Evaluating the clinical and cost-effectiveness of a conservative approach to oxygen therapy for invasively ventilated adults in intensive care: Protocol for the UK-ROX trial.

Background: In the United Kingdom, around 184,000 adults are admitted to an intensive care unit (ICU) each year with over 30% receiving mechanical ventilation. Oxygen is the commonest therapeutic intervention provided to these patients but it is unclear how much oxygen should be administered for the best clinical outcomes. Methods: The UK-ROX trial will evaluate the clinical and cost-effectiveness of conservative oxygen therapy (the minimum oxygen concentration required to maintain an oxygen saturation of 90% ± 2%) versus usual oxygen therapy in critically ill adults receiving supplemental oxygen when invasively mechanically ventilated in ICUs in England, Wales and Northern Ireland. The trial will recruit 16,500 patients from approximately 100 UK adult ICUs. Using a deferred consent model, enrolled participants will be randomly allocated (1:1) to conservative or usual oxygen therapy until ICU discharge or 90 days after randomisation. Objectives: The primary clinical outcome is all cause mortality at 90 days following randomisation. Discussion: The UK-ROX trial has received ethical approval from the South Central - Oxford C Research Ethics Committee (Reference: 20/SC/0423) and the Confidentiality Advisory Group (Reference: 22/CAG/0154). The trial commenced in May 2021 and, at the time of publication, 95 sites had opened to recruitment.

Fragmented QRS - Its significance.

Fragment QRS (fQRS) complex is a myocardial conduction abnormality that indicates myocardial scar. It is defined as additional notches in the QRS complex. Though initially fQRS was defined in the setting of normal QRS duration (<120 m s), later it has been expanded to include conditions with wide QRS complexes as in bundle branch block, ventricular ectopy and paced rhythm, when more than 2 notches are present. It is an important, yet often overlooked marker of mortality and arrhythmic events in many cardiac diseases. The significance of fQRS lies in the fact that it just requires a surface ECG for its recording and the value of information about the condition of the heart it dispenses based on the clinical setting. We review the role of fQRS in predicting adverse cardiac events in various conditions.

Genome Sequences of Five African Swine Fever Virus Genotype IX Isolates from Domestic Pigs in Uganda.

Complete genome sequences of five African swine fever virus isolates were determined directly from clinical material obtained from domestic pigs in Uganda. Four sequences were essentially identical to each other, and all were closely related to the only known genome sequence of p72 genotype IX.

Actualizing veterans education in nursing.

A grant driven partnership among a west Texas university, Texas Workforce Commission's College Credits for Heroes, and the Health Resources and Services Administration provided the funding needed to create a competency based education (CBE) model for recognizing military veteran service training and experience. Through this model, we call Competency Assessment Placement (CAP), prior learning credits can be awarded for upper division nursing courses leading to a Bachelor of Science in Nursing. The process used by faculty to create this direct assessment method for awarding credit, performance data of Cohort I using the CAP, and our initial "lessons learned" are provided. Incorporating an on-going reflection of military veteran student learning needs, a persistent concern for improvement of the nursing program, as well as a frequent review of veteran educational benefit policies will continue as this CAP model provides beneficial outcomes for the students.

ECG monitoring leads and special leads.

ECG monitoring is common place in the hospital and even pre-hospital setting. The need for different types of lead systems in different settings has been emphasised. Simple three electrode bipolar recording is ubiquitous for monitoring. This can be used to record modified bipolar chest leads as well. Using five leads gives the option of getting a chest lead in addition to bipolar limb leads, enhancing detection of ischemia during procedures. Lead stability is important when the movement of the subject is maximum as in exercise testing. Mason-Likar modification with limb leads shifted to the torso is popular for exercise testing, though the diagnostic value of the ECG is altered. Lund system with leads on proximal part of limbs have both stability and fair diagnostic value. EASI lead system permits derivation of 12 leads from just five electrodes. Lewis lead and the newly devised modified limb lead system are useful in enhancing detection of atrial activity. Fontaine lead has been designed to improve visualization of Epsilon wave in arrhythmogenic right ventricular dysplasia.

Wearable cardioverter defibrillator: a life vest till the life boat (ICD) arrives.

It is well established that implantable cardioverter defibrillator (ICD) is a life saving device ensuring protection against life threatening ventricular arrhythmias. But there are certain situations like a recent myocardial infarction where the standard guidelines do not recommend the implantation of an ICD while the patient can still be at a risk of demise due to a life threatening ventricular arrhythmia. There could also be a temporary indication for protection while explanting an infected ICD system. The wearable cardioverter defibrillator (WCD) is a device which comes to the rescue in such situations. In this brief review, we discuss the historical aspects of the development of a WCD, technical aspects as well as the clinical trial data and real world scenario of its use.

Arrhythmia occurrence with takotsubo cardiomyopathy: a literature review.

AIMS: Takotsubo cardiomyopathy (TC) or the apical ballooning syndrome is a reversible cardiomyopathy mimicking acute myocardial infarction (AMI). Although malignant arrhythmia is considered less likely to occur in TC than with AMI, sporadic reports of malignant arrhythmia with TC, however, have been reported. We reviewed the medical literature on TC and arrhythmias and describe in the summary the reported findings and discuss possible specific scenarios where arrhythmia may be more likely in patients with TC. METHODS AND RESULTS: Articles were identified on PubMed using the MeSH terms 'Takotsubo Cardiomyopathy' or 'Apical Ballooning Syndrome'. Seventy-four unique case series with five or more TC patients were identified, with a cumulative total of 1876 cases. Twelve series (242 cases) were excluded because Mayo criteria were not met. Twenty-five series (816 cases, 43.5%) reported on arrhythmia and were included in the analysis. CONCLUSION: Areas for further prospective study include the duration and mechanism of residual risk and optimal risk stratification and modification. The current state of evidence would support beta-blockers in the acute setting to control tachyarrhythmia, although there is little evidence to support their use beyond convalescence when used for this indication alone. Those in heart failure and cardiogenic shock should be managed with established evidence-based therapies for these conditions. The use of internal defibrillators in TC requires consideration only on a case-by-case basis.