Reduction of inappropriate shock rate through signal filtering (smart-pass) in patients with implantable subcutaneous cardioverter-defibrillator: a systematic review and meta-analysis.

Subcutaneous implantable cardioverter-defibrillators (S-ICD) are effective in protecting patients against sudden death but expose them to a higher risk of inappropriate shock (IAS). We performed a systematic search of studies published between January 2010 and December 2019 assessing IAS due to cardiac oversensing by the selection process (PRISMA) and identified 17 eligible articles. Fifteen studies were observational, and two studies were retrospective. For the meta-analysis, the final population included 6111 patients: 3356 without SMART pass (SP) filter (group 1) and 2755 with SP filter (group 2). 1614 shocks (appropriate shocks plus IAS) were registered (1245 in group 1 and 369 in group 2). The random effects meta-analysis estimated an overall IAS rate of 7.78% (95% confidence interval: 4.93-10.64) with substantial variability between studies (I square=96.05%, p<0.001). The IAS rate was 10.75% (95% confidence interval: 8.49-13.02) for group 1 and 3.61% (95% confidence interval: 1.36-5.86) for group 2 (p<0.001). Third-generation S-ICD technology with SP filters reduced the risk of cardiac signal-related IAS.

Identification of organizational barriers to HPV vaccination uptake in medical students in southern Italy: a cross-sectional study.

Introduction: Despite proven efficacy, HPV vaccination coverage is still suboptimal. Factors influencing vaccination uptake are education attainment, socio-economic position, and knowledge about HPV. This study aimed to assess HPV vaccination uptake and its correlates among medical students and identify logistic-organizational barriers, knowledge, and attitudes with regard towards HPV vaccination to improve current public health vaccination strategies. Medical students, with their acquired biological knowledge, were selected as a low-risk groups for HPV vaccination uptake. This cross-sectional study was conducted using a validated questionnaire. Methods: Students in their the first 3 years of study students were preferentially invited. Eventually, the invitation was extended to every medical student. Logistic multivariable regression was used to assess determinants of HPV vaccination uptake. Additional analysis explored determinants of knowledge of and attitude toward HPV vaccination. Finally, a sensitive analysis was conducted to further assess the effect of knowledge and attitude on the HPV vaccination rate. Results: A total of 882 medical students participated, with 74.5% enrolled in the first 3 years of their training. HPV vaccination uptake was 55.5%, ranging from 78.5% for females to 16.5% for males. Male sex and increasing age were consistently associated with a lower vaccination uptake (males sex: OR 0.03, CI 0.02-0.05; age: OR 0.77, CI 0.68-0.88), whereasilst progress in their academic career was associated with a to higher likelihood of being vaccinated (6th year: OR 3.45, CI 1.24-9.57). These associations were confirmed when considering the knowledge of and attitude towards HPV. Additionally also, an active outreach from healthcare institutions was associated with a higher likelihood of receiving HPV vaccination (OR 1.70, CI 1.09-2.65. Conclusion: HPV vaccination in medical students was higher than in the general population; however, it was still suboptimal. An active and up-to-date call strategy and extending the free-of-charge offer are essential measures for to improvinge vaccination uptake. The findings support the need to improve public health strategies and increase awareness and knowledge ofregarding HPV vaccination.

European Cardiac Arrhythmia Society Statement on the cardiovascular events associated with the use or abuse of energy drinks.

Energy drinks are increasingly used by young people and young athletes in order to improve their performance alone or in association of other substances, particularly alcohol. In recent years, a number of reports of reports have raised attention on the side-effects associated with the use or abuse of energy drinks particularly serious cardiovascular events. The European Cardiac Arrhythmia Society (ECAS) has undertaken a systematic and critical review of reported data on cardiovascular events including life-threatening arrhythmias with or without cardiac arrest and other cardiovascular events, and discussed in this review the possible causal effect of caffeine and other ingredients contained in energy drinks and the reported events. Twenty-two cardiovascular events were reported in association with the use or abuse of energy drinks. The European Cardiac Arrhythmia Society would like to draw attention on the possible cardiovascular complications that may occur with the consumption of these beverages and to emphasize the prevention measures to be taken particularly in the young population. Well-designed prospective studies are needed to clarify the possible role of energy drinks in inducing the cardiovascular events reported.

Adult immunization with 13-valent pneumococcal vaccine in Campania region, South Italy: an economic evaluation.

Pneumococcal pneumonia has a high clinical burden in terms of morbidity, mortality and hospitalization rate, with heavy implications for worldwide health systems. In particular, higher incidence and mortality rates of community-acquired pneumonia (CAP) cases, with related costs, are registered among elderly. This study aimed to an economic evaluation about the immunization with PCV13 in the adult population in Campania region, South Italy. For this purpose we performed, considering a period of 5 y, a budget impact analysis (BIA) and a cost-effectiveness analysis which considered 2 scenarios of immunization compared with lack of immunization for 2 targeted cohorts: first, the high risk subjects aged 50-79 y, and second the high risk individuals aged 50-64 y, together with all those aged 65 y. Regarding the first group, the decrease of pneumonia could give savings equal to €29,005,660, while the immunization of the second cohort could allow savings equal to €10,006,017. The economic evaluation of pneumococcal vaccine for adult groups represents an essential instrument to support health policies. This study showed that both hypothesized immunization strategies could produce savings. Obtained results support the use of pneumococcal conjugate vaccine for adults. This strategy could represent a sustainable and savings-producer health policy.

