Background
Implantable cardioverter defibrillator (ICD) acceptance and shock anxiety are issues that clinicians should address to improve quality of life among device recipients. Previous findings have indicated that younger patients experience poorer device adjustment. The purpose of this study was to examine age and ICD-specific quality-of-life outcomes in a large sample of Canadian ICD patients. We tested the hypothesis that patient age is related to device acceptance and shock anxiety in an Alberta (Canada) ICD population.
Methods
The Florida Patient Acceptance Survey (FPAS) and Florida Shock Acceptance Survey (FSAS) were completed by ICD patients attending the Cardiac Implantable Electrical Device Clinics in Alberta. The population was dichotomized into those aged ≤ 65 years (younger) and those aged > 65 years (older). Sex, ICD shock history, and remote monitoring use were also examined.
Results
Surveys were completed by 126 younger (53 ± 11 years; 79% male) and 216 older (74 ± 6 years; 85% male) patients. Younger, compared with older, patients had greater device-related distress (
P
< 0.001) and more body-image concerns (
P
< 0.001), but no differences in return to function or positive appraisal. Younger patients reported lower total device acceptance (
P
= 0.001) and greater total shock anxiety (
P
< 0.001) compared with older patients.
Conclusions
ICD patients aged ≤ 65 years reported poorer device acceptance and greater shock anxiety than older patients. Younger patients may require targeted interventions addressing adjustment to the ICD, and impact of the ICD on body image. Moreover, education about the relatively low probability of shocks may alleviate shock anxiety in younger patients.
Background
Injury is the leading cause of morbidity and mortality in low- and lower middle-income countries (LMICs). Trauma training is a cost-effective way to improve injury outcomes. Several trauma programs have been implemented in LMICs; however, their scope and effectiveness remain unclear. In this review, we sought to describe and assess the current state of trauma training in LMICs.
Methods
We searched MEDLINE, Embase, Global Health, Cochrane Library, and ProQuest Dissertations & Theses Global for trauma training courses in LMICs. An additional gray literature search was conducted on university, governmental, and non- governmental organizations’ websites to identify trauma-related postgraduate medical education (PGME) opportunities.
Results
Most studies occurred in sub-Saharan Africa and participants were primarily physicians/surgeons, medical students/residents, and nurses. General and surgical trauma management courses were most common, followed by orthopedic trauma or plastic surgery trauma/burn care courses. 32/45 studies reported on participant knowledge and skills, 27 of which had minimal follow-up. Of the four studies commenting on cost of courses, only one demonstrated cost-effectiveness. Three articles evaluated post-course effects on patient outcomes, two of which failed to demonstrate significant improvements. Overall, 43.0% of LMICs have PGME programs with defined trauma competency requirements.
Conclusions
Current studies on trauma training in LMICs do not clearly demonstrate sustainability, cost-effectiveness, nor improved outcomes. Trauma training programs should be in response to a need, championed locally, and work within a cohesive system to demonstrate concrete benefits. We recommend standardized and contextualized trauma training with recertifications in LMICs for lasting and improved trauma care.
Equilibrative nucleoside transporter 1 (ENT1) is a ubiquitously expressed membrane transporter in mammalian cells responsible for the transmembrane flux of endogenous nucleosides such as adenosine, as well as, chemotherapeutic, anti‐vial, and anti‐parasitic nucleoside analogues. The present study was designed to assess whether ENT1, like many other solute transporters, functions as a dimer or higher order oligomer.Previous functional studies from our laboratory suggested the presence of two populations of ENT1 with differential sensitivities to sulfhydryl reagents at the plasma membrane. Studies of ENT1 photoaffinity labelled membranes revealed multiple molecular mass bands on denaturing gels. Non‐denaturing Blue Native PAGE resulted in a molecular mass of ENT1 of 137 kDa (versus 55kDa monomer) suggesting a higher order oligomer or association with other proteins. Co‐immunoprecipitation studies on HEK293 cells expressing MYC‐ and HA‐hENT1 indicated that hENT1 can oligomerize. This was confirmed by immunofluorescence experiments, which showed a 1.5‐fold increase in colocalization of MYC‐hENT1 and HA‐hENT1 signal when the amount of transfected HA‐hENT1 cDNA was gradually increased while MYC‐hENT1 was kept constant in HEK293 cells. Finally, proximity ligation assays, performed on WT‐hENT1‐PK15 cells transiently transfected with MYC‐hENT1, showed interaction between the two pools of hENT1.These data support the hypothesis that ENT1 exists in the plasma membrane as a dimer, and possibly higher level protein complexes. Further work regarding the identity of the ENT1 complex components as well as the impact of these interactions on the function and inhibitor/substrate association with ENT1 remains to be determined.Supported by the Natural Science and Engineering Research Council of Canada.
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