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1.
J Nucl Cardiol ; 28(6): 2633-2637, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-31376003

RESUMO

Recent advances in software and hardware for cardiac SPECT have the potential to revolutionize nuclear cardiology. It is easy to use these technologies to maintain the status quo and lower radiation dose, despite the fact there is very little evidence that lowering patient dose in already low dose imaging protocols confers any benefit to patients. Cardiac SPECT has tremendous potential for risk stratification, molecular tracers, and high temporal resolution management of patients with electrophysiological disorders. In addition, these new reconstruction techniques can offer spatial resolution that is comparable and sometimes even superior to PET. Lastly, recent research has also held out the potential for performing absolute blood flow qualification using SPECT instrumentation. As these new technologies become available, the goal should be to make images better and improve patient care first, then optimize the dose.


Assuntos
Cardiologia , Tomografia por Emissão de Pósitrons , Cardiologia/instrumentação , Humanos , Tomografia por Emissão de Pósitrons/métodos , Software , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Tomografia Computadorizada por Raios X
2.
Bull World Health Organ ; 97(11): 735-736, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31673188

RESUMO

Balram Bhargava talks with Sophie Cousins about fostering affordable, need-driven innovation.


Assuntos
Biotecnologia , Internacionalidade , Invenções , Biotecnologia/instrumentação , California , Cardiologia/instrumentação , Cardiologia/métodos , História do Século XX , História do Século XXI , Índia , Invenções/história , Stents
3.
J Nucl Cardiol ; 26(2): 543-556, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-28718074

RESUMO

Advances in imaging instrumentation and technology have greatly contributed to nuclear cardiology. Dedicated cardiac SPECT cameras incorporating novel, highly efficient detector, collimator, and system designs have emerged with the expansion of nuclear cardiology. Solid-state radiation detectors incorporating cadmium zinc telluride, which directly convert radiation to electrical signals and yield improved energy resolution and spatial resolution and enhanced count sensitivity geometries, are increasingly gaining favor as the detector of choice for application in dedicated cardiac SPECT systems. Additionally, hybrid imaging systems in which SPECT and PET are combined with X-ray CT are currently widely used, with PET/MRI hybrid systems having also been recently introduced. The improved quantitative SPECT/CT has the potential to measure the absolute quantification of myocardial blood flow and flow reserve. Rapid development of silicon photomultipliers leads to enhancement in PET image quality and count rates. In addition, the reduction of emission-transmission mismatch artifacts via application of accurate time-of-flight information, and cardiac motion de-blurring aided by anatomical images, are emerging techniques for further improvement of cardiac PET. This article reviews recent advances such as these in nuclear cardiology imaging instrumentation and technology, and the corresponding diagnostic benefits.


Assuntos
Cardiologia/tendências , Imagem de Perfusão do Miocárdio/instrumentação , Medicina Nuclear/tendências , Tomografia Computadorizada de Emissão de Fóton Único/instrumentação , Algoritmos , Animais , Cádmio , Cardiologia/instrumentação , Vasos Coronários/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador , Cinética , Imageamento por Ressonância Magnética/instrumentação , Movimento (Física) , Imagem Multimodal/instrumentação , Dinâmica não Linear , Medicina Nuclear/instrumentação , Tomografia por Emissão de Pósitrons/instrumentação , Doses de Radiação , Semicondutores , Silício , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único/instrumentação , Telúrio , Zinco
4.
Echocardiography ; 36(9): 1615-1624, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31441528

RESUMO

BACKGROUND: Intersocietal Accreditation Commission (IAC) accreditation is granted or delayed depending on the fulfillment of several quality metrics. Investing in up-to-date equipment might reflect a commitment to quality. METHODS: Data from echocardiography (n = 3079) and nuclear cardiology (n = 1835) accreditation applications submitted between 2012 and 2014 were evaluated to determine the mean age of laboratory equipment. Laboratory quality was assessed by the number of missing quality metrics, and a composite quality score was calculated as the sum of missing quality metrics. A lower score thus represented better laboratory quality. The relationship between equipment age and quality was explored as an interaction term between equipment age and the composite quality score and was incorporated into regression models for prediction of accreditation status. RESULTS: During the study period, 49% of echocardiography and 42% of nuclear laboratories were granted accreditation without delay. For both echocardiography and nuclear laboratories, there was a statistically significant trend toward an increasing number of missing quality metrics with increasing quartiles of equipment age. The interaction between equipment age and the composite quality score was a significant predictor of delay of accreditation for both echocardiography and nuclear cardiology laboratories, with a stronger association for 1st-time applicants. Among sites applying for accreditation in both modalities simultaneously, accreditation in one modality predicted the accreditation decision for the other. CONCLUSIONS: Laboratory quality is an important determinant of IAC accreditation, and equipment age is an effect modifier of this relationship. Contemporary equipment likely reflects a commitment to quality, for both echocardiography and nuclear laboratories.


