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PubMed1994

Successful and unsuccessful sites of radiofrequency catheter ablation of accessory atrioventricular connections.

Local electrograms from 47 consecutive patients who underwent successful radiofrequency catheter ablation of 49 accessory atrioventricular (AV) connections were analyzed. One hundred twenty-two local electrograms were recorded at 27 successful and 95 unsuccessful sites immediately before radiofrequency catheter ablation of 27 manifest accessory AV connections during preexcited sinus rhythm or atrial pacing. Continuous electric activity was found in 96% of successful sites versus 71% of unsuccessful sites (p < 0.01). Possible accessory pathway (AP) potentials were present only in 15% of successful and 2% of unsuccessful sites, respectively (p < 0.05). All measured time intervals were significantly shorter for successful sites as compared to unsuccessful sites of ablation of manifest accessory AV connections. Unipolar electrograms from the tip of the ablation catheter of each successful and unsuccessful ablation site were available for the last 16 patients with manifest accessory AV connections. A PQS pattern of the unipolar electrogram was associated with a higher success rate, whereas a PrS pattern never resulted in successful ablation of an accessory AV connection. Multivariate logistic regression analysis of the local electrogram characteristics of rapidly conducting, concealed accessory AV connections revealed the interval between the onset of the local ventricular and atrial electrogram (VoAo interval) as the only independent variable associated with successful sites for radiofrequency catheter ablation. The only study patient with a slowly conducting, concealed accessory AV connection underwent successful ablation with the first lesion of radiofrequency energy at the site with the shortest VoAo interval. We conclude that (1) the shortest local AV intervals and local ventricular electrograms preceding the earliest onset of the delta wave in any surface lead are predictive of successful ablation of manifest accessory AV connections; (2) the shortest local VA intervals during orthodromic AV reentry tachycardia or right ventricular pacing are predictive of successful ablation of concealed accessory AV connections; and (3) unipolar recordings from the tip of the ablation catheter should be recorded routinely during mapping of manifest accessory AV connections to identify appropriate target sites for radiofrequency energy applications.

Action Potentials↗
PubMed2004

Using success stories to share knowledge and lessons learned in health promotion.

BACKGROUND: Compelling success stories, rich with details about real-life events and people, are a tool that health agencies can use to convey how their health promotion programs work, why they are successful, what lessons they have learned, and how others can launch similar programs. Success stories describe project accomplishments that are not easily captured by quantitative evaluation methods, such as surveys. METHODS: Although success stories have not been widely used in public health, the North Carolina Department of Health and Human Services developed a series of stories, the Community Change Chronicles, to highlight environmental and policy changes that promote cardiovascular health. In 2003, the Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program used the Community Change Chronicles as a model to develop success stories about WISEWOMAN projects. RESULTS: WISEWOMAN Works: A Collection of Success Stories from Program Inception Through 2002 includes 12 stories and offers advice on how to create and use success stories in public health. This paper reviews the rationale for developing the stories, presents one success story as an example, and describes the process used to gather information, write the stories, and produce a resource for others interested in developing success stories. We also discuss how the WISEWOMAN success stories are being used to promote women's health and cardiovascular health. CONCLUSIONS: As the WISEWOMAN experience suggests, healthcare providers and organizations can use success stories to gain support for successful activities, inform the public about program benefits, complement other quantitative and qualitative evaluation methods, and publicly acknowledge the contributions of staff and organizational partners.

Alaska↗
PubMed2002

How well do mating frequency and duration predict paternity success in the polygynandrous water strider Aquarius remigis?

The relationship between mating success and paternity success is a key component of sexual selection but has seldom been estimated for species in which both sexes mate with many partners (polygynandry). We used a modification of Parker's sterile male technique to measure this relationship for the water strider Aquarius remigis in 47 laboratory populations simulating natural conditions of polygynandry. We also tested the hypothesis that prolonged copulation, a characteristic of this species, enhances paternity success. Mating behavior and paternity success were assayed for four days while males and females freely interacted. Paternity success was also assayed for an additional 7 days when females were isolated from males. Mating success significantly predicted paternity success and accounted for < or = 36% of the variance. Copulation duration was negatively related to both mating success and paternity success and did not explain any of the residual variance in paternity success. Thus, we found no evidence that prolonged copulation functions as a paternity assurance strategy in this species. Comparisons of sterile and fertile males suggested that paternity success is directly influenced by the quantity of sperm transferred. Our results support previous studies that have used mating success to estimate sexual selection, but also highlight the potential importance of sperm competition and other postinsemination processes.

