Intravascular lithotripsy to treat an underexpanded coronary stent during index procedure: A case report study.

Management of heavily calcified lesions during percutaneous coronary intervention (PCI) is often associated with high incidence of complications and long-term adverse outcomes. There is growing evidence of the efficacy of intravascular lithotripsy (IVL) in de novo coronary lesion preparation; however, little experience has been documented within freshly deployed stent underexpansion. We report a 66-year-old male with a marked stent underexpansion despite extensive lesion preparation due to severe underlying calcification. The stent was resistant to balloon postdilatation; therefore, IVL was applied, resulting in excellent stent expansion. IVL could be considered for treating acute stent underexpansion caused by severe underlying calcification.

Psychometric analysis and construct validation of Health Professional Education in Patient Safety Survey in the Indian context.

Background Improving patient safety (PS) is critical to optimizing healthcare delivery. There is a need to develop curricula or incorporate PS concepts in health professionals' (HPs) education, in both theoretical and practical training. Consequently, there is a need to measure the perception of HPs regarding various PS competencies imparted to them during their training. The Health Professional Education in Patient Safety Survey (H-PEPSS) is a tool that measures HPs' self-reported PS competence and was designed to reflect six sociocultural areas central to PS. The tool has been validated in Canada but not in India. We did a confirmatory factor analysis (CFA) and psychometric validation of the H-PEPSS in the Indian context. Methods The sample comprised 240 HPs. We used the maximum likelihood estimation method on AMOS V20 (SPSS Inc.) to carry out a CFA of the tool. We used the normed fit index, Tucker-Lewis index, comparative fit index, standard root mean square residual, root mean square residual and root mean square error of approximation to evaluate the model fit. Internal consistency and reliability of the six factors of the model were examined using Cronbach's alpha. Convergent validity of the model was examined using average variance extracted and composite reliability. Discriminant validity was examined using the Fornell and Larcker criterion and the heterotrait-monotrait method. Results The results indicate a good fit. The H-PEPSS was found to be reliable and valid for assessing PS competencies among HPs. Comparison of the results with the results of the Canadian setting confirmed external validity. Conclusion The 16-item H-PEPSS has good psychometric properties for use in the Indian context. The 23-item HPEPSS was found to be reliable and valid for assessing PS.

The information imperative: to study the impact of informational discontinuity on clinical decision making among doctors.

BACKGROUND: Informational discontinuity can have far reaching consequences like medical errors, increased re-hospitalization rates and adverse events among others. Thus the holy grail of seamless informational continuity in healthcare has been an enigma with some nations going the digital way. Digitization in healthcare in India is fast catching up. The current study explores the components of informational continuity, its impact on clinical decision-making and captures the general perception among the doctors towards a digital solution. METHODS: Cross-sectional study with snowball sampling. A survey questionnaire was developed and validated through a pilot study, then circulated through online platforms. Responses from doctors were obtained through an online Google form for a period of 3 months and analyzed using SPSS 20. The categorical variables were analyzed using Chi-square test. RESULTS: 1413 responses were obtained through a national level survey. Respondents were from a wide range of work experiences, locations, sectors, specialties and patient load. Components of patient records like clinical notes, investigation reports, previous diagnosis and treatment details were rated to be very important. 41% reported about half and 20% reported about 3/4th of their patients do not bring relevant records. Patients from rural areas, visiting state government hospitals and visiting general practitioners were less likely to bring relevant records during consultations. The fallouts of not having timely relevant patient information of the patients include more time per patient, repeat investigations, difficulty to arrive at definitive diagnosis, difficulty to take further treatment decisions and impaired overall clinical decision making which were said to be significant by respondents across the spectrum. The benefits of having timely relevant patient information were also reported consistently across the spectrum. An overwhelming proportion (83%), from across the spectrum, unequivocally expressed their willingness to use digital platforms for accessing patients' relevant medical records. CONCLUSION: Prevalence of informational discontinuity and its impact on clinical decision making is significant with definite benefits of having timely relevant medical history. There is strong willingness among the doctors to use digital solution(s) without any extra investment or effort on their part making customized solutions pertinent.

ABC, VED and lead time analysis in the surgical store of a public sector tertiary care hospital in Delhi.