Assuntos
Acreditação , Cardiologia/instrumentação , Ecocardiografia/instrumentação , Medicina Nuclear/instrumentação , Tomografia por Emissão de Pósitrons/instrumentação , Controle de Qualidade , Cardiologia/normas , Ecocardiografia/normas , Fidelidade a Diretrizes , Humanos , Medicina Nuclear/normas , Tomografia por Emissão de Pósitrons/normas , Estados Unidos
5.
Childs Nerv Syst ; 34(2): 227-233, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29124390

RESUMO

PURPOSE: The aim of the study is to provide a comparison between Liebau's effect, underlying the working principles of impedance pumps, and the cerebrospinal fluid (CSF) circulation. METHODS: Gerhard Liebau was a cardiologist with a specific interest in severe aortic regurgitation. Such interest drew his scientific attention to the flow-driven efficiency of valveless pumps. During one of his experiments, he assembled two rubber tubes of different sizes and documented how water could be aspirated against gravity when the tube of larger diameter underwent rhythmic compression. He subsequently tested an elastic tube connected to glass pipes of the same size on both ends, immersed in a water bucket. When the elastic tube was periodically pumped with a finger, a net flow could be observed in both directions; depending on the pumping site on the elastic tube, the flow was directed towards the most closely connected glass tube. The principles of a hydraulic system of different elasticity and compliance were also recently applied to the physiology and fluid dynamics of embryonic hearts. RESULTS: Impedance pumps and the CSF dynamics model are both valveless systems and can both be activated by the effects of the cardiac cycle. The novel hydraulic model of impedance pumps was the foundation for the development of modern valveless micropumps and contributes to explain how the embryonic valveless tubular heart is capable of generating blood flow. CONCLUSIONS: Liebau's effect and the mechanism of impedance pumps can enlighten some of the aspects of CSF dynamics and related flow disturbances.


Assuntos
Cardiologia/métodos , Líquido Cefalorraquidiano/fisiologia , Fluxo Pulsátil/fisiologia , Pesquisa Translacional Biomédica/métodos , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/fisiopatologia , Cardiologia/instrumentação , Desenvolvimento Embrionário/fisiologia , Humanos , Pesquisa Translacional Biomédica/instrumentação
6.
Health Econ ; 26 Suppl 1: 124-144, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-28139093

RESUMO

Decisions to adopt medical devices at the hospital level have consequences for health technology assessment (HTA) on system level and are therefore important to decision makers. Our aim was to investigate the characteristics of organizations and individuals that are more inclined to adopt and utilize cardiovascular devices based on a comprehensive analysis of environmental, organizational, individual, and technological factors and to identify corresponding implications for HTA. Seven random intercept hurdle models were estimated using the data obtained from 1249 surveys completed by members of the European Society of Cardiology. The major findings were that better manufacturer support increased the adoption probability of 'new' devices (i.e. in terms of CE mark approval dates), and that budget pressure increased the adoption probability of 'old' devices. Based on our findings, we suggest investigating the role of manufacturer support in more detail to identify diffusion patterns relevant to HTA on system level, to verify whether it functions as a substitute for medical evidence of new devices, and to receive new insights about its relationship with clinical effectiveness and cost-effectiveness. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd.


