Developing a Brief Cognitive Task Intervention to Reduce Long-Standing Intrusive Memories of Trauma: A Feasibility Study With Remote Delivery for Women in Iceland.

Background: There is emerging evidence that a brief cognitive task intervention may reduce the frequency of intrusive memories, even long-standing memories of older trauma. However, evaluations to date have involved in-person researcher contact. We investigated the feasibility and acceptability of remote delivery to women (n = 12) in Iceland who had experienced trauma on average two decades earlier. Method: Participants monitored intrusive memories in a daily diary for one week (i.e., baseline phase), completed (at least) two guided, remote intervention sessions (e.g., via secure video platform), and were encouraged to continue to use the intervention self-guided. Results: Eight participants completed the primary outcome and reported fewer intrusive memories in Week 5 (M = 6.98, SD = 5.73) compared to baseline (M = 25.98, SD = 29.39) - a 68% reduction. Intrusions decreased at each subsequent time point; at 3-months (n = 7) there was a 91% reduction compared to baseline. Other psychological symptoms reduced and functioning improved. Importantly, participant ratings and qualitative feedback support feasibility and acceptability. Conclusion: Findings suggest the feasibility of remote delivery of the brief imagery-competing task intervention by non-specialists (who were not mental health professionals) and hold promise for developing psychotherapeutic innovations supporting women with intrusive memories even decades after trauma.

Importance of hospital and clinical factors for early mortality in Takotsubo syndrome: Insights from the Swedish Coronary Angiography and Angioplasty Registry.

BACKGROUND: Takotsubo syndrome (TTS) is an acute heart failure syndrome with symptoms similar to acute myocardial infarction. TTS is often triggered by acute emotional or physical stress and is a significant cause of morbidity and mortality. Predictors of mortality in patients with TS are not well understood, and there is a need to identify high-risk patients and tailor treatment accordingly. This study aimed to assess the importance of various clinical factors in predicting 30-day mortality in TTS patients using a machine learning algorithm. METHODS: We analyzed data from the nationwide Swedish Coronary Angiography and Angioplasty Registry (SCAAR) for all patients with TTS in Sweden between 2015 and 2022. Gradient boosting was used to assess the relative importance of variables in predicting 30-day mortality in TTS patients. RESULTS: Of 3,180 patients hospitalized with TTS, 76.0% were women. The median age was 71.0 years (interquartile range 62-77). The crude all-cause mortality rate was 3.2% at 30 days. Machine learning algorithms by gradient boosting identified treating hospitals as the most important predictor of 30-day mortality. This factor was followed in significance by the clinical indication for angiography, creatinine level, Killip class, and age. Other less important factors included weight, height, and certain medical conditions such as hyperlipidemia and smoking status. CONCLUSIONS: Using machine learning with gradient boosting, we analyzed all Swedish patients diagnosed with TTS over seven years and found that the treating hospital was the most significant predictor of 30-day mortality.

Inter- and intra-observer variability in the echocardiographic evaluation of wall motion abnormality in patients with ST-elevation myocardial infarction or takotsubo syndrome - A novel approach.

INTRODUCTION AND OBJECTIVES: Using existing transthoracic echocardiographic indices to quantify left ventricular wall motion abnormalities (WMAs) can be difficult due to the variations in the location of the abnormalities within the left ventricle, the quality of examinations, and the inter-/intra-observer variability of available indices. This study aimed to evaluate a new approach for measuring the extent of WMA by calculating the percentage of abnormal wall motion and comparing it to the wall motion score index (WMSI). The study also sought to assess inter- and intra-observer variability. METHODS: The study included 140 echocardiograms from 54 patients presenting with ST-elevation myocardial infarction or Takotsubo syndrome. All patients underwent an echocardiographic examination according to a standard protocol and the images were used to measure the extent of akinesia (proportion akinesia, PrA), akinesia and hypokinesia (proportion akinesia/hypokinesia, PrAH), and WMSI. The inter-observer variability between the two operators was analyzed. The intra-observer analysis was performed by one observer using the same images at least 1 month after the first measurement. The agreement was analyzed using the Pearson correlation coefficient and Bland-Altman plots. RESULTS: Inter- and intra-observer variability for PrA and PrAH were low and comparable to those for WMSI. CONCLUSION: PrA and PrAH are reliable and reproducible echocardiographic methods for the evaluation of left ventricular wall motion.

Temporal electrocardiographic changes in anterior ST elevation myocardial infarction versus the Takotsubo syndrome.