Animals↗
PubMed2004

Prevalence and correlates of successful transfer from pediatric to adult health care among a cohort of young adults with complex congenital heart defects.

OBJECTIVES: More than 85% of children born today with chronic medical conditions will live to adulthood, and many should transfer from pediatric to adult health care. The numbers of adults with congenital heart defects (CHDs) are increasing rapidly. Current guidelines recommend that just over half of adult CHD patients should be seen every 12 to 24 months by a cardiologist with specific CHD expertise at a regional CHD center, because they are at risk for serious complications (eg, reoperation and/or arrhythmias) and premature mortality. The present study aimed to determine the percent of young adults with CHDs who successfully transferred from pediatric to adult care and examine correlates of successful transfer. DESIGN: Cross-sectional study with prevalence data from an entire cohort. SETTING AND PATIENTS: All patients (n = 360) aged 19 to 21 years with complex CHDs who, according to current practice guidelines, should be seen annually at a specialized adult CHD center were identified from the database of the cardiology program at the Hospital for Sick Children in Toronto, Canada, a pediatric tertiary care center. Of these patients, 234 completed measures about health beliefs, health behaviors, and medical care since age 18 years. MAIN OUTCOME MEASURE: All 15 specialized adult CHD centers in Canada formed the Canadian Adult Congenital Heart (CACH) Network. Attendance for at least 1 follow-up appointment at a CACH center before the age of 22 years was ascertained for all eligible patients. Attendance at a CACH center provides a clear criterion for successful transfer. RESULTS: In the total cohort, 47% (95% confidence interval [CI]: 42-52) had transferred successfully to adult care. There was no difference in rates of successful transfer between patients consenting to complete questionnaires (48%) and those who declined (47%). More than one quarter (27%) of the patients reported having had no cardiac appointments since 18 years. In multivariate analyses of the entire cohort, successful transfer was significantly associated with more pediatric cardiovascular surgeries (odds ratio [OR]: 2.47; 95% CI: 1.40-4.37), older age at last visit to the Hospital for Sick Children (OR: 1.29; 95% CI: 1.10-1.51), and documented recommendations in the medical chart for follow-up at a CACH center. In multivariate analyses of the patients completing questionnaires, successful transfer was significantly related to documented recommendations and patient beliefs that adult CHD care should be at a CACH center (OR: 3.64; 95% CI: 1.34-9.90). Comorbid conditions (OR: 3.13; 95% CI: 1.13-8.67), not using substances (eg, binge drinking; OR: 0.18; 95% CI: 0.07-0.50), using dental antibiotic prophylaxis (OR: 4.23; 95% CI: 1.48-12.06), and attending cardiac appointments without parents or siblings (OR: 6.59; 95% CI: 1.61-27.00) also correlated with successful transfer. CONCLUSIONS: This is the first study to document the percent of young adults with a chronic illness who successfully transfer to adult care in a timely manner. Patients were from an entire birth cohort from the largest pediatric cardiac center in Canada, and outcome data were obtained on all eligible patients. Similar data should be obtained for other chronic illnesses. There is need for considerable improvement in the numbers of young adults with CHDs who successfully transfer to adult care. At-risk adolescents with CHDs should begin the transition process before their teens, should be educated in the importance of antibiotic prophylaxis, should be contacted if a follow-up appointment is missed, and should be directed to a specific CHD cardiologist or program, with the planned timing being stated explicitly. Adult care needs to be discussed in the pediatric setting, and patients must acquire appropriate beliefs about adult care well before transfer. Developmentally appropriate, staged discussions involving the patient, with and without parents, throughout adolescence may help patients acquire these beliefs and an understanding of the need for ongoing care. Improved continuity of pediatric care and provision of clear details for adult follow-up might be sufficient to cause substantive improvements in successful transfer. An understanding of why patients drop out of pediatric care may be needed to improve the continuity of care throughout adolescence. Almost one quarter of the patients believed adult care should be somewhere other than at a CACH center despite opposite recommendations. For these patients, a single discussion of adult care during the final pediatric visit may be too little, too late. In addition to earlier discussions, multiple mechanisms such as referral letters and transition clinics are needed. Similarly, patients engaging in multiple risky or poor health behaviors such as substance use may need more intensive programs to make substantial changes in these behaviors, which hopefully would lead to successful transfer. Overall, these data support the view that transition to adult care (a planned process of discussing and preparing for transfer to an adult health center) is important and should begin well before patients are transferred. The future health of adults with chronic conditions may depend on our ability to make these changes.

Adolescent↗
PubMedDate not supplied

A long-term-care setting pilot study evaluating predictors of success in medication self-administration.