[Public access defibrillation in the Sorrento Peninsula]. / Il progetto di defibrillazione precoce della Penisola Sorrentina.

Early cardiac defibrillation is the only effective therapy to stop ventricular fibrillation or pulseless ventricular tachycardia. It is still considered the gold standard for the treatment of ventricular tachycardia/fibrillation, and is the only intervention capable of improving survival in cardiac arrest survivors. Timing of intervention, however, is crucial because after only 10 min success rates are very low (0-2%). Unfortunately, adequate relief cannot always be provided within the necessary time. The purpose of the public access defibrillation project in Sorrento was to create fixed and mobile first aid with automated external defibrillators in combination with the local 118 emergency system. With the involvement of pharmacies, bathing establishments and schools, 31 equally distant sites for public access defibrillation were made available. This organization was supplemented by mobile units on the cars of the Municipal Police and Civil Protection, and on patrol boats in the harbor.

[Medical-legal issues in remote monitoring of implantable cardioverter-defibrillators]. / Aspetti medico-legali del controllo remoto dei defibrillatori impiantabili.

Patients with implanted automatic defibrillators should undergo careful monitoring during follow-up and may require access to the emergency department or hospitalization for device-related problems. Nowadays, the progressive development of information technology allows remote monitoring of patients with cardiac defibrillators using dedicated systems which make it possible to transfer clinical and technical data derived from device interrogation to the Cardiology Center through telephonic line. In patients with an implantable defibrillator, remote monitoring is effective in identifying device malfunctioning and clinical problems, such as heart failure, to an extent similar to traditional ambulatory monitoring, while allowing significant advantages for the patient quality of life and savings in resource management. This different way of organizing care has created new problems in terms of responsibility for manufacturers, responsible for the technical aspect, for the healthcare system, responsible for service supply and management, and for the physician, who should supervise the whole process and ensure the safety of the information provided. Telemedicine is configured as a highly complex activity and therefore any treatment provided through it will, in terms of responsibility, be assessed bearing in mind that "if performance involves the solution of technical problems of special difficulty, lenders are not liable for damages, except in cases of intent or gross negligence". Also important are minor legal issues, such as permissions, problems of inaccessibility to the service, the assessment of medical liability compared to the activity of the team, and all issues related to informed consent and privacy protection.

[Responsibilities for the remote monitoring of heart failure patients]. / La responsabilità nel controllo a distanza del paziente con scompenso cardiaco.

Heart failure patients may frequently undergo repeat hospitalizations, and for this reason recent guidelines recommend a multidisciplinary approach including remote clinical state management through systems such as electronic devices, portable or implantable, with the aim of simplifying patient management and optimizing healthcare resources. This different way of healthcare organization has brought about new levels of responsibility, including device manufacturers responsible for the technical aspects, healthcare facilities responsible for the information systems used for patient clinical data transmission and for ambulatory patient access, and in particular the clinicians who should ensure the process supervision by providing prompt medical assistance if alarm signals are received. The use of telemedicine, however, may engender technical problems of varying difficulties. In terms of responsibility, service providers are not liable for damage deriving from technical default, except in the case of willful misconduct or gross negligence. No less important are the legal issues concerning permissions, conflicts of jurisdiction among nations, problems of service inaccessibility, as well as the identification of medical liability in relation to the activity of a multidisciplinary team, besides issues relating to informed consent and privacy protection. In conclusion, risk management with telemedicine may provide more accurate information and better traceability of operators' activity.

[Evaluation of BLS-D training in lay people]. / Valutazione dell'apprendimento delle manovre di BLS-D da parte di personale laico.

BACKGROUND: The possibility of saving persons with sudden cardiac arrest (SCA) lowers of 10% every minute since the beginning of the event. The early defibrillation (within 4 min) of a person with SCA performed by first responders suitably trained increases the survival rate up to 50%. The basic aim is that early defibrillation is performed as soon as possible by the first responder. METHODS: Within the Public Access Defibrillation (PAD) "Napoli Cuore" Project, 220 highway patrol agents of the Campania Region district were trained through theoretical and practical courses to acquire suitable psychomotor skills to perform the first aid. The learning evaluation was performed with a written exam and a practical test to assess how much every agent had learned about basic life support-defibrillation (BLS-D) schemes. RESULTS: 98.5% of the participants passed the exams and obtained the BLS-D rescuer license, and 15.5% of them obtained the highest score. The analysis of the report cards showed that most of the participants expressed an excellent opinion about this experience. CONCLUSIONS: To implement a PAD project it is necessary to awaken all the structures involved in the campaign against SCA. Hence, it is important that all emergency specialists, public institutions and police departments work all together to make everyone feels safe.

Role of semiautomatic defibrillators in a general hospital: "Naples Heart Project".

In Italian hospitals, 85% of patients hospitalized in general medical wards who experience cardiac arrest die, while the incidence is much lower in patients in intensive care units. Defibrillation, in Italian hospitals, often occurs very late, either due to a lack of defibrillators, or due to architectural and structural barriers. The object of an in-hospital emergency service is to prevent and treat cardiac arrest without subsequent complications, such as brain damage, renal failure etc. The Naples Heart Project was based on a feasibility study of the in-hospital emergency service to evaluate and analyze problems associated with type of structure, departmental and institutional dislocation, internal practicability (architectural features and preferential ways), staff numbers and distribution, the calling system for emergency, and the equipment available. The Naples Heart Project began in July 2001, since then it has already created 835 BLSD first responders among the hospital staff; 440 were physicians and physicians still in training, 310 were nurses and 85 were administrative staff.