Thinking inside the box: Custom pacemaker improves device longevity in a congenital heart patient.

Patients with congenital heart disease have unique pacing challenges and often require epicardial systems. High pacing threshold is one of the major factors that decrease these systems' durability. Sometimes surgical reintervention or lead replacement is difficult or prohibitive in these patients due to repeated surgeries and extensive epicardial scar. We present a case report of a patient with Fontan physiology and chronically high epicardial lead pacing thresholds requiring frequent generator changes and a unique solution focusing on improving generator longevity.

Risk factors for infections in international travelers: an analysis of travel-related notifiable communicable diseases.

BACKGROUND: We sought to describe travel-related illness among our residents and gain insight into targeting pre-travel health advice to prevent travel-related illness. METHODS: A supplemental travel questionnaire was developed and administered for cases with a legally notifiable communicable disease reported in 2011-2012, who spent at least part of their exposure period outside the United States. RESULTS: Among 451 cases meeting the eligibility criteria, 259 were interviewed. Forty four percent reported receiving pre-travel advice. Two-thirds adhered fully with risk behavior recommendations; 94% followed immunization recommendations partially or fully; and 84% adhered fully with malaria prophylaxis recommendations. The primary reasons for not obtaining pre-travel advice were being unaware of the need (47.5%), or believing they already knew what to do (34.5%). Adults (OR = 2.8, 95% CI = 1.4-5.5), males (OR = 1.8, 95% CI = 1.1-3.0), those born outside the United States (OR = 2.0, 95% CI = 1.1-3.7), and those with planning time under two weeks (OR = 4.8, 95% CI = 1.5-15.9) or travel duration less than 7 days (OR = 7.9, 95% CI = 3.0-20.9) were more likely to travel without seeking pre-travel advice. CONCLUSIONS: The majority of cases reported not receiving pre-travel advