7 research outputs found
Ectopic Beats: How Many Count?
No full textPremature atrial and ventricular contractions, or ectopic beats, are frequently detected on routine electrocardiogram monitoring. They are often considered to be benign with no pathological significance; however, the literature suggests that higher ectopic burdens may have clinical importance. This paper reviews the current literature and provides the treating physician with an understanding of when ectopic beats should be deemed significant and when treatment may be appropriate
Robert Buchanan 1841-1901: an assessment of his career.
No full textPhDRobert Buchanan was widely regarded during his
lifetime as a poet of distinction, a capable and powerful
novelist, and a critic of some perception, yet his name is
now associated only with one regrettable episode, while
those of lesser men and women continue to be remembered for
work inferior to his. A man possessing large reserves of
energy, and pressed to write for a living at an early age,
he produced much work that deserves the oblivion it has
found; but his early verse, expressing his profound compassion
for the sufferings of the unfortunate in the simplest
language, some of his ballads, and not a little of his
later more vatic verse, is still worthy of study. As a
novelist his work is provocative and readable, but too
often descends to the level of the sentimental melodrama
which earned him, for a while, a very good income from the
stage. As a critic he was not profound, but was quick to
detect and praise expression of his own sympathy for humanity
that came to represent for him art's highest aspiration;
Dickens, Browning and Whitman were his heroes, and for the
last two he did sterling work in helping them to gain widespread
recognition. As a polemist he rushed into several
arenas, for some of which his talents were not especially
suited; but he publicly supported C. S. Parnell and Oscar
Wilde when few found the courage to do so. An interesting
man of impressive variety and undoubted talent has found an
undeserved neglect, and a full-scale critical biography of
Robert Buchanan is long overdue
Highlighting reported psychological issues of co-survivors post-delivery of CPR in Out-of-Hospital Cardiac Arrest; a qualitative study
No full textOut of hospital cardiac arrest (OHCA) is a major healthcare concern affecting up to half a million people per year worldwide. In England, up to 80% of OHCA’s occur in a person’s own place of residence, with approximately half of all cases witnessed by a bystander, and bystander initiated cardiopulmonary resuscitation (CPR) is attempted in 78% of witnessed cases. There is growing recognition that witnessing an OHCA and assisting in CPR is a highly traumatic event and that so-called ‘co-survivors’ (those involved in the resuscitation attempt) are likely to have unmet needs. Currently, there is no nationally agreed commissioned model for the follow-up of OHCA survivors or co-survivors despite calls from one major national society to standardise practices</p
Expedited conveyance of out-of-hospital-cardiac arrest patients with STEMI and shockable rhythms to cardiac arrest centres : a feasibility pilot study of the British Cardiovascular Intervention Society conveyance algorithm
No full textBACKGROUND AND AIMS: Guidelines suggest non-traumatic out-of-hospital cardiac arrest (OHCA) be conveyed to cardiac arrest centres (CAC). We hypothesised that (a) a pre-hospital conveyance algorithm based on initial presenting rhythm following OHCA is feasible and (b) that would demonstrate survival advantage.METHODS: This observational pilot study included all consecutive patients with OHCA from suspected cardiac aetiology from the county of Essex, United Kingdom from April 2022-April 2023. For the first 6 months, OHCA patients had conveyance as standard of care. For the next 6 months, consecutive OHCA patients with STEMI or initial shockable rhythm were directly conveyed to the CAC, initial non-shockable rhythm without STEMI continued to be taken to the nearest Emergency Department (BCIS protocol). Primary outcome was death from any cause at 30 days. Secondary outcome was survival with favourable neurological outcome.RESULTS: Of 330 patients (mean age 67.5 ± 13.1, 66% male), 162 patients were in the standard care group and 168 in the BCIS conveyance group. Algorithm implementation was associated with numerically lower all cause 30-day mortality [(81% vs 73%, RR 1.10 (95% CI 0.98-1.24) p = 0.10] and numerically higher 30-day survival with favourable neurological outcome [15% vs 19%, RR 1.05 (0.95-1.15), p = 0.38]. Post hoc analysis showed that the BCIS conveyance algorithm was associated with lower 30 day mortality in those with an initial shockable rhythm [(61% vs 41%, RR 1.5 (95% CI 1.05-2.13) p = 0.02 and in those with a MIRACLE 2 score ≤ 5 [(63%% vs 38%, RR 0.59 (95% CI 0.61-0.86) p = 0.005]. CONCLUSIONS: The BCIS algorithm is feasible and did not impact overall mortality, but there is signal that direct conveyance of OHCA patients with an initial shockable rhythm and low MIRACLE 2 score, to a dedicated CAC may improve survival. </p
Assessing the impact of prolonged averaging of coronary continuous thermodilution traces
