Improving atrial fibrillation detection in patients with implantable cardiac devices by means of a remote monitoring and management application.

BACKGROUND: Atrial fibrillation (AF) is common in patients with cardiac implantable electronic devices (CIED) and has been associated with an increased stroke risk. The aim of our project was to assess the clinical value of a web-based application, Discovery Link AFinder, in improving AF detection in CIED patients. METHODS AND RESULTS: Seven Italian hospitals performed an observational study consisting of four phases. During phase 1, expert nurses and cardiologists prospectively followed-up CIED patients via in-hospital examinations and remote monitoring, and classified clinically relevant events, particularly AF occurrence. During phase 2, Discovery Link AFinder was exploited to identify patients who had suffered AF in the previous 12 months through the systematic scanning of device data remote transmissions. Phases 3 and 4 were repetitions of phases 1 and 2, respectively, and were implemented 6 months after the previous phases. A total of 472 consecutive patients were included in phase 1; AF occurred in 170 patients, 61 of whom were identified as new AF patients. Evidence of AF during this phase prompted prescription of oral anticoagulation (OAC) therapy in 30 patients. In phase 2, AFinder uncovered new AF, unidentified in phase 1, in 54 patients and prompted implementation of OAC therapy in 11 patients. During phase 3, 30 new AF patients were identified by means of remote monitoring, while during phase 4, a further three AF patients were identified by AFinder only. CONCLUSIONS: The AFinder web-based software, applied on top of standard in-hospital and remote monitoring, improved AF detection and enabled OAC treatment to be undertaken.

The career paths of researchers in long-term employment on short-term contracts: Case study from a UK university.

The career stage between PhD and lectureship, conventionally called "postdoctoral", has traditionally been seen as transitional. However, with an estimated one third of university researchers in the United Kingdom having been employed on temporary contracts for more than 10 years, the transitional nature of this career stage is questionable. Despite so many research staff being in long-term employment on short-term contracts, the lack of visibility of this population, which does not have a legitimate place within the current academic career structure, means that we do not know how deliberate or accidental their career choices are. Based on semi-structured interviews with long-term researchers (LTRS) at one university in the United Kingdom, this is the first study to investigate the personal and professional circumstances behind the career path of long-term researchers on temporary contracts. Three categories of LTRS were identified: 1) the candidate, who wants to follow the traditional academic career pathway and to secure a lectureship 2) the accidental long-term researcher, who did not or could not plan their career path 3) the career researcher, who sustains a research-only career despite the precarity of such positions. Most participants had belonged successively to two categories. Some obstacles to career progression transcended the categories: inequal access to opportunities for developing one's teaching portfolio, poor or lack of managerial support, the perceived prestige or lack thereof of one's field, and bullying and discrimination. We argue that short-termism and lack of visibility play down considerably the contribution of long-term researchers to the financial and academic success of research institutions. We also argue that traditional-but still in place-structures in academia are ill adapted to the contemporary demographics and practices of the research community; we recommend that future studies involve HE sector stakeholders to review and to reform the academic career structure.