OBJECTIVE: To determine whether any specific patient variables or a short battery of neuropsychological tests of cognition and memory predict success in medication self-administration. DESIGN: A prospective, single-blinded design. SETTING: An extended care center of a university-affiliated VA Medical Center. PATIENTS: Thirty predominately male, older veteran patients, mean age 70 +/- 4 years with a range of 63 to 79 years. INTERVENTIONS: Neuropsychological testing [Mini-Mental Status Examination (MMSE), Delayed Word Recall Test (DWRT), Shipley Institute of Living Scale (SILS), Neurobehavioral Cognitive Status Examination (NCSE), Hopkins Verbal Learning Test (HVLT)], twice a week unannounced bedside medication counts and medication administration record inspections, and educational instruction, if needed, by nurses and pharmacists. MAIN OUTCOME MEASURES: Patient characteristics such as age, number of medications, presence of a disorder that can alter cognitive or memory function, years of education, and results from the above listed neuropsychological tests. The dependent variable was successful or not successful as defined by whether the patient required a re-education intervention. RESULTS: Fifteen patients required one or more re-education intervention(s) as a result of meeting the criteria for not being successful. The absence of major depression, stroke, or anxiety disorder did tend to predict success (P = 0.0716) in medication self-administration. The other patient specific characteristics did not predict success. Among the neuropsychological tests administered, only the Judgment Subtest of the NCSE tended to predict success (P = 0.098). The MMSE, DWRT, SILS,HVLT tests did not predict successful performance in the self-medication program. CONCLUSIONS: Although the presence of a diagnosis that could potentially alter cognitive and memory function tended to predict success, no patient characteristics were found that predicted success independently. Among the neuropsychological tests, only the Judgment subtest of the NCSE tended to predict success in medication self-administration. We conclude that the NCSE and characterization of patient-specific factors, including diseases that may affect cognitive and memory function, seem to be the best predictors of success in medication self-administration in a long-term-care setting.

Journal Article↗
PubMed1998

Masking author identity in peer review: what factors influence masking success? PEER Investigators.

CONTEXT: In a previous study, we found that masking success was higher at a journal that masked reviewers to author identity. We hypothesized that masking policy or other factors could be associated with masking success. OBJECTIVES: To evaluate differences in success of masking reviewers to author identity at 7 biomedical journals and to identify factors associated with these differences. DESIGN: Written questionnaire. PARTICIPANTS: Reviewers at 3 journals with a long-standing policy of masking author identity (Annals of Emergency Medicine, Epidemiology, and Journal of the American Geriatrics Society) and 4 journals without a policy of masking author identity (Annals of Internal Medicine, JAMA, Obstetrics & Gynecology, and Ophthalmology). MAIN OUTCOME MEASURES: Masking success (percentage of reviewers successfully masked) and reviewer characteristics associated with masking. RESULTS: There was no significant difference in masking success between journals with a policy of masking (60%) and those without (58%) (P= .92). We found no association between masking success and a policy of masking when adjusted for the reviewer characteristics of age, sex, years of reviewing experience, number of articles published, number of articles reviewed, percentage of time spent in research, editorial experience, or academic rank (odds ratio [OR], 1.3; 95% confidence interval [CI], 0.64-2.8; P=.43). In multivariable analysis of reviewer characteristics, reviewers spending a greater percentage of time in research, the only significant predictor of masking success, were less likely to be successfully masked (OR, 1.01; 95% CI, 1.00-1.02) (P=.04). CONCLUSIONS: Masking success appears unrelated to a journal policy of masking, but is associated with reviewers' research experience and could be affected by other characteristics. Using reviewers with less research and reviewing experience might increase masking success, but the effect on review quality is unknown.

Authorship↗
PubMed2001

Academic and non-academic predictors of success on the Nottingham undergraduate medical course 1970-1995.