No full textContinuous Thermodilution is a novel method of quantifying coronary flow (Q) in mL/min. To account for variability of Q within the cardiac cycle, the trace is smoothened with a 2 s moving average filter. This can sometimes be ineffective due to significant heart rate variability, ventricular extrasystoles, and deep inspiration, resulting in a fluctuating temperature trace and ambiguity in the location of the “steady state”. This study aims to assess whether a longer moving average filter would smoothen any fluctuations within the continuous thermodilution traces resulting in improved interpretability and reproducibility on a test–retest basis. Patients with ANOCA underwent repeat continuous thermodilution measurements. Analysis of traces were performed at averages of 10, 15, and 20 s to determine the maximum acceptable average. The maximum acceptable average was subsequently applied as a moving average filter and the traces were re-analysed to assess the practical consequences of a longer moving average. Reproducibility was then assessed and compared to a 2 s moving average. Of the averages tested, only 10 s met the criteria for acceptance. When the data was reanalysed with a 10 s moving average filter, there was no significant improvement in reproducibility, however, it resulted in a 12% diagnostic mismatch. Applying a longer moving average filter to continuous thermodilution data does not improve reproducibility. Furthermore, it results in a loss of fidelity on the traces, and a 12% diagnostic mismatch. Overall, current practice should be maintained.</p
Assessing the impact of prolonged averaging of coronary continuous thermodilution traces
No full textContinuous Thermodilution is a novel method of quantifying coronary flow (Q) in mL/min. To account for variability of Q within the cardiac cycle, the trace is smoothened with a 2 s moving average filter. This can sometimes be ineffective due to significant heart rate variability, ventricular extrasystoles, and deep inspiration, resulting in a fluctuating temperature trace and ambiguity in the location of the “steady state”. This study aims to assess whether a longer moving average filter would smoothen any fluctuations within the continuous thermodilution traces resulting in improved interpretability and reproducibility on a test–retest basis. Patients with ANOCA underwent repeat continuous thermodilution measurements. Analysis of traces were performed at averages of 10, 15, and 20 s to determine the maximum acceptable average. The maximum acceptable average was subsequently applied as a moving average filter and the traces were re-analysed to assess the practical consequences of a longer moving average. Reproducibility was then assessed and compared to a 2 s moving average. Of the averages tested, only 10 s met the criteria for acceptance. When the data was reanalysed with a 10 s moving average filter, there was no significant improvement in reproducibility, however, it resulted in a 12% diagnostic mismatch. Applying a longer moving average filter to continuous thermodilution data does not improve reproducibility. Furthermore, it results in a loss of fidelity on the traces, and a 12% diagnostic mismatch. Overall, current practice should be maintained.</p
Designing a theory-informed feedback system for prehospital cardiac arrest care: a qualitative study
No full textIntroduction: Feedback is a vital yet underused tool for improving clinical outcomes in prehospital emergency care. This study aimed to develop and pilot a novel, theoretically grounded feedback mechanism for helicopter emergency medical service (HEMS) clinicians involved in out-of-hospital cardiac arrest (OHCA) in the East of England, UK. Methods: Semistructured interviews were conducted in September 2022 with HEMS clinicians from Essex & Herts Air Ambulance, and the feedback process was co-designed with the Essex Cardiothoracic Centre (Essex, UK). Using the COM-B model (Capability, Opportunity, Motivation-Behaviour), we conducted qualitative interviews with prehospitalists (seven paramedics, three prehospital doctors) to explore gaps in existing feedback processes and identify their information needs, then iteratively co-developed a structured feedback proforma with stakeholders. Results: Three themes emerged, specifically about weaknesses in current feedback and preferences for an improved system: (1) dissatisfaction with current ad hoc, ‘punitive’ approaches; (2) the educational and emotional importance of timely, targeted feedback; and (3) a strong preference for standardised, confidentiality-compliant delivery methods. The resulting feedback proforma included working diagnoses, key investigations completed, optimisation opportunities and patient outcomes (if already available), to be delivered within 24–48 hours of hospital admission. Conclusions: Our study underscores the importance of stakeholder-driven development in shaping an effective prehospital feedback mechanism for OHCA aligned to clinicians’ needs. By exploring feedback preferences and mapping insights onto the COM-B model, we highlight how knowledge, context and motivation can all steer behavioural change. Further research is needed in diverse emergency medical service contexts to test its impact on clinical practice and patient outcomes.</p
