly higher in patients with inducible ventricular arrhythmias (p = 0.017) and in patients in whom both the results of signal-averaged electrocardiographic analysis and the response to programmed ventricular stimulation were abnormal (p = 0.002). This study demonstrates that results of signal-averaged electrocardiographic analysis and the response to programmed ventricular stimulation improve risk stratification for sudden cardiac death in patients awaiting cardiac transplantation.

Actuarial Analysis↗
PubMed2001

An assessment of the effectiveness of the Mottep model for increasing donation rates and preventing the need for transplantation--adult findings: program years 1998 and 1999.

The National Minority Organ Tissue Transplant Education Program (MOTTEP) evaluated the effects of a community-implemented health education program for adult members of minority population groups to affect attitude, knowledge, and intent to change behavior. In addition, this study represents 1 of the first major initiatives to formally address prevention as a strategy to contribute to reducing the need for organ/tissue transplantation among minorities in the United States. The study targeted students (youth) and adults representing different ethnic groups (African-Americans, Alaskan Natives, Filipinos, Latinos, and Native Americans) who attended health education presentations addressing organ tissue donation, transplantation, and illness prevention in 15 different cities in churches, schools, and other sites. A cross-sectional study that used questionnaires was designed for collecting data from all participants. This article presents data on the adult sample only. Preintervention and postintervention data were collected from 914 adult participants to determine any immediate effects of the intervention. By using data from matched sets of the preintervention and postintervention questionnaires for all adult participants, there were significant increases in (P < or =.000) trust in doctors, future plans to become organ donors, and in participants' spiritual/religious beliefs about organ/tissue donation. There was also a significant increase (P <.05) in participants' awareness of the perceived need for organ/tissue donation. African-American participants were significantly more likely (P < or =.000) to report trust in doctors, future plans to donate organs/tissue, and perceive the need for donation as a result of MOTTEP presentation. Caucasian participants showed a significant increase (P < or =.007) in trust in doctors, perceived need for organ donation (P < or =.05), and in shifting spiritual/religious beliefs about organ/tissue donation (P < or =.02). Attitudes, knowledge, beliefs, and behavioral intentions about organ/tissue donation and illness prevention can be affected by culturally appropriate health education programs designed for targeted population groups. Sustained changes in behavioral intentions toward organ donation and illness prevention may require multiple educational interventions in different community settings to increase donation rates and improve behavioral health practices to prevent illness.

Adult↗
PubMed1999

[Economic evaluation of health care program for hepatitis C virus antibody screening].

We made a trial of introducing a health care program for hepatitis C virus (HCV) antibody screening in Saga prefecture, where mortality rate of hepatoma is one of the highest in Japan. The program started in 1992 and covered nearly the entire population older than 30 years in this prefecture. This was the first implementation in Japan. In the present study, we performed a cost-benefit analysis of this program. It included three steps; early detection of hepatitis C cases in the free-living population; implementation of interferon (IFN) therapy for detected chronic active hepatitis cases; follow-up of the cases who underwent IFN therapy. We counted, as cost, expenditure for primary screening, that for subsequent clinical examinations, that for IFN therapy, that for follow-up of detected HCV carriers, and loss of earned income during a leave of absence from work for the IFN therapy. On the other hand, we counted as benefit the medical expenditures saved, and gained earned income by reduction of hepatoma, cirrhosis and hepatitis due to medical intervention, both of which would have sustained losses had the health care program not been implemented. The employed model assumed age and gender specific natural histories for hepatitis C. The benefit/cost ratio was found to be in 1.71 to 2.32, suggesting economic validity of the proposed health care program. We further evaluated the economic validity by sensitivity analysis by changing rates of HCV carriers, discounting rates, rates of "complete responder" of chronic active hepatitis cases to IFN therapy, and detection rate of otherwise submerged chronic active hepatitis cases. Benefit/cost ratios were found to be greater than unity, given that the population rate of HCV carriers is higher than 1%.

Adult↗
PubMedDate not supplied

Cancer prevention in the community: a survey of community residents.

