Background
Atrial 4D flow MRI was employed for the characterization of left atrial (LA) and left atrial appendage (LAA) flow dynamics in patients with atrial fibrillation (AF).
Methods and Result
4D flow MRI measured in-vivo 3D blood flow velocities in 60 AF patients and 15 controls. Anatomic maps of LA and LAA stasis and velocity were calculated to quantify atrial peak velocity, mean velocity, and stasis (velocities<0.1m/s). In a sub-study with 30 AF patients, 4D flow metrics were compared to Doppler transesophageal echocardiography (TEE). For all 15 controls, LAA mean and peak velocities were consistently lower (by 21%/12%, p<0.001) while LAA stasis was higher (by 58%, p<0.001) compared to the LA. In contrast, lower LAA velocity and increased LAA stasis was only found in a fraction (38 of 60) of AF patients. In AF patients, increased CHA2DS2-VASc score was associated with significantly (p<0.043) reduced LA velocities and elevated stasis. There was a heterogeneous expression of atrial flow dynamics and 25–68% of AF patients demonstrated flow in the normal range: 25%/68% for LA/LAA stasis, 38%/60% for LA/LAA peak velocities. TEE velocities were modestly but significantly (p<0.05) correlated with 4D flow based LA velocities (r=0.41) and stasis (r=−0.39).
Conclusions
AF resulted in overall impaired but individually variable flow dynamics in both the LA and LAA. AF patients demonstrated atrial flow in the normal range despite elevated CHA2DS2-VASc score.
BACKGROUND: Simple interventions such as facecards can improve patients' knowledge of names and roles of hospital physicians, but the effect on other aspects of the patient-physician relationship is not clear.
Background
Whether cognitive and patient care skills attained during simulation-based mastery learning (SBML) are retained is largely unknown.
Objective
We studied retention of intensive care unit (ICU) clinical skills after an SBML boot camp experience.
Methods
Forty-seven postgraduate year (PGY)-1 residents completed SBML intervention designed to increase procedural, communication, and patient care skills. The intervention included ICU skills such as ventilator and hemodynamic parameter management. Residents were required to meet or exceed a minimum passing score (MPS) on a clinical skills examination before starting actual patient care. Skill retention was assessed in 42 residents who rotated in the medical ICU. Residents received a standardized 15-minute booster teaching session reviewing key concepts during the first week of the rotation. During the fourth week of their rotation, PGY-1 residents completed a clinical skills examination at the bedside of an actual ICU patient. Group mean examination scores and the proportion of subjects who met or exceeded the MPS at each testing occasion were compared.
Results
Residents scored a mean 90% (SD = 6.5%) on the simulated skills examination immediately after training. Residents retained skills obtained through SBML as the mean score at bedside follow-up testing was 89% (SD = 8.9%, P = .36). Thirty-seven of 42 (88%) PGY-1 residents met or exceeded the MPS at follow-up.
Conclusion
SBML leads to substantial retention of critical care knowledge, and patient care skills PGY-1 boot camp is a highly efficient and effective model that can be administered at the beginning of the academic year.
Immunosuppression following heart transplantation has improved graft longevity through the reduction of cellular and antibody mediated rejection. The attempt to limit the unintended consequences of immunosuppressive therapies and address sensitized patients has led to a revolution in immunosuppression. Areas covered: This review will focus on the current emerging immunosuppressive therapies in heart transplantation while reviewing the effective contemporary treatments, and explore the potential development of new immunomodulatory therapies. An exhaustive review of the PubMed database and abstract data from national meetings was performed to compile the data for the manuscript. Expert commentary: The timing and targets of immunosuppressive therapies are evolving to provide adjunctive therapies to the established treatments. Recent advances will allow for further tailoring of immunomodulatory therapies to the individual patient.
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