Assuntos
Cardiologia/instrumentação , Tomada de Decisões Gerenciais , Equipamentos e Provisões/normas , Avaliação da Tecnologia Biomédica/normas , Reabilitação Cardíaca/economia , Reabilitação Cardíaca/instrumentação , Reabilitação Cardíaca/métodos , Cardiologia/economia , Cardiologia/métodos , Cardiologia/normas , Procedimentos Cirúrgicos Cardiovasculares/economia , Procedimentos Cirúrgicos Cardiovasculares/instrumentação , Análise Custo-Benefício , Equipamentos e Provisões/economia , Equipamentos e Provisões/estatística & dados numéricos , Pesquisas sobre Atenção à Saúde , Humanos , Próteses e Implantes/economia , Próteses e Implantes/normas , Próteses e Implantes/estatística & dados numéricos , Avaliação da Tecnologia Biomédica/economia , Avaliação da Tecnologia Biomédica/métodos
7.
Postgrad Med J ; 93(1101): 430-435, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28455284

RESUMO

BACKGROUND: Alarm fatigue (AF) is a distressing factor for staff and patients in the hospital. Using cardiac telemetry (CT) without clinical indications can create unnecessary alarms, and increase AF and cost of healthcare. We sought to reduce AF and cost associated with CT monitoring. METHODS: After implementing a new protocol for CT placement, data were collected on telemetry orders, alarms and bed cost for 13 weeks from 1 January 2015 through 31 March 2015. We also retrospectively collected data on the same variables for the 13 weeks prior to the intervention. A survey was administered to nurses to assess past and present perceptions of AF. Interventions included protocol creation and education for participants. RESULTS: At baseline, 77% of patients were monitored with CT. A total of 145 (31%) order discrepancies were discovered during data collection, of which 72% had no indication for CT, so CT was discontinued. The other 28% had indications, so orders were placed. A total of 8336 alarms were recorded during 4 weeks of data collection, of which 333 (4%) were classified as true actionable alarms. Postintervention data showed 67% CT assignment with 10% reduction in CT usage, with no increase in mortality (p<0.001 and >0.05, respectively). A 42% cost reduction was achieved after adjusting the patient status. Nurses reported 27% perceived reduction in AF. One-year follow-up revealed that 69% of patients were being monitored by CT, and the rate of order discrepancies due to lack of indication was 9%. CONCLUSION: All hospital units may benefit from the protocols created during this study. If applied appropriately, these protocols can lead to reduced AF and cost per episode of care.


Assuntos
Esgotamento Profissional/prevenção & controle , Cardiologia/instrumentação , Alarmes Clínicos , Fadiga/prevenção & controle , Melhoria de Qualidade , Telemetria , Humanos , Estudos Retrospectivos
8.
J Clin Monit Comput ; 31(2): 253-259, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27566472

RESUMO

Many mobile phone or tablet applications have been designed to control cardiovascular risk factors (obesity, smoking, sedentary lifestyle, diabetes and hypertension) or to optimize treatment adherence. Some have been shown to be useful but the long-term benefits remain to be demonstrated. Digital stethoscopes make easier the interpretation of abnormal heart sounds, and the development of pocket-sized echo machines may quickly and significantly expand the use of ultrasounds. Daily home monitoring of pulmonary artery pressures with wireless implantable sensors has been shown to be associated with a significant decrease in hospital readmissions for heart failure. There are more and more non-invasive, wireless, and wearable sensors designed to monitor heart rate, heart rate variability, respiratory rate, arterial oxygen saturation, and thoracic fluid content. They have the potential to change the way we monitor and treat patients with cardiovascular diseases in the hospital and beyond. Some may have the ability to improve quality of care, decrease the number of medical visits and hospitalization, and ultimately health care costs. Validation and outcome studies are needed to clarify, among the growing number of digital innovations and wearable sensors, which tools have real clinical value.


Assuntos
Cardiologia/instrumentação , Monitorização Ambulatorial/instrumentação , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Doenças Cardiovasculares , Vestuário , Computadores de Mão , Ecocardiografia , Desenho de Equipamento , Insuficiência Cardíaca , Frequência Cardíaca , Humanos , Monitorização Ambulatorial/métodos , Artéria Pulmonar , Fatores de Risco , Smartphone , Estetoscópios , Tecnologia sem Fio
9.
Fed Regist ; 82(144): 35065-7, 2017 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-28753259

RESUMO

The Food and Drug Administration (FDA) is classifying the adjunctive cardiovascular status indicator into class II (special controls). The special controls that will apply to the device are identified in this order and will be part of the codified language for the adjunctive cardiovascular status indicator's classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.