Lifestyle exposures account for the greatest proportion of risk factors for cancer, yet these exposures have proven most difficult to alter. Despite intensive intervention efforts, many behaviour change programs are ill suited to the community. This research was undertaken to increase our understanding of prevention activities of interest to a sample of residents in two Ontario communities. 248 (62.3%) adult residents responded to a semi-structured self-administered questionnaire including open-ended questions on health issues, exposures and prevention activities of interest. While some of the beliefs expressed by respondents might have been anticipated (e.g., cigarette smoking and family history increase risk of cancer), others were not (e.g., only between 40 and 75% of respondents thought a high fat diet increased risk). Furthermore, many of those with personal health concerns expressed an interest in prevention. This process is proposed as a first step in launching more appropriate and sustainable community-based health promotion programs for cancer prevention.

Adult↗
PubMed1994

Personal computers in psychiatric rehabilitation: a new approach to skills training.

A rehabilitation program called the Learning Center provides computer-assisted instruction to patients with long-term psychiatric illnesses. Clients in the program, located at a New York State psychiatric facility serving a mostly minority, low-income population, are enrolled in either a vocational component that teaches advanced computer applications or a general education component to improve basic math, spelling, vocabulary, and grammar. Participants work at their own pace to achieve mastery of material. They have shown unusual enthusiasm about the program, as evidenced by high attendance rates, ability to concentrate and sustain interest in tasks, acquisition of skills, and favorable perceptions of the program. Computer-assisted instruction offers persons with chronic mental illness the potential to compensate for cognitive and motivational problems that interfere with learning.

Adult↗
PubMed2003

Beta receptor blockade potentiates the antiarrhythmic actions of d-sotalol on reentrant ventricular tachycardia in a canine model of myocardial infarction.

INTRODUCTION: The importance of beta receptor blockade for the antiarrhythmic action of sotalol has not been completely elucidated. We determined how beta receptor blockade interacts with the effects of potassium channel blockade on reentrant circuits. METHODS AND RESULTS: Sustained ventricular tachycardia was induced by programmed stimulation in dogs 4 days after left anterior coronary artery occlusion and reentrant circuits in the epicardial border zone (EBZ) mapped. The effects of the beta receptor-blocking drug, esmolol, the potassium channel-blocking drug d-sotalol, which lacks beta receptor-blocking effects, and the combination of the two drugs on the reentrant circuits that cause tachycardia were determined. Esmolol did not alter the ability to induce tachycardia. Small changes in the location or extent of lines of block in reentrant circuits accounted for small decreases or increases in tachycardia cycle lengths. d-Sotalol prolonged the lines of block in reentrant circuits, slowed propagation around the circuits, and prolonged tachycardia cycle length, but it did not stop tachycardia or prevent the induction of tachycardia. The combination of esmolol and d-sotalol prevented the initiation of sustained tachycardia. The stimulated premature impulse either blocked before reentering or traversed the circuit several times prior to blocking in a region of fractionated electrograms. The addition of esmolol to d-sotalol abolished the reverse use-dependent effects of d-sotalol alone on effective refractory period (ERP) and significantly prolonged ERP in the area of the reentrant circuit. CONCLUSION: Beta receptor blockade is important for the antiarrhythmic effects of d,l-sotalol on reentrant ventricular tachycardia in this model. The mechanism is speculative but may involve potentiation of d-sotalol actions to prolong ERP or effects on gap junctions.

Adrenergic beta-Antagonists↗
PubMed1981

Disparity between the clinical and electrophysiologic effects of amiodarone in the treatment of recurrent ventricular tachyarrhythmias.

Nine patients with life-threatening ventricular arrhythmias were administered oral amiodarone over a period of months. Sustained ventricular tachycardia (VT) was induced during programmed stimulation in seven of the nine patients prior to their receiving amiodarone therapy. Despite an excellent clinical response to the drug over a period of 10 to 24 months (median 15 months), sustained VT was still able to be initiated in seven patients after 7 to 20 weeks of therapy, with multiform VT induced in several patients both before and after amiodarone. Some effects of the drug were noted, however, in that the induced VT was often slower with an increased QRS width, and right ventricular refractory periods were prolonged. Repeated ambulatory ECG monitoring in six patients showed a reduction in the frequency and complexity of spontaneous ventricular arrhythmias, but there was no consistent effect on the prematurity of the ventricular complexes. The reason for the disparity in some patients between the effects of amiodarone on the electrical initiation of VT and its clinical recurrence is unclear, but the findings suggest that the clinical efficacy of amiodarone in patients with ventricular arrhythmias may not be reliably predicted by electrophysiologic studies (EPS).

