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Ablation of cavo-tricuspid isthmus dependent atrial flutter using a focal monopolar pulsed-field ablation catheter:Feasibility, periprocedural coronary spasms and conduction disorders
No full textBackground: Pulsed-field ablation for the treatment of cavotricuspid isthmus (CTI)–dependent atrial flutter has been associated with coronary spasms (CS) and atrioventricular conduction disorders (CD). Objectives: The purpose of this study was to evaluate the feasibility of CTI ablation using a monopolar focal pulsed-field ablation (F-PFA) catheter and to assess the risk of CS and CD during and after the procedure. Methods: We prospectively enrolled patients with atrial flutter treated with an F-PFA system (CardioFocus, Marlborough, MA) or by focal radiofrequency ablation (RFA) using contact force–sensing catheters integrated into electroanatomic mapping systems. Intravenous nitroglycerin was administered prior to F-PFA. Feasibility and safety with a focus on CS or CD were assessed. In a subgroup of patients, the course of the right coronary artery and the His position were determined. Results: In total, 82 patients underwent CTI ablation with F-PFA (mean age 66 ± 8 years; 15 (18%) being female; CHA 2DS 2-VA score 1.6 ± 1.3) and 27 patients underwent CTI ablation with RFA (mean age 63 ± 9 years; 4 (23%) being female; CHA 2DS 2-VA score 2 ± 1.3). For F-PFA, the rate of first-pass block was higher (93% vs 55%) and the median (interquartile range) procedure times were shorter (7 [5–11] minutes vs 17 [15–19] minutes) than for RFA. In the F-PFA group, 4 patients (5%) had transient ST-segment elevation and 2 patients (2%) had transient complete atrioventricular block during ablation. There was a small but significant prolongation of the PQ interval after CTI ablation in the F-PFA group. Conclusion: CTI ablation using F-PFA is feasible, but operators should be aware of rare but critical CD and CS during the procedure, even when preventive measures such as nitroglycerin administration are used.</p
Rethinking Workplace-Based Assessment:The Costly Illusion of Authenticity
No full textThe current practice of workplace-based assessment (WBA) in many health professions education contexts does not live up to the expectations regarding WBA's both formative (for learning) and summative (for decision-making) potential. In this Scholarly Perspective, the authors argue that the ambition to observe and assess so-called authentic behavior of trainees plays a role in this. According to the literature, for assessments in the workplace to be valid, direct observation of authentic behavior of trainees performing authentic clinical work is key. Guidelines, therefore, advise supervisors to observe their trainees silently from a distance, while avoiding direct eye contact with the patient. If these guidelines are followed, trainee-patient-supervisor situations that could be used for teaching in dialogue, with bidirectional observations, must be transformed into distanced, silent, unidirectional assessments. Research outcomes, however, suggest that direct observation and assessment of true authentic behavior of trainees in true authentic clinical work is an illusion; the presence of an observing supervisor, however distanced, changes the situation and, with that, the conduct of the trainee. Additionally, this illusion is costly because distancing the supervisor from the trainee comes at the expense of teaching and learning in dialogue. Although assessments in the workplace may serve summative purposes, they do not fit well with formative goals of health professions education. Therefore, WBA's current central position in health professions education, which is based on both its summative and formative promises, should be questioned. More specifically, the prominent role of assessment when supervisors are present while their trainee works with a patient should be reconsidered. The authors propose to use these trainee-patient-supervisor situations predominantly for teaching and learning, with bidirectional direct observation and dialogue, and then determine the needs for and purposes of assessment
Increased fracture risk and fracture prevention
No full textAn increased fracture risk is a common chronic condition leading to a rising number of fractures, which are injurious to patients and costly to the health care system. Effective diagnostic and treatment options are available for fracture prevention. In this article, we will answer specific practical questions with respect to increased fracture risk and fracture prevention. Topics discussed include definitions, risk factors, the diagnostic modalities and treatment options
Synthesis of 2,5-Substituted 1,3,4-Oxadiazoles via a Tandem Reaction Involving a Cobalt-Catalyzed Carbene Transfer to N-Isocyaniminotriphenylphosphorane