OBJECTIVES: To identify academic and non-academic predictors of success of entrants to the Nottingham medical course over the first 25 completed years of the course's existence. SETTING, DESIGN AND MAIN OUTCOME MEASURES: Retrospective study of academic and non-academic characteristics of 2270 entrants between 1970 and 1990, and their subsequent success. Analyses were undertaken of two cohorts (entrants between 1970 and 1985 and entrants between 1986 and 1990). RESULTS: Overall, 148 of 2270 (6.5%) entrants left the course, with the highest proportion being from the first 6 years (10.7%). Of the 148 leavers, 58 (39.2%) did so after obtaining their BMedSci degree. Concerning non-academic factors, in the 1970-85 cohort, applicants from the later years and those not taking a year out were more successful. However, these two factors had no influence on outcome in 1986-90. In contrast, ethnicity and gender were highly significant predictors of success in obtaining honours at BMBS in 1986-90 but at no other exam nor in the earlier years. Older, mature or graduate entrants were more successful at obtaining a first-class degree at BMedSci for the whole 21 years. However, they were less likely to be successful at passing the BMBS. With regard to academic factors, overall, A grades at Ordinary level/General Certificate of Secondary Education (O-Level/GCSE) were inconsistent independent predictors of success. However, for 1986-90, high grades at O-Level/GCSE chemistry and biology were strong independent predictors of success at BMedSci and BMBS. Very few Advanced level (A-Level) criteria were independent predictors of success for 1970-85. In contrast, for 1986-90 entrants, achieving a high grade at A-Level chemistry predicted success at obtaining a first-class degree at BMedSci, and a high grade at A-Level biology predicted success at BMBS. Over the 21 years, the majority of entrants achieved significantly lower grades at A-Level than predicted. General Studies A-Level was a poor predictor of achievement. CONCLUSIONS: On balance our current GCSE A-grade requirements should remain. Biology should be added to Chemistry as a compulsory A-Level subject. If predicted A-Level grades are borderline then the lower estimate should be used. General Studies should continue not to be used in selection. Performance of more recent mature entrants at BMBS needs further study. The recent gender and ethnic biases in obtaining honours at BMBS is currently being examined. The motivation of applicants planning to take deferred entry should be carefully explored at interview.

Achievement↗
PubMedDate not supplied

Predictors of intubation success and therapeutic value of paramedic airway management in a large, urban EMS system.

BACKGROUND: Endotracheal intubation (ETI) is commonly used by paramedics for definitive airway management. The predictors of success and therapeutic value with regard to oxygenation are not well studied. OBJECTIVES: 1) To explore the relationship between intubation success and perfusion status, Glasgow Coma Scale (GCS) score, and end-tidal carbon dioxide (EtCO2); 2) to describe the incidence of unrecognized esophageal intubations with use of continuous capnometry; and 3) to document the incremental benefit of invasive versus noninvasive airway management techniques in correcting hypoxemia. METHODS: This was a prospective, observational study conducted in a large urban emergency medical services system. Paramedics completed a telephone debriefing interview with quality assurance personnel following delivery of all patients in whom invasive airway management had been attempted. Continuous capnometry was used for confirmation of tube position in all patients. Descriptive statistics were used to document airway management performance, including first-attempt ETI success, overall ETI success, and Combitube insertion (CTI) success. In addition, the incidence of unrecognized esophageal intubation was recorded. The relationship between intubation success and perfusion status, GCS score, and initial EtCO2 value was explored using logistic regression. Finally, recorded SpO2 values and the incidence of hypoxemia (SpO2 < 90%) at baseline, following noninvasive airway maneuvers, and after invasive airway management were compared for perfusing patients. RESULTS: A total of 703 patients were enrolled over 12 months. First-attempt ETI success was 61%, and overall ETI success was 81%; invasive airway management (ETI or CTI) was unsuccessful in 11% of patients. A single unrecognized esophageal intubation was observed (0.1%). A clear relationship between airway management success and perfusion status, GCS score, and initial EtCO2 value was observed. Only EtCO2 demonstrated an independent association with ETI success after adjusting for the other variables. Significant improvements in mean SpO2 and the incidence of hypoxemia over baseline were observed with both noninvasive and invasive airway management techniques in 168 perfusing patients. CONCLUSIONS: A relationship between intubation success and perfusion status, GCS score, and initial EtCO2 value was observed. Capnometry was effective in eliminating unrecognized esophageal intubations. Both noninvasive and invasive airway management strategies were effective in increasing SpO2 values and decreasing the incidence of hypoxemia, with additional benefit observed with invasive airway maneuvers in some patients.

California↗
PubMed2006

Correlates of self-rated successful aging among community-dwelling older adults.