Assuntos
Cardiologia/classificação , Cardiologia/instrumentação , Segurança de Equipamentos/classificação , Monitorização Fisiológica/classificação , Monitorização Fisiológica/instrumentação , Humanos
10.
Herz ; 41(2): 120-4, 2016 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-26919989

RESUMO

Cardiology is rapidly developing on many levels. New treatment methods are introduced at ever decreasing intervals. Against the background of economization of other areas in medicine, dangers are lurking here for patients if safety, usefulness and sustainability of the treatment methods cannot be sufficiently proven. The German Federal Ministry of Health (Bundesministerium für Gesundheit, BMG) aims to adjust the regulatory framework for the approval of new medical products to the legal requirements of the European Union. With the establishment of the Institute for Quality Assessment and Transparency in Health Care (Institut für Qualitätssicherung und Transparenz im Gesundheitswesen, IQTIG) more precise quality controls should be carried out. Implantation registers will be soon implemented and the routinely performed quality control of different interventions will be coordinated across different healthcare sectors in order to achieve a better understanding of long-term results. Medicine in general and the safety of patients in particular, ultimately benefit from more stringent controls, neutrality and transparency in the assessment of new methods.


Assuntos
Cardiologia/instrumentação , Aprovação de Equipamentos/legislação & jurisprudência , Equipamentos e Provisões/normas , Erros Médicos/prevenção & controle , Segurança do Paciente , Cardiologia/tendências , Aprovação de Equipamentos/normas , Difusão de Inovações , Desenho de Equipamento , Falha de Equipamento , Alemanha , Humanos , Segurança do Paciente/legislação & jurisprudência , Segurança do Paciente/normas
11.
Eur Heart J ; 36(40): 2686-95, 2015 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-26261296

RESUMO

Treatment-resistant hypertension (TRH) affects between 3 and 30% of hypertensive patients, and its presence is associated with increased cardiovascular morbidity and mortality. Until recently, the interest on these patients has been limited, because providing care for them is difficult and often frustrating. However, the arrival of new treatment options [i.e. catheter-based renal denervation (RDN) and baroreceptor stimulation] has revitalized the interest in this topic. The very promising results of the initial uncontrolled studies on the blood pressure (BP)-lowering effect of RDN in TRH seemed to suggest that this intervention might represent an easy solution for a complex problem. However, subsequently, data from controlled studies have tempered the enthusiasm of the medical community (and the industry). Conversely, these new studies emphasized some seminal aspects on this topic: (i) the key role of 24 h ambulatory BP and arterial stiffness measurement to identify 'true' resistant patients; (ii) the high prevalence of secondary hypertension among this population; and (iii) the difficulty to identify those patients who may profit from device-based interventions. Accordingly, for those patients with documented TRH, the guidelines suggest to refer them to a hypertension specialist/centre in order to perform adequate work-up and treatment strategies. The aim of this review is to provide guidance for the cardiologist on how to identify patients with TRH and elucidate the prevailing underlying pathophysiological mechanism(s), to define a strategy for the identification of patients with TRH who may benefit from device-based interventions and discuss results and limitations of these interventions, and finally to briefly summarize the different drug-based treatment strategies.


Assuntos
Hipertensão/terapia , Anti-Hipertensivos/uso terapêutico , Monitorização Ambulatorial da Pressão Arterial , Cardiologia/instrumentação , Ablação por Cateter/métodos , Doença Crônica , Resistência a Medicamentos , Ecocardiografia , Terapia por Estimulação Elétrica/métodos , Humanos , Hipertensão/diagnóstico , Hipertensão/etiologia , Testes de Função Renal/métodos , Próteses e Implantes , Simpatectomia/métodos , Falha de Tratamento , Remodelação Vascular/fisiologia , Rigidez Vascular/fisiologia
12.
J Clin Monit Comput ; 30(5): 621-7, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26370094