No full textA cobalt(II)-catalyzed three-component synthesis of 2,5-substituted 1,3,4-oxadiazoles using N-isocyaniminotriphenylphosphorane (NIITP), diazo compounds, and carboxylic acids has been developed. The tandem reaction involves a carbene transfer to NIITP, followed by the addition of the carboxylic acid to the in situ-formed ketenimine and a subsequent intramolecular aza-Wittig reaction. The protocol tolerates a broad range of carboxylic acids and diazoacetates. This includes medicinally relevant carboxylic acids that were successfully converted into their corresponding 1,3,4-oxadiazole bioisosteres. Postfunctionalization extends the applicability of this three-component reaction.</p
Preliminary efficacy of an online intervention based on Acceptance and Commitment Therapy for family caregivers of people with dementia:a feasibility study
No full textWith the rising number of dementia cases, supporting family caregivers to maintain their well-being is crucial. Acceptance and Commitment Therapy (ACT) shows promise in promoting psychological flexibility and positive behaviour change. However, it is still developing in caregiving contexts. This study evaluated the preliminary efficacy of a fully online ACT intervention for caregivers of people with dementia. This study employed a pre-post design with two follow-up assessments at 3 and 6 months. A 9-week web-based self-help ACT program, including individual goal setting prior to the intervention, and minimal contact motivational coaching, was provided to 30 family caregivers in the Netherlands. Linear mixed-effect models based on a complete-case analysis showed significant changes in depressive symptoms (mean difference: −3.34, d = −0.78). Significant and sustained improvements were observed in stress (mean difference: −6, d = −1.13) and anxiety (mean difference: −5.55, d = −1.38), both of which were clinically significant. Sense of competence increased (mean difference: 1.1, d = 0.45). ACT-specific measures, including psychological flexibility, engaged living, and inflexibility, also showed significant improvements with medium-to-large effect sizes. This online intervention demonstrated promising preliminary evidence of ACT’s potential efficacy on caregivers’ well-being, warranting further research in larger-scale controlled trials.</p
Bone Health of Female Elite Cyclists Is Characterized by Impaired Cortical and Trabecular Microarchitecture
No full textPurpose: Many elite road-race cyclists have low areal bone mineral density (aBMD) as previously shown by dual-energy X-ray absorptiometry (DXA). However, aBMD provides limited insight into bone quality. Therefore, this cross-sectional study aimed to assess volumetric BMD (vBMD), bone microarchitecture, and bone strength in elite road-race cyclists using high-resolution peripheral computed tomography (HR-pQCT), along with aBMD measured by DXA. Methods: Twenty female elite (Tier 3/ 4) road-race cyclists (21±2 y; BMI 20.8±1.6 kg/m 2) had DXA scans at the hip, lumbar spine, and total body to assess aBMD, and HR-pQCT scans at the distal radius and tibia to assess vBMD, bone microarchitecture, and failure load. Z-scores were calculated for all outcomes, with Z-scores <-1 considered as low or impaired. The risk of low energy availability was assessed using the Low Energy Availability in Females Questionnaire (LEAF-Q). Results: Low aBMD was observed in 20%, 25%, 35%, and 10% of the participants at the hip, femoral neck, lumbar spine, and total body, respectively. Low total vBMD was present in 45% and 40% at the distal radius and tibia, respectively. With regard to bone microarchitecture, the tibial cortical area and tibial cortical thickness were low in 40% and 60% of the participants, respectively, and number and thickness of trabeculae at the tibia were low in 40% and 30% of the participants. The impairments were less pronounced at the distal radius. Failure load was low in 15% (radius) and 20% (tibia) of the participants. Conclusions: Along with low aBMD, a substantial proportion of female elite cyclists had impaired bone microarchitecture, mainly characterized by a low cortical area and thickness and low trabecular number and thickness, especially at the distal tibia.</p
Community Perspectives on Inequalities in the Provision of Basic Healthcare Services for the Most Vulnerable Populations in the Eastern Congo:A Qualitative Study