OBJECTIVE: There is no consensus on how to define successful aging. The authors sought to determine the correlates of self-rated successful aging as well as its correspondence with major researcher-defined criteria. METHODS: Participants were 205 community-dwelling adults over age 60. A questionnaire survey asked the participants to rate their own degree of successful aging and inquired about demographic characteristics, medical history, activity levels, resilience, daily functioning, and health-related quality of life (Medical Outcomes study 36-item Short-Form [MOS-SF-36]). Participants' subjective ratings of successful aging were contrasted with sets of researcher-defined criteria, and correlates of subjectively rated successful aging were examined. RESULTS: Ninety-two percent of the participants rated themselves as aging successfully. A majority of them also met other research criteria for successful aging such as independent living, mastery/growth, and positive adaptation but not those requiring an absence of chronic medical illness or physical disability. Higher SF-36 scores as compared with a published sample indirectly corroborated participants' subjectively rated successful aging. Subjective ratings of successful aging were significantly correlated with higher scores on health-related quality of life as well as resilience, greater activity, and number of close friends but not with several demographic characteristics. CONCLUSION: Most community-dwelling older adults viewed themselves as aging successfully despite having chronic physical illnesses and some disability. Longitudinal studies of the reliability and validity of subjective ratings of successful aging are warranted.

Aged↗
PubMed2004

Effect of implant design on survival and success rates of titanium oral implants: a 10-year prospective cohort study of the ITI Dental Implant System.

AIM: The aim of this 10-year study (observation time 8-12 years, mean: 10 years) was to compare the survival rates, success rates and incidences of biological complications using three different implant designs of the ITI Dental Implant System. MATERIAL AND METHODS: In 89 dental patients treated comprehensively, a total of 112 hollow screw (HS), 49 hollow cylinder (HC) and 18 angulated hollow cylinder (AHC) implants were installed depending on the available bone volume and according to prosthetic needs. One and 10 years after surgical placement, clinical and radiographic parameters were assessed. The incidences of peri-implantitis according to various thresholds were registered over 10 years of maintenance. RESULTS: Success criteria at 10 years were set at: pocket probing depth (PPD)< or =5 mm, bleeding on probing (BoP)-, bone loss < 0.2 mm annually. The survival rate for HS was 95.4%, for HC 85.7% and for AHC 91.7%. Ninety percent of all the HS, 71% of the HC and 88% of the AHC did not present with an incidence of peri-implantitis over the 10 years, HC having significantly higher incidence of peri-implantitis than HS (P< 0.004). With the success criteria set above, a success rate for HS of 74%, for HC of 63% and for AHC of 61% was identified at 10 years. However, including a definition of PPD< or =6 mm, BoP - and bone loss < 0.2 mm annually for success, the rates for HS were 78%, for HC 65% and for AHC 67%, respectively. Basing success criteria purely on clinical parameters (without radiographic analysis), such as: PPD< or =5 mm and BoP-, the success rates increased to 90%, 76% and 89%, respectively. With PPD< or =6 mm and BoP - as success criteria chosen, the respective rates were 94%, 82% and 94% for HS, HC and AHC implants, respectively. CONCLUSIONS: A significantly higher survival rate as well as a significantly lower incidence of peri-implantitis was identified for hollow screw design ITI Dental Implants after 10 years of service when compared to hollow cylinder design ITI Dental Implants (95.4% vs. 85.7%; 10% vs. 29%). Depending on the setting of the threshold criteria for success, success rates are highly variable and hence, reporting of success rates with elaboration on the criteria set appears crucial for comparison of different studies.

Adult↗
PubMed2002

Percutaneous abscess drainage in Crohn disease: technical success and short- and long-term outcomes during 14 years.

PURPOSE: To determine technical success with percutaneous abscess drainage (PAD) in patients with Crohn disease during 14 years. MATERIALS AND METHODS: Medical records of 32 patients with Crohn disease who underwent PAD from 1985 to 1999 were reviewed. Results of abscess drainage and nature of subsequent surgical procedures were recorded. Factors assessed included postoperative or spontaneous nature of the abscess, documentation of a proved fistula, history of occurrence of prior abscesses, duration of Crohn disease, and use of steroid treatment. Technical success was defined as complete abscess drainage. Short-term success was defined as avoidance of surgery within 60 days of drainage. Long-term success was defined as avoidance of surgery beyond the initial 60-day period. Short-term avoidance of surgery was assessed as a predictor of the need for surgery in the long term. Statistical analysis was performed with the chi(2) test to evaluate predictors of short-term success and to assess short-term success as a predictor of long-term success. RESULTS: The technical success rate was 96%. In 16 (50%) of 32 patients, the need for surgery in the short term was avoided, and surgery was more likely to be avoided in patients with postoperative abscesses than in those with spontaneous abscesses (P =.07). At long-term follow-up, short-term avoidance of surgery did not significantly increase the likelihood of need for surgery in the long term, which occurred in nine of 16 short-term successes versus five of 15 short-term failures (P =.55). Recurrent abscesses occurred in seven (22%) patients, a rate comparable to that with surgical abscess drainage; four (44%) of nine cases of re-drainage were successful. CONCLUSION: PAD has a high technical success rate of 96%. Half of patients may avoid surgery in the short term.