Background: Electrocardiography (ECG) on admission is similar in ST elevation myocardial infarction (STEMI) and Takotsubo syndrome (TTS). ECG on admission has been extensively investigated and compared between STEMI and TTS, however, only a few studies have compared temporal ECG. Our aim was to compare ECG in anterior STEMI versus female TTS from admission to day 30. Methods: Adult patients with anterior STEMI or TTS treated at Sahlgrenska University Hospital (Gothenburg, Sweden) from December 2019 to June 2022 were prospectively enrolled. Baseline characteristics, clinical variables and ECGs from admission to day 30 were analyzed. Using a mixed effects model, we compared temporal ECG between female patients with anterior STEMI or TTS, as well as between female and male patients with anterior STEMI. Results: A total of 101 anterior STEMI patients (31 female, 70 male) and 34 TTS patients (29 female, 5 male) were included. The temporal pattern of T wave inversion was similar between female anterior STEMI and female TTS, as well as between female and male anterior STEMI. ST elevation was more common, whereas QT prolongation was less common, in anterior STEMI compared with TTS. Q wave pathology was more similar between female anterior STEMI and female TTS than between female and male anterior STEMI. Conclusions: The pattern of T wave inversion and Q wave pathology from admission to day 30 was similar in female patients with anterior STEMI and female patients with TTS. Temporal ECG in female patients with TTS may be interpreted as following a "transient ischemic" pattern.

[Reduction of shoulder dislocation with the Cunningham method].

INTRODUCTION: The Cunningham technique has been shown to be an effective and simple method to reduce a dislocated shoulder. It is based on the theory that the humeral head remains outside the glenoid fossa due to tension in the long biceps tendon. In the beginning of 2013 doctors at the emergency department in Landspitali University Hospital (LUH) in Reykjavik were instructed in the Cunningham method for reduction of anterior dislocation without sedation. The goal of this retrospective study was to evaluate the impact of its induction with regards to number of attempts, successful relocations, sedation, use of analgesics and length of stay in the ED. MATERIAL AND METHODS: We searched our electronic database for patients coming to the ED in LUH in 2012 and 2013 with anterior shoulder dislocation. Information was obtained on age and gender, the ED length of stay, first to fourth attempted methods of reduction, medications given for pain relief and sedation and whether this was the first dislocation or not. We used descriptive statistics and comparing the two groups we used independent sample t-test or chi-square to calculate the p-value. RESULTS: During the study period, a reduction was attempted on 190 patients with a shoulder dislocation with 95% of dislocations successfully reduced in the ED. The proportion of patients on which the Cunningham method was applied on first attempt increased from 1% to 27% between years. Average number of attempts was 1.15 in the first year and 1.38 the second year (p = 0.002). The proportion of successful first attempts fell from 81.6% to 66% (p = 0.016) but successful relocation in the emergency department after all attempts was 93.1% and 97.1%, respectively (p = 0,305). The duration of treatment was similar between years or 226 and 219 minutes (p = 0,839). Sedation ratio decreased from 85.1% to 73.8% (p = 0.024) and use of analgesics was similar between years, 70.6% and 69.6% (p = 0.843). CONCLUSION: Induction of the Cunningham method resulted in a significant reduction in the need for sedation. It reduced the rate of successful relocations in the first attempt and increased the number of attempts to but had no effect on the length of stay in the emergency room or the overall rate of successful relocations. Key words: Cunningham, shoulder, dislocation, reduction Correspondence: Hjalti Mar Bjornsson hjaltimb@landspitali.is.

[Acoustic neuroma in Iceland for 30 years (1979-2009)]. / Heyrnartaugaslíðursæxli á Íslandi í 30 ár (1979-2009)

INTRODUCTION: Acoustic neuroma (AN) is a tumor of the 8th cranial nerve. The goal of this study was to find the incidence of AN in Iceland from 1979 - 2009 as well as investigate other epidemiological factors. MATERIAL AND METHODS: The group of patients with the AN diagnosis was gathered retrospectively through medical records. We looked at several epidemiological factors including age and symptoms at diagnosis, and the treatment chosen for each individual. RESULTS: The incidence rate of AN in Iceland is 1.24/100,000. About 10% of diagnosed tumors were found incidentally. Most of those were found in the last 10 years of the investigation and in that period fewer large and giant tumors at diagnosis. Present complaints of patients at diagnosis were hearing loss (69%), dysequilibrium/dizziness (47%) and tinnitus (43%). Treatments were surgery (n=47), observation (n=30) and gamma knife radiosurgery (n=16). We had information concerning postoperative hearing loss and facial paralysis in 39 patients who underwent surgery. Loss of hearing postoperatively occurred in 69% (n=27) and 44% (n=17) had facial paralysis. For an average of 3.5 years, 17% of tumors followed by imaging grew. CONCLUSION: The incidence of AN is similar to that in Europe and is increasing. More tumors are found incidentally. Small tumors can be followed by regular imaging, at least for the short term. Larger tumors are treated by surgery or gamma knife radiosurgery. A high percentage of patients receiving surgery lost their hearing postoperatively.