Aged↗
PubMed1998

Internal quality control of the malaria microscopy diagnosis for 10 laboratories on the Thai-Myanmar border.

On the Thai-Myanmar border, where multidrug resistance to anti-malaria medications is a major problem, a quality control program for diagnostic laboratories has been set up. This study examines the "passive" screening performed in 10 laboratories. Monthly evaluation of the quality of thick and thin smear practice, Giemsa staining and microscopy took place during the year 1994. Considering the general context and the methodology applied, the evaluation of performance and strategy of the malaria diagnostic test showed satisfactory results for all 10 laboratories. Performance of technics = 64% (62-66) to 96% (95-97); Sensitivity = 92.6 (91.5-95.5) to 96.6% (95.8-99.0); Specificity = 93.5% (91.4-95.5) to 98.3% (97.6-99.0); Predictive Positive Value = 92.0% (90.9-93.1) to 98.3% (97.6-99.0); Predictive Negative Value = 94.3% (93.0-95.6) to 98.5% (98.0-99.0). The study underlines the importance of a reliable quality control method for microscopy diagnosis of malaria in hyperendemic areas, with Plasmodium falciparum as the main species. A high level of input from the international laboratory technician, performing training, follow-up and evaluation was required. The need for adequate training of national technicians and supervisors, especially regarding long-term sustainability, is stressed. The type of program presented can be used as a model for similar projects in developing countries.

Clinical Laboratory Techniques↗
PubMed1988

Long-term care of obese individuals in a community-based primary health care program.

A four-year treatment program for severe obesity containing behavioural modification, exercise and nutrition advice was developed at the obesity unit at the Karolinska Hospital. The program made it possible to achieve a sustained weight loss. As far as we know such long-term treatment result has not been reported for this group of patients before. As a consequence of the positive outcome the hospital treatment program was transformed to an out-patient program that could be used in a primary health care setting. The transformation process is emphasized in this presentation but also preliminary results of the weight reduction and the attrition rate in the primary health care setting of the weight reduction program are presented. The evaluation indicates that instructors and participants in the program overall have accepted the program. The mean weight reduction after ten weeks was 6.3 kg. The attrition rate during that time was 2%.

Adult↗
PubMed1996

Syncopal sustained ventricular tachycardia in a patient with right ventricular dysplasia.

A 41-year-old man was hospitalized for syncopal sustained ventricular tachycardia with left bundle branch morphology. Diagnostic screening confirmed a right ventricular dysplasia: fibrofatty replacement of myocardium on endomyocardial biopsy and severe dilation of right ventricle with no left ventricular impairment was documented. His bundle recording showed an abnormally long HV interval, and programmed ventricular stimulation induced high-rate sustained ventricular tachycardia with left bundle branch block morphology associated with reduced systolic blood pressure and dizziness. Right ventricular burst pacing proved to be effective in restoring sinus rhythm. A single lead pectoral cardioverter-defibrillator was implanted and programmed for VVI and antitachycardia pacing, as first ventricular tachycardia therapeutic intervention. During 6-month follow-up, 1 asymptomatic ventricular tachycardia recurrence terminated by antitachycardia pacing was reported by the device. The possible role of the other therapeutic options such as drugs, ablation, and surgery for this specific case is also discussed.

Adult↗
PubMed1995

Sustaining interventions in community systems: on the relationship between researchers and communities.

Important goals of research-based community interventions include the long-term maintenance of effects and fostering of collaboration between researchers and community leaders. This article reviews the challenges associated with transferring innovations to community systems, changing program delivery from an experimental context controlled by researchers to program delivery controlled by community organizations, and sustaining long-term effects of interventions. It is suggested that researchers who develop and implement community interventions in diverse health areas need to confront several issues: (a) fostering effective long-term relationships between researchers and the communities they study and in which they intervene and (b) designing and implementing interventions that are useful to community systems after the formal phase of research ends.