Abdominal Abscess↗
PubMed1992

Percutaneous transluminal coronary angioplasty of chronic total occlusions. Primary success, restenosis, and long-term clinical follow-up.

BACKGROUND: Angioplasty of chronically totally occluded vessels has been associated with a success rate well below and restenosis rate well above that for angioplasty of stenosed segments. However, long-term clinical outcome after successful revascularization of a chronically totally occluded vessel has not been reported in detail. METHODS AND RESULTS: Accordingly, data for 480 patients undergoing angioplasty for chronic total occlusion at Emory University Hospital, Atlanta, Ga., from 1980 to 1988 were analyzed for predictors of in-hospital procedural and clinical (procedural success and absence of in-hospital complications) success, restenosis, and 4-year clinical follow-up. The study population was grouped by procedural and clinical success and failure. The groups were then compared for outcome, both in hospital and long term. The initial clinical success rate was 66% (317 of 480 patients). Independent correlates of failure were the number of vessels diseased (p less than 0.001), vessel location of the lesion (p = 0.016), and absence of any distal antegrade filling (p = 0.002). Follow-up data revealed 98% cardiac survival and 96% overall survival at 4 years for the group as a whole. Freedom from myocardial infarction or cardiac death was significantly greater in patients with clinical success (93%) than with clinical failure (89%, p = 0.0044). In the successful group, 87% were free from coronary surgery after 4 years compared with 64% in the failure group (p less than 0.0001). Two thirds of the patients were free of angina at last follow-up. The presence of angina at follow-up was the same for patients successfully treated and for those with failed angioplasty, which may be related to the frequent use of coronary surgery in the failure group. CONCLUSIONS: In well-selected cases, the success rate for angioplasty of chronic total occlusion is acceptable. Furthermore, long-term clinical benefit is suggested by the high freedom from coronary surgery, myocardial infarction, and death in the patients who underwent successful revascularization.

Angioplasty, Balloon, Coronary↗
PubMed1997

Probability of successful defibrillation at multiples of the defibrillation energy requirement in patients with an implantable defibrillator.

BACKGROUND: The probability of successful defibrillation has been determined in normal animals but not in patients undergoing defibrillator implantation. Therefore, the purpose of this prospective study was to determine the probability of successful defibrillation in humans on the basis of a step-down defibrillation energy requirement. METHODS AND RESULTS: Fifty-three consecutive patients underwent five separate inductions of ventricular fibrillation after the defibrillation energy requirement was determined with the use of small decrements and a step-down protocol (20, 15, 12, 10, 8, 6, 5, 4, 3, 2, 1, and 0.8 J). The first shock energy for defibrillation was either 1.0, 1.3, 1.5, 1.7, or 2.0 times the defibrillation energy requirement, and the likelihoods of successful defibrillation were 70+/-27%, 84+/-12%, 86+/-25%, 80+/-29%, and 88+/-32%, respectively (P=.03). The frequencies of uniformly successful defibrillation (5 of 5 defibrillation attempts) were 30%, 27%, 60%, 64%, and 73%, respectively (P=.01). Seven patients in whom the defibrillation energy requirement was <4 J had an overall rate of successful defibrillation of 54+/-20% compared with 86+/-20% in the remaining 47 patients (P=.002). The likelihood of successful defibrillation at twice the defibrillation energy requirement was 98% in the 46 patients with a defibrillation energy requirement of >4 J and 67% in the 7 patients with a defibrillation energy requirement of <4 J (P=.17). An absolute safety margin of 7 J was associated with a 96% probability of successful defibrillation. CONCLUSIONS: The probability of successful defibrillation is 70% at the defibrillation energy requirement. The probability plateaus at 88%, at twice the defibrillation energy requirement. A 96% probability of successful defibrillation is achieved at an absolute safety margin of 7 J, and a 98% success rate is achieved at energies that are twice the defibrillation energy requirement if the defibrillation energy requirement is >4 J. If the defibrillation energy requirement is <4 J, larger multiples of the defibrillation energy requirement are needed to achieve a high probability of successful defibrillation.

Arrhythmias, Cardiac↗
PubMed1991

Factors determining success and energy requirements for cardioversion of atrial fibrillation: revised version.

