Background: The rate of left ventricular (LV) lead displacement after cardiac resynchronization therapy (CRT) remains high despite improvements in lead technology. In 2017, a novel quadripolar lead with active fixation technology became available in the UK.Methods: This was a retrospective, observational study analyzing device complications in 476 consecutive patients undergoing successful first-time implantation of a CRT device at a tertiary center from 2017 to 2020.Results: Both active (n = 135) and passive fixation (n = 341) quadripolar leads had similar success rates for implantation (99.3% vs. 98.8%, p = 1.00), although the pacing threshold (0.89 [0.60-1.25] vs. 1.00 [0.70-1.60] V, p = .01) and lead impedance (632 [552-794] vs. 730 [636-862] Ohms, p < .0001) were significantly lower for the active fixation lead. Patients receiving an active fixation lead had a reduced incidence of lead displacement at 6 months (0.74% vs. 4.69%, p = .036). There was no significant difference in the rate of right atrial (RA) and right ventricular (RV) lead displacement between the two groups (RA: 1.48% vs. 1.17%, p = .68; RV: 2.22% vs.1.76%, p = .72). Reprogramming the LV lead after displacement was unsuccessful in most cases (successful reprogramming: Active fix = 0/1, Passive fix = 1/16) therefore nearly all patients required a repeat procedure. As a result, the rate of intervention
The aim of this review was to establish the current evidence base regarding parental involvement in decision-making in the NICU. The review question was set as 'What is known about the process of parental participation in clinical decision-making in the NICU?' The findings of this critical literature review illustrate the process of decision-making for parents in NICU. The available evidence base was minimal. The parental role in decision-making is variable with current literature suggesting that the informed parental role, allowing parents to make the ultimate decision, is increasingly desired. Despite this there is still a requirement for medical and shared decisionmaking for some families. Regardless of the role parents assume it is evident that there will always be an array of emotional complexities to follow. Most feelings and emotional responses reported by parents were negative. The literature suggests several reasons for these feelings. A lack of parental knowledge and experience in NICU leading to confusion as to whether the right decision has been made alongside parents having a heightened awareness of the potential for suffering and harm for their baby. There are the added pressures of time and the weight of responsibility. The burden appears to be unequally distributed between parents. Several studies illustrate the transfer of responsibility from the father to mothers.
The incidence of oesophageal adenocarcinoma (OA) in the Western World has drastically increased by almost 400% in the last 30 years, making it the 8th most common cancer in the World. This cancer normally presents in late-stage disease meaning that therapeutic options are limited. Given this, identification of modifiable predisposing factors is crucial in order that therapeutic intervention can be targeted correctly. In the present case report, we describe the case of a 59 year-old woman diagnosed with T2 oesophageal adenocarcinoma on a background of BMI 49 and few other predisposing co-morbidities. This case highlights the difficulty in identfying causal relationships between obesity and oesophageal adnocarcinoma, and the limitations this brings to managing cases in practice. Further evidence is needed to define the pathophysiology of the disease as well as potential predisposing factors which can be targeted therapeutically to mitigate against disease development and progression.
Aim This study was undertaken to specifically identify challenges associated with the popular single‐family room (SFR) design in our new neonatal intensive care unit (NICU), so as to reap the full benefits of this architectural model. Methods A survey was sent to all 223, newly recruited staff on our NICU. Questions explored staff perceptions of family experience, safety and staff's experience of the SFR in comparison with the open bay model. Results We obtained a response rate of 66%. Most staff perceived SFR as having a positive impact on communication with families, privacy, feasibility for skin‐to‐skin contact, reduction in noise levels and family access to their baby. There were however concerns raised about patient safety and isolation of staff and families in the SFR architecture. Lack of opportunities to leave the patient room for breaks and increased physical demands were highlighted. Staff also felt physically and emotionally less well supported. Conclusion Whilst the SFR configuration was felt to be beneficial for infants and families, staff shared their perceived concerns regarding infant safety and isolation and staff satisfaction, and implied modifications to workflows. The survey findings resulted in re‐organisation of our staff numbers and communication systems and further facilitation of parent interactions in order to optimise benefits of SFR design.
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