RESUMO

Estimated continuous cardiac output (esCCO), a noninvasive technique for continuously measuring cardiac output (CO), is based on modified pulse wave transit time, which in turn is determined by pulse oximetry and electrocardiography. However, its trending ability has never been evaluated in patients undergoing non-cardiac surgery. Therefore, this study examined esCCO's ability to detect the exact changes in CO, compared with currently available arterial waveform analysis methods, in patients undergoing kidney transplantation. CO was measured using an esCCO system and arterial pressure-based CO (APCO), and compared with a corresponding intermittent bolus thermodilution CO (ICO) method. Percentage error and statistical methods, including concordance analysis and polar plot analysis, were used to analyze results from 15 adult patients. The difference in the CO values between esCCO and ICO was -0.39 ± 1.15 L min(-1) (percentage error, 35.6 %). And corrected precision for repeated measures was 1.16 L min(-1) (percentage error for repeated measures, 36.0 %). A concordance analysis showed that the concordance rate was 93.1 %. The mean angular bias was -1.8° and the radial limits of agreement were ±37.6°. The difference between the APCO and ICO CO values was 0.04 ± 1.37 L min(-1) (percentage error, 42.4 %). And corrected precision for repeated measures was 1.37 L min(-1) (percentage error for repeated measures, 42.5 %). The concordance rate was 89.7 %, with a mean angular bias of -3.3° and radial limits of agreement of ±42.2°. This study demonstrated that the trending ability of the esCCO system is not clinically acceptable, as judged by polar plots analysis; however, its trending ability is clinically acceptable based on a concordance analysis, and is comparable with currently available arterial waveform analysis methods.


Assuntos
Pressão Arterial , Débito Cardíaco , Cardiologia/instrumentação , Monitorização Fisiológica/métodos , Adulto , Idoso , Anestesia Epidural/métodos , Artérias/patologia , Pressão Sanguínea , Dióxido de Carbono/química , Cateterismo , Eletrocardiografia/métodos , Feminino , Hidratação , Insuficiência Cardíaca/complicações , Frequência Cardíaca , Humanos , Transplante de Rim , Masculino , Pessoa de Meia-Idade , Oximetria/métodos , Artéria Pulmonar/patologia , Pulso Arterial , Insuficiência Renal/complicações , Insuficiência Renal/cirurgia , Reprodutibilidade dos Testes , Volume de Ventilação Pulmonar , Adulto Jovem
13.
Catheter Cardiovasc Interv ; 86(5): 935-40, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26154301

RESUMO

OBJECTIVES: To assess the occupational dose reduction effect of a new interventional cardiology shield for radial access combined with a scatter reducing drape. BACKGROUND: Transradial access for catheterization has been shown to increase occupational radiation dose. Current shielding techniques are primarily based on the femoral access. This article looks at the clinical occupational combined dose reduction effect of a commercially available shield and drape which is specific to access type. METHODS: The evaluation took place in a busy interventional cardiology laboratory, with a single plane 30×40 cm flat panel detector (Siemens Artis Zee, Germany). Radiation exposure to staff was measured using electronic personal dosimeters (Unfors RaysafeAB, Sweden) placed at the collar. Patient radiation exposure was assessed using screening time and dose area product per case. Both staff and patient radiation exposure were monitored for a number of case types and operators before, during, and after deployment of the new shield and drapes. RESULTS: The cardiologists' overall median collar badge reading per case reduced from 15.4 µSv per case without the shield/drape combination to 7.3 µSv per case with the shield drape combination in situ (P<0.001). The radiographers badge reading was reduced from 4.2 µSv per case without to 2.5 µSv per case with the shield drape combination in situ (P<0.001). There was no statistical difference in the cardiac technician's badge reading. Patient's dose area product was not significantly affected by the placement of the shield and drape combination. CONCLUSIONS: The shield/drape combination can significantly reduce operator exposure in a cardiac catheterization laboratory.


Assuntos
Cateterismo Cardíaco/instrumentação , Cardiologia/instrumentação , Exposição Ocupacional/prevenção & controle , Saúde Ocupacional , Doses de Radiação , Lesões por Radiação/prevenção & controle , Proteção Radiológica/instrumentação , Radiografia Intervencionista/instrumentação , Espalhamento de Radiação , Cateterismo Cardíaco/efeitos adversos , Desenho de Equipamento , Humanos , Chumbo , Pessoal de Laboratório Médico , Enfermeiras e Enfermeiros , Exposição Ocupacional/efeitos adversos , Médicos , Polimetil Metacrilato , Artéria Radial/diagnóstico por imagem , Lesões por Radiação/etiologia , Monitoramento de Radiação , Radiografia Intervencionista/efeitos adversos , Fatores de Risco , Fatores de Tempo
15.
J Nucl Cardiol ; 22(3): 563-70, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25824018