Factors thought to affect the success of and energy requirements for cardioversion of atrial fibrillation were studied in 80 (49 male, 31 female) patients aged 21-88 (mean 61.5 years). Transthoracic impedance was measured in advance of the countershock using a 30 kHz low amplitude AC current passed through self-adhesive ECG/defibrillator pads (diameters 8 and 12 cm) applied to the chest in the antero-posterior (AP) position in 57 patients and the anteroapical (AA) position in 23 patients. Mean transthoracic impedance for all patients was 69.3 +/- 16 (SD) ohms (range 39-131 ohms), but transthoracic impedance was significantly greater in the AA than the AP position (75.4 +/- 13 vs. 66.7 +/- 16 ohms, p = 0.02). Initial energy was 50 J (delivered) and was gradually increased to a maximum of 360 J if required. Cardioversion was successful in 73 of 80 (91.2 per cent), and low energy shocks (< or = 200 J) were successful in 45 of 80 (56.2 per cent) patients. Using single factor analysis, sex, left atrial enlargement, electrode pad positions, aetiology of atrial fibrillation, presence of left ventricular failure, and prior treatment with verapamil or beta-adrenergic blockers were not significant determinants of cardioversion success or success of low energy shocks but prior treatment with digoxin was, both for cardioversion success and success at low energies. In patients with transthoracic impedance < or = 70 ohms, low energy shocks were more often successful (33 of 50, 66 per cent) than in patients with transthoracic impedance > 70 ohms (12 of 30, 40 per cent), p = 0.04. Using univariate analysis, cardioversion success with low energy shocks was not only significantly associated with prior treatment with digoxin but also with the duration of atrial fibrillation (24 hours to less than one month and one month to three years) and for shocks of < or = 100 J, with prior treatment with amiodarone. Multifactorial linear regression analysis selected, in rank order, only duration of atrial fibrillation of 24 hours to less than one month and one month to three years as significant predictors of both cardioversion success irrespective of shock strength, and success of low energy shocks.

Adult↗
PubMed1990

Factors determining success and energy requirements for cardioversion of atrial fibrillation.

Factors thought to affect the success of and energy requirements for cardioversion of atrial fibrillation were studied in 80 (49 male, 31 female) patients aged 21-88 (mean 61.5 years). Transthoracic impedance was measured in advance of the countershock using a 30 kHz low amplitude AC current passed through self-adhesive ECG/defibrillator pads (diameters 8-12 cm) applied to the chest in the antero-posterior (AP) position in 57 patients and the anteroapical (AA) position in 23 patients. Mean transthoracic impedance for all patients was 69.3 +/- 16 (SD) ohms (range 39-131 ohms), but transthoracic impedance was significantly greater in the AA than the AP position (75.4 +/- 13 vs. 66.7 +/- 16 ohms, p = 0.02). Initial energy was 50 J (delivered) and was gradually increased to a maximum of 360 J if required. Cardioversion was successful in 73 of 80 (91.2 per cent), and low energy shocks (less than or equal to 200 J) were successful in 45 of 80 (56.2 per cent) patients. Using single factor analysis, sex, left atrial enlargement, electrode pad positions, aetiology of atrial fibrillation, presence of left ventricular failure, and prior treatment with verapamil or beta-adrenergic blockers were not significant determinants of cardioversion success or success of low energy shocks but prior treatment with digoxin was, both for cardioversion success and success at low energies. In patients with transthoracic impedance less than or equal to 70 ohms, low energy shocks were more often successful (33 or 50, 66 per cent) than in patients with transthoracic impedance greater than 70 ohms (12 of 30, 40 per cent), p = 0.04. Using univariate analysis, cardioversion success with low energy shocks was not only significantly associated with prior treatment with digoxin but also with the duration of atrial fibrillation (24 hours to one month and one month to three years) and for shocks of less than or equal to 100 J, with prior treatment with amiodarone. Multifactorial linear regression analysis selected, in rank order, only duration of atrial fibrillation of 24 hours to less than one month and one month to three years as significant predictors of both cardioversion success irrespective of shock strength, and success of low energy shocks.

Adult↗
PubMed2006

Assessment of the influence of operative factors in the success of endoscopic third ventriculostomy in children.