BACKGROUND: An efficient inventory control system would help optimize the use of resources and eventually help improve patient care. OBJECTIVES: The study aimed to find out the surgical consumables using always, better, and control (ABC) and vital, essential, and desirable (VED) technique as well as calculating the lead time of specific category A and vital surgical consumables. METHODS: This was a descriptive, record-based study conducted from January to March 2016 in the surgical stores of the All India Institute of Medical Sciences, New Delhi. The study comprised all the surgical consumables which were procured during the financial year 2014-2015. Stores ledger containing details of the consumption of the items, supply orders, and procurement files of the items were studied for performing ABC analysis and calculating the lead time. A list of surgical consumables was distributed to the doctors, nursing staff, technical staff, and hospital stores personnel to categorize them into VED categories after explaining them the basis for the classification. RESULTS: ABC analysis revealed that 35 items (14%), 52 items (21%), and 171 items (69%) were categorized into A (70% annual consumption value [ACV]), B (20% ACV), and C (10% ACV) category, respectively. In the current study, vital items comprised the majority of the items, i.e., 73% of the total items and essential (E) category of items comprised 26% of all the items. The average internal, external, and total lead time was 17 days (range 3-30 days), 25 days (range 5-38) and 44 days (range 18-98 days), respectively. CONCLUSIONS: Hospitals stores need to implement inventory management techniques to reduce the number of stock-outs and internal lead time.

Pre-procedural fasting for coronary interventions: is it time to change practice?

INTRODUCTION: Traditionally, patients are kept nil-per-os/nil-by-mouth (NPO/NBM) prior to invasive cardiac procedures, yet there exists neither evidence nor clear guidance about the benefits of this practice. OBJECTIVES: To demonstrate that percutaneous cardiac catheterisation does not require prior fasting. METHODS: The data source is a retrospective analysis of data registry of consecutive patients who underwent percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) and stable angina at two district general hospitals in the UK with no on-site cardiac surgery services. RESULTS: A total of 1916 PCI procedures were performed over a 3-year period. None of the patients were kept NPO/NBM prior to their coronary procedures. The mean age was 67±16 years. 1349 (70%) were men; 38.5% (738/1916) had chronic stable angina, while the rest had ACS. 21% (398/1916) were diabetics while 53% (1017/1916) were hypertensive. PCI was technically successful in 95% (1821/1916) patients. 88.5% (1697/1916) had transradial approach. 77% (570/738) of elective PCI patients were discharged within 6 h postprocedure. No patients required emergency endotracheal intubation and there were no occurrences of intraprocedural or postprocedural aspiration pneumonia. CONCLUSIONS: Our observational study demonstrates that patients undergoing PCI do not need to be fasted prior to their procedures.

Exploring the Pathogens Present at the Patient Care Equipments & Supplies to Sensitise the Health Care Workers for Preventing Health Care-Associated Infections among In-Patients.

Health care-associated infection (HCAI) is an infection that a person acquires in hospital after 24 hours of his/her admission. A health care worker (HCW) does not have any right to provide another infection to in-patients. While caring the patients, HCW innocently or otherwise can transmit various pathogens to the patient. It is both ethically and legally wrong and HCW is answerable for it. The current study was conducted with the objectives to find out the rate of presence of pathogens at the patient care equipments & supplies, to identify the most common pathogens present at the patient care equipments & supplies and to identify such equipments & supplies that are at high risk of contamination. Investigator collected 1,145 samples of different equipments & supplies used for patient care from operation theaters, labour room & medical wards of a tertiary care hospital in New Delhi. The sample was collected from April 2012 to April 2013 by random sampling. Out of 1,145 samples, 112 were positive or contaminated with certain kind of pathogen. The finding revealed that the contamination rate of patient care equipments & supplies is 9.78 percent. The most common and frequent pathogen present at the equipments & supplies is Pseudomonas (39.29%) and water of oxygen humidifier is most commonly and frequently infected (47.32%). Nurses as the backbone of hospital should strictly adhere to the policies and protocols of the institution. She/he must update the knowledge of infection control practices and various methods of controlling HCAI including hand hygiene, disinfection of patient care equipments & supplies and cleanliness of environment. A Nurse should also transmit this knowledge to other team members so as to minimise the health care-associated infection rate.