RESUMO

Advances in PET and SPECT and imaging hardware and software are vastly improving the noninvasive evaluation of myocardial perfusion and function. PET perfusion imaging has benefitted from the introduction of novel detectors that now allow true 3D imaging, and precise attenuation correction (AC). These developments have also resulted in perfusion images with higher spatial and contrast resolution that may be acquired in shorter protocols and/or with less patient radiation exposure than traditional PET or SPECT studies. Hybrid PET/CT cameras utilize transmission computed tomographic (CT) scans for AC, and offer the additional clinical advantages of evaluating coronary calcium and myocardial anatomy but at a higher cost than PET scanners that use (68)Ge radioactive line sources. As cardiac PET systems continue to improve, dedicated cardiac SPECT systems are also undergoing a profound change in their design. The scintillation camera general purpose design is being replaced with systems with multiple detectors focused on the heart yielding 5 to 10 times the sensitivity of conventional SPECT. As a result, shorter acquisition times and/or lower tracer doses produce higher quality SPECT images than were possible before. This article reviews these concepts and compares the attributes of PET and SPECT instrumentation.


Assuntos
Cardiologia/instrumentação , Medicina Nuclear/instrumentação , Tomografia por Emissão de Pósitrons/instrumentação , Tomografia Computadorizada de Emissão de Fóton Único/instrumentação , Algoritmos , Baltimore , Congressos como Assunto , Desenho de Equipamento , Humanos , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Imagem de Perfusão do Miocárdio , Perfusão , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X
17.
J Cardiothorac Vasc Anesth ; 29(6): 1504-10, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26341879

RESUMO

OBJECTIVE: To investigate whether a transesophageal echocardiography (TEE) simulator with motion analysis can be used to impart proficiency in TEE in an integrated curriculum-based model. DESIGN: A prospective cohort study. SETTING: A tertiary-care university hospital. PARTICIPANTS: TEE-naïve cardiology fellows. INTERVENTIONS: Participants underwent an 8-session multimodal TEE training program. Manual skills were assessed at the end of sessions 2 and 8 using motion analysis of the TEE simulator's probe. At the end of the course, participants performed an intraoperative TEE; their examinations were video captured, and a blinded investigator evaluated the total time and image transitions needed for each view. Results are reported as mean±standard deviation, or median (interquartile range) where appropriate. MEASUREMENTS AND MAIN RESULTS: Eleven fellows completed the knowledge and kinematic portions of the study. Five participants were excluded from the evaluation in the clinical setting because of interim exposure to TEE or having participated in a TEE rotation after the training course. An increase of 12.95% in post-test knowledge scores was observed. From the start to the end of the course, there was a significant reduction (p<0.001 for all) in the number of probe. During clinical performance evaluation, trainees were able to obtain all the required echocardiographic views unassisted but required a longer time and had more probe transitions when compared with an expert. CONCLUSION: A curriculum-based approach to TEE training for cardiology fellows can be complemented with kinematic analyses to objectify acquisition of manual skills during simulator-based training.


Assuntos
Cardiologia/educação , Cardiologia/normas , Competência Clínica/normas , Simulação por Computador/normas , Ecocardiografia Transesofagiana/normas , Internato e Residência/normas , Fenômenos Biomecânicos , Cardiologia/instrumentação , Estudos de Coortes , Ecocardiografia Transesofagiana/instrumentação , Estudos de Viabilidade , Feminino , Humanos , Internato e Residência/métodos , Masculino , Estudos Prospectivos
20.
Fed Regist ; 80(159): 49895-7, 2015 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-26292372

RESUMO

The Food and Drug Administration (FDA) is classifying the esophageal thermal regulation device into class II (special controls). The special controls that will apply to the device are identified in this order and will be part of the codified language for the esophageal thermal regulation device's classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.


Assuntos
Cardiologia/classificação , Cardiologia/instrumentação , Crioterapia/classificação , Crioterapia/instrumentação , Segurança de Equipamentos/classificação , Aprovação de Equipamentos/legislação & jurisprudência , Esôfago , Humanos , Estados Unidos
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