Diagnostic yield and cost analysis of electrocardiographic screening in Swiss paediatric athletes.

OBJECTIVES: Athletes performing sports on high level are at increased risk for sudden cardiac death. This includes paediatric athletes, even though data on screening strategies in this age group remain scarce. This study aimed to assess electrocardiogram interpretation criteria in paediatric athletes and to evaluate the cost of screening. METHODS: National, multicentre, retrospective, observational study on 891 athletes of paediatric age (<18 years) evaluated by history, physical examination and 12-lead electrocardiogram. The primary outcome measure was abnormal electrocardiogram findings according to the International Recommendations for Electrographic Interpretation in Athletes. The secondary outcome measure was cost of screening. RESULTS: 19 athletes (2.1%) presented abnormal electrocardiogram findings requiring further investigations, mainly abnormal T-wave inversion. These 19 athletes were predominantly males, performing endurance sports with a mean volume of 10 weekly hours for a mean duration of 6 years of training. Further investigations did not identify any relevant pathology. All athletes were cleared for competition with regular follow-up. Total costs of the screening were 108,860 USD (122 USD per athlete). CONCLUSIONS: Our study using the International Recommendations for Electrographic Interpretation in Athletes identified a low count of abnormal findings in paediatric athletes, yet raising substantially the cost of screening. Hence, the utility of electrocardiogram-inclusive screening of paediatric athletes remains to be elucidated by longitudinal data.

Occupational need in severe dementia: a descriptive study.

This project represents the first phase of a larger study, the whole of which is intended to demonstrate the occupational need of elderly persons, in hospital or residential settings, who have severe dementia and to identify those therapeutic approaches which serve to meet such need. One hundred and nine severely impaired persons in nine dementia care units were each observed over the course of a day, using the dementia care mapping instrument. Results indicate a severe dearth of occupational provision for this client group, most of whom spent the greater part of their day unoccupied. They also highlight the conditions of minimum well-being experienced by most residents for most of the time. The anomaly of those units whose dementia care mapping scores did not match the perceived quality of their social and physical environments is discussed. A hypothesis of an altered perception of environment in severely impaired persons is proposed.