ILEEM-survey on the Heart Team approach and team training for lead extraction procedures.

BACKGROUND: The Heart Team approach has become an integral part of modern cardiovascular medicine. To evaluate current opinions and real-world practice among lead extraction practitioners, an online survey was created and distributed among a pool of lead extraction specialists participating in the International Lead Extraction Expert Meeting (ILEEM) 2018. METHODS: The online survey consisted of 10 questions and was performed using an online survey tool (www.surveymonkey.com). The collector link was sent to 48 lead extraction experts via email. RESULTS: A total of 43 answers were collected (89% return rate) from lead extraction experts in 16 different countries. A great majority (83.7%) of the respondents performed more than 30 lead extraction procedures per year. The most common procedural environment in this survey was the hybrid operating room (67.4%). Most procedures were performed by electrophysiologists and cardiologists (80.9%). Important additional members of the current lead extraction teams were cardiac surgeons (79.1%), anesthesiologists (95.3%) and operating room scrub nurses (76.7%). An extended Heart Team is regarded beneficial for patient care by 86.0%, with potential further members being infectious diseases specialists, intensivists and radiologists. Team training activities are performed in 48.8% of participating centers. CONCLUSIONS: This survey supports the importance of establishing lead extraction Heart Teams in specialized lead extraction centers to potentially improve patient outcomes. The concept of a core and an extended Heart Team approach in lead extraction procedures is introduced.

Performance and outcomes of transvenous rotational lead extraction: Results from a prospective, monitored, international clinical study.

BACKGROUND: Transvenous lead extraction (TLE) plays a critical role in managing patients with cardiovascular implantable electronic devices. Mechanical TLE tools, including rotational sheaths, are used to overcome fibrosis and calcification surrounding leads. Prospective clinical data are limited regarding the safety and effectiveness of use of mechanical TLE devices, especially rotational tools. OBJECTIVE: To prospectively investigate the safety and effectiveness of mechanical TLE in real-world usage. METHODS: Patients were enrolled at 10 sites in the United States and Europe to evaluate the use of mechanical TLE devices. Clinical success, complete procedural success, and complications were evaluated through follow-up (median, 29 days). Patient data were source verified and complications were adjudicated by an independent clinical events committee (CEC). RESULTS: Between October 2018 and January 2020, mechanical TLE tools, including rotational sheaths, were used to extract 460 leads with a median indwell time of 7.4 years from 230 patients (mean age 64.3 ± 14.4 years). Noninfectious indications for TLE were more common than infectious indications (61.5% vs 38.5%, respectively). The extracted leads included 305 pacemaker leads (66.3%) and 155 implantable cardioverter-defibrillator leads (33.7%), including 85 leads with passive fixation (18.5%). A bidirectional rotational sheath was needed for 368 leads (88.0%). Clinical success was obtained in 98.7% of procedures; complete procedural success was achieved for 96.3% of leads. CEC-adjudicated device-related major complications occurred in 6 of 230 (2.6%) procedures. No isolated superior vena cava injury or procedural death occurred. CONCLUSION: This prospective clinical study demonstrates that use of mechanical TLE tools, especially bidirectional rotational sheaths, are effective and safe.

The effects of directive and nondirective prompts on noncompliant vocal behavior exhibited by a child with autism.

Results of an analogue functional analysis indicated that noncompliant vocal behavior exhibited by a young girl with autism was maintained by negative reinforcement. Follow-up analyses suggested that the immediate escape contingency assessed in the demand condition did not appear to maintain the behavior. Instead, noncompliant vocal behavior occurred in response to directive prompts. Nondirective prompts reduced noncompliant vocal behavior to near zero.

Rate-decreasing effects of the atypical neuroleptic risperidone attenuated by conditions of reinforcement in a woman with mental retardation.

Effects of two doses of risperidone on the performance of a matching task under tangible reinforcement and nonreinforcement conditions were measured in a woman with mental retardation. In both conditions, time to complete the task increased and response rates decreased under two doses of risperidone. Accuracy was generally unchanged. These changes were much smaller in the tangible reinforcement condition; thus, reinforcement seemed to protect performance from the rate-decreasing effects of risperidone.

Characterization of solid waste disposed at Columbia Sanitary Landfill in Missouri.

Waste sorts were conducted during each of the four quarters (or seasons) of 1996 at the City of Columbia Sanitary Landfill. A detailed physical sampling protocol was outlined. Weight fractions of 32 waste components were quantified from all geographic areas that contribute to the Columbia Sanitary Landfill using a two-way stratification method, which accounted for variations in geographical regions and seasons. Comparisons of solid waste generated between locations and seasons were conducted at the 80% confidence level. The composition of the entire waste stream was 41% paper, 21% organic, 16% plastic, 6% metal, 3% glass and 13% other waste. Paper was the largest composition and glass was the smallest composition for all geographical regions. The result of this study was also compared with a 1987 Columbia, Missouri study conducted by EIERA (1987), with studies conducted in other states such as Minnesota, Wisconsin, Oregon and with national study conducted by the USEPA (USEPA 530-R-96-001, PB96-152 160. US Environmental Protection Agency, Office of Solid Waste, Washington, DC). The results of studies from other states are different from this study due to different local conditions, different methodologies and a different scope. There was a small (5%) increase in per capita weight from 1987 to 1996. The total per capita weight in the present study was 60% greater than the national per capita weight reported by the USEPA (1996) due to that the USEPA report excluded industrial, construction and certain commercial waste. The total per capita weight agrees with the national per capita weight for municipal waste reported by Tchobanoglous (1993), which included industrial, construction and commercial sources. The geographical and seasonal effects on the waste composition are evaluated and discussed. Statistical analysis indicates that waste characteristics are different among geographical regions and seasons. The potential for waste recovery and reduction is also discussed.