Conventional versus 3-dimensional miniplate in management of mandibular fracture: a prospective randomized study.

OBJECTIVE: The aim of this study was to compare conventional miniplate (Champy's) and 3-dimensional miniplate fixation in the management of mandibular fracture. STUDY DESIGN: Prospective study. SETTING: The study was carried out in the Department of Oral and Maxillofacial Surgery, Govt. Dental College, Pt. B.D. Sharma University of Health Sciences, Rohtak, India. SUBJECTS AND METHODS: A prospective randomized clinical trial was carried out in 50 patients. Patients were randomly assigned to receive a 2.0-mm 3-dimensional miniplate (group A) or a 2.0-mm conventional miniplate (group B). All patients were followed up for 12 weeks postoperatively. Complications were analyzed according to the type of plate used and the site of fracture. RESULTS: Twenty-eight fracture sites were treated with the 3-dimensional miniplate and 28 with the conventional miniplate. Five complications occurred, representing 8.9% of the total. Two complications occurred in group A and 3 in group B, with complication rates equaling 7.14% and 10.71%, respectively. When comparing the overall complication rates according to plates used, the χ(2) test showed no statistically significant difference between the 2 groups (P > .05). CONCLUSION: No major difference in terms of treatment outcome is observed in both systems, and both are equally effective in managing mandibular fracture.

Myocardial bridging with a coronary artery aneurysm and left ventricular stunning.

The authors present a case demonstrating the unusual combination of myocardial bridging with a coronary artery aneurysm complicated by acute transient left ventricular dysfunction due to myocardial stunning. The pathophysiology and current insights into myocardial bridging, coronary aneurysms and myocardial stunning are briefly discussed. The literature reveals only one other reported case of coronary aneurysms associated with myocardial bridging. In addition, although there are several reports of angina and myocardial infarction complicating bridging, there is only 1 other report of myocardial stunning specifically.

A comparison of self-reported quality of life between patients with epilepsy and neurocardiogenic syncope.

Epilepsy and neurocardiogenic syncope share a final common pathway of loss of consciousness and consequent social disruption. We compared 52 patients with syncope, 96 with epilepsy and 100 controls. Epilepsy and syncope patients expressed significantly higher levels of anxiety and depression and reported significantly less good quality of life (QoL) compared with controls. There were no significant differences on any of the QoL parameters measured between the syncope and epilepsy patients. These findings suggest the main contributor to poor QoL in epilepsy may be the unpredictable loss of control that is the hallmark of the condition.

Repetitive 4-week periods of atrial electrical remodeling promote stability of atrial fibrillation: time course of a second factor involved in the self-perpetuation of atrial fibrillation.

BACKGROUND: Episodes of atrial fibrillation (AF) are known to cause both a rapid reduction in atrial refractoriness (atrial electrical remodeling) and a more delayed increase in AF stability thought to be due to a so-called "second factor." The aim of this study was to quantify the effects and time course of such a factor on AF stability in the chronic goat model. METHODS AND RESULTS: AF was maintained in 6 goats by burst atrial pacing for 3 consecutive 4-week periods separated a mean of 6+/-2.1 days of sinus rhythm. Six days of sinus rhythm was just sufficient for refractoriness changes to reverse fully in all goats. Atrial effective refractory period, AF inducibility, and duration of individual episodes of AF were assessed at regular intervals. There was a progressive reduction from month 1 to 2 to 3 in the mean duration of burst pacing required to induce individual episodes of AF of 60 seconds (178+/-251, 110+/-102, and 21+/-30 hours), 1 hour (229+/-224, 136+/-104, and 68+/-51 hours), and 24 hours (277+/-218, 192+/-190, and 102+/-75 hours; P<0.03). The frequency with which AF was induced during extrastimulus pacing increased progressively from 16.7% in month 1 to 31.7% in month 2 and 46.9% in month 3 (P<0.001). CONCLUSIONS: Sequential 4-week periods of atrial fibrillation result in a progressive increase in AF stability independent of baseline atrial refractory period. This finding suggests the presence of a second factor in the self-perpetuation of AF with a time course comparable to that of AF-induced ultrastructural changes in the atria.