No full textBackground There is a notable lack of evidence regarding the factors that shape the provision of essential healthcare services in post-conflict settings.Purpose This study aimed to explore and describe the factors influencing the provision of basic health care services for the most vulnerable populations in the Eastern Congo.Method Employing a qualitative research approach, twenty individual interviews with community members and thirteen focus group discussions were conducted. Participants were drawn from three geographically and demographically diverse locations with a history of decades-long armed conflicts in the Congo. Inductive thematic coding used the Health System Dynamics Framework categories (i.e. goals and outcomes, values and principles; service delivery; the population; the context; leadership & governance; and the organization of resources (finances; human resources; infrastructure and supplies; knowledge and information), while allowing for additional themes.Results Our findings are presented thematically according to these ten categories. The following factors were perceived as key areas enabling or hindering healthcare provision to the community: (1) the context for organizing basic healthcare service delivery is complex and challenging; (2) the population plays a crucial role as an active producer of health and potential change agents; (3) there is a poor strategic policy framework to guide local-level communities in the provision of basic healthcare services; (4) several critical barriers and facilitators related to effective healthcare service delivery were identified; (5) the classification of basic health service delivery methods to meet the healthcare needs of the vulnerable population; (6) the healthcare system is pluralistic and consists of multiple overlapping systems and providers; and (7) service providers and potential service users still consider access to basic healthcare services challenging, potentially resulting in reduced coverage.Conclusion These findings suggest that substantial changes in the factors contributing to the provision of basic healthcare services are necessary to ensure the delivery of basic healthcare services to the most vulnerable populations in the Eastern Congo. Consequently, there is a critical need to reconsider the healthcare delivery system, specifically addressing these contributing factors in the context of the Eastern Congo
Sensory Feedback in Parkinson Disease Voice Production:A Systematic Review
No full textBACKGROUND: Understanding voice and speech impairments in Parkinson's disease (PD) is essential for developing effective interventions and ensuring efficient social communication. OBJECTIVE: This review reports findings on voice perception and production in PD with a specific focus on sensory feedback (auditory and somatosensory) of the self-voice, neural correlates of the voice, and voice quality parameters such as pitch, loudness, and emotion modulation. METHODS: A combined bibliometric analysis and a systematic review should identify key trends and knowledge gaps in the neuroimaging (functional magnetic resonance imaging (fMRI)/EEG) literature on PD self-voice processing. RESULTS: EEG studies focusing on pitch revealed significant differences in the P200 event-related potential, but no differences in the N100, between healthy controls and individuals with PD. fMRI studies showed reduced activation in the motor cortex and basal ganglia during speech production in PD, accompanied by increased activation in other brain regions, such as the auditory cortex, which was associated with pitch variability and loudness control. A decrease in right dorsal premotor cortex activation was linked to impaired voice control, particularly regarding loudness modulation. Additionally, the review identified missing research on the emotion modulation of the voice, despite its critical role in social communication. Altered sensory feedback plays a significant role in compensatory cortical responses during vocalization, underscoring the importance of sensory feedback in maintaining normal voice production in PD. CONCLUSIONS: This review identified missing research on voice loudness perception and the potential impact of emotion perception deficits regarding voice modulation in persons with PD
Potential and value of rescuing dying neurons
No full textUnwarranted death of neurons is a major cause of neurodegenerative diseases. Since mature neurons are postmitotic and do not replicate, their death usually constitutes an irreversible step in pathology. A logical strategy to prevent neurodegeneration would then be to save all neurons that are still alive, i.e. protecting the ones that are still healthy as well as trying to rescue the ones that are damaged and in the process of dying. Regarding the latter, recent experiments have indicated that the possibility of reversing the cell death process and rescuing dying cells is more significant than previously anticipated. In many situations, the elimination of the cell death trigger alone enables dying cells to spontaneously repair their damage, recover, and survive. In this review, we explore the factors, which determine the fate of neurons engaged in the cell death process. A deeper insight into cell death mechanisms and the intrinsic capacity of cells to recover could pave the way for novel therapeutic approaches to neurodegenerative diseases