California↗
PubMed1997

Nonlinear analysis of the pharmacological conversion of sustained atrial fibrillation in conscious goats by the class Ic drug cibenzoline.

Methods from nonlinear dynamics were applied to test the hypothesis that the dynamics of sustained atrial fibrillation (AF) is modified by the class Ic drug cibenzoline during pharmacological conversion. The experiments were performed in conscious goats in which sustained AF was induced by continuous maintenance of AF via programmed electrical stimulation. Data were collected from electrophysiological experiments in five goats to terminate sustained AF by continuous infusion of cibenzoline. Sets of five unipolar epicardial electrograms of one minute duration were recorded from the left and right atrial free wall during sustained AF (control), and at three episodes during infusion of cibenzoline, when the mean AF interval had been prolonged to 25%, 50% and 85% with respect to control. Ventricular far-field potentials were removed from atrial electrograms by a coherent averaging procedure. Using the Grassberger-Procaccia method, the dynamics of the local atrial electrograms was investigated by estimating the (coarse-grained) correlation dimension and correlation entropy from the correlation integral. The results were related to a recently proposed classification (types I-III) of AF based on the degree of complexity of atrial activation patterns. The coarse-grained correlation dimension D(cg) and entropy K(cg) indicated that sustained AF corresponded to type II. During drug administration the coarse-grained parameters were not significantly different from control. Scaling regions in the correlation integral were observed after infusion of cibenzoline (3 out of 5 goats) suggesting that the drug introduced low-dimensional features (type I) in the dynamics of AF (correlation dimension D ranging from 2.8 to 4.4 and correlation entropy K from 1.6 to 6.2 nats/s). Sinus rhythm recorded shortly after cardioversion was very regular (D<2 and K<3 nats/s). The hypothesis that the electrograms during AF and sinus rhythm were generated by a static transformation of a linear Gaussian random process was rejected using a test for time reversibility. The nonlinear analysis revealed that cibenzoline does not significantly alter the dynamics of sustained AF during pharmacological conversion other than a slowing down of the atrial activation and a somewhat increasing global organization of the atrial activation pattern. The sudden change in the dynamical behavior at cardioversion suggests a mechanism that is reminiscent of a bifurcation. (c) 1997 American Institute of Physics.

Journal Article↗
PubMed2006

Implementation of the Adelaide Hills Palliative Care project.

The Rural Palliative Care Program (RPCP) is currently being implemented in eight pilot sites across Australia, under the banner of the National Palliative Care Program. It is one of a number of initiatives commissioned by the Department of Health and Ageing that are designed to achieve the goals of the National Palliative Care Strategy. Specifically the RPCP is testing service components that aim to improve access to palliative care for people living in rural and remote communities. With facilitation from the Australian Divisions of General Practice (ADGP), each project and the program as a whole, is undergoing a formal evaluation by the Centre for Health Service Development (CHSD), University of Wollongong. A key question being investigated is whether any systemic improvements in palliative care delivery are sustainable beyond completion of the 3-year program. This paper gives the background to the RPCP. The Adelaide Hills Palliative Care Project is discussed as an example of how strategies are derived and applied in order to test key service components pertinent to the delivery of palliative care in a rural setting.

Palliative Care↗
PubMedDate not supplied

Communicating alcohol and drug prevention strategies and models across cultural boundaries: preliminary report on an ILO/WHO/UNDCP [International Labour Office/World Health Organization/United Nations International Drug Control Program] Interagency Program.

The joint ILO/WHO/UNDCP collaborative program "Prevention of Drug and Alcohol Problems among Workers and their Families" represents transfer of an innovative model to a culturally diverse group of nations: Egypt, Mexico, Namibia, Poland, and Sri Lanka. The concept is to move from reactive programs-led by alcohol and drug experts, reactive to problem employees-to proactive prevention led by management. Nontechnical language and metaphors have been developed to secure the commitment of managers in the private and public sectors. Participating countries and enterprises adapt the program to local conditions, fostering "local ownership" with the objective of creating self-sustaining activities. The objective is to describe elements of the program which may be readily transferable worldwide across the cultural borders that characterize nations, enterprises, and public sector workplaces.

Communication↗