OBJECTIVE: To determine if operative factors correlate with success of endoscopic third ventriculostomy (ETV) in the treatment of hydrocephalus. MATERIALS AND METHODS: The ETV procedure video of 33 hydrocephalic children was reviewed. Mean age at operation was 76 months (range: 1-196). Success was defined as no need for shunt in the long term. We calculated the relative size of stoma as the percentage of stoma diameter to the distance between posterior clinoid-basilar artery. Factors analysed were: intra-operative haemorrhage, stoma size, thick/double third ventricular floor, pre-pontine adhesions presence, brisk cerebro-spinal fluid (CSF) flow through the stoma as well as hydrocephalus cause, previous shunt presence, CSF infection or haemorrhage and previous ETV. Analysis was performed using chi-square, linear regression, and one-way ANOVA. RESULTS: Overall ETV success rate was 42%. Mean stoma size was 37%. For the entire group, none of the operative factors correlated statistically with success. Previous shunt presence adversely correlated with success (p=0.008). The highest success rate was in the aqueduct stenosis group. In patients without previous shunt (n=17), stoma size over 30% tended towards significance (p=0.094), CSF leak was adversely associated with ETV success (p=0.041) and mean stoma size was 41.3% in successful ETV and 27.8% in unsuccessful ETV (p=0.072). In patients with previous shunt (n=16), thin third ventricular floor was a negative predisposing factor (p=0.057). CONCLUSION: This study did not demonstrate a correlation between the presence of pre-pontine adhesions, double or thickened floor of third ventricle and ETV success. In patients without previous shunt, stoma size may correlate with success. CSF leak was strongly associated with failure.

Adolescent↗
PubMed1993

Long-term outcome following successful reopening of abrupt closure after coronary angioplasty.

Abrupt closure after coronary angioplasty is often successfully treated by repeat dilation. Long-term follow-up, including 6-month repeat catheterization and 12-month clinical evaluation, was obtained in 1,056 patients treated with acute (n = 335) or elective (n = 721) coronary angioplasty to evaluate the long-term impact of successful reopening of abrupt closure. Abrupt closure occurred in 13.5% of patients and was successfully reopened in 58%. Adverse outcomes including restenosis, death, bypass surgery, myocardial infarction and repeat angioplasty were compared between patients with successfully treated abrupt closure and those with successful procedures (residual diameter stenosis < or = 50%) without abrupt closure. For patients with acute angioplasty, the restenosis rates (> 50% diameter stenosis at follow-up) were 64% for those with successfully treated abrupt closure versus 36% for those with successful procedures without abrupt closure (p < 0.01). In addition, subsequent myocardial infarction (12 vs 3%; p = 0.01) and repeat angioplasty (21 vs 10%; p = 0.03) were more frequent in the group with abrupt closure. For patients with elective angioplasty, restenosis was 43% in those with successfully treated abrupt closure versus 45% in those without abrupt closure (p = NS). Subsequent death and myocardial infarction were more frequent in patients with abrupt closure (death: 12 vs 3% [p < 0.01]; myocardial infarction: 13 vs 3% [p < 0.01]). Long-term adverse events are increased in patients with successfully treated abrupt closure compared to those with successful procedures without abrupt closure.

Acute Disease↗
PubMed2004

The impact of maternal obesity and weight gain on vaginal birth after cesarean section success.

OBJECTIVE: This study was undertaken to determine the impact of maternal obesity on success of a trial of labor (vaginal birth after cesarean section [VBAC]) after a single low transverse cesarean delivery. STUDY DESIGN: Individual charts of women with low transverse cesarean delivery in their first viable pregnancy who underwent a VBAC in their second viable pregnancy at our urban tertiary care institution were reviewed. Maternal body mass index (BMI) was classified as underweight (<19.8 kg/m2), normal (19.8-24.9 kg/m2), overweight (25-29.9 kg/m2), or obese (> or =30 kg/m2). Clinical characteristics and labor outcomes were assessed. Factors potentially affecting VBAC success were analyzed by univariate analysis. Logistic regressions were performed to determine the impact of maternal pregravid BMI on VBAC success after controlling for confounding factors. RESULTS: Of 510 women attempting a trial of labor, 337 (66%) were successful and 173 (34%) failed VBAC. Decreased VBAC success was seen in obese (54.6%) but not overweight (65.5%) women compared with women of normal BMI (70.5%), P = .003 and .36, respectively. Underweight women had more VBAC success than women of normal BMI (84.7% vs 70.5%, P = .04). Controlling for other factors, the association between increasing pregravid BMI and BMI > or =30 kg/m 2 with decreased VBAC success persisted, P = .03 and .006, respectively. Normal BMI women who became overweight before the second pregnancy had decreased VBAC success compared with those whose BMI remained normal (56.6% vs 74.2%, P = .006). However, overweight women who decreased their BMI to normal before the second pregnancy did not significantly improve VBAC success (64.0% vs 58.4%, P = .67). CONCLUSION: Increasing pregravid BMI and weight gain between pregnancies reduce VBAC success after a single low transverse cesarean delivery.

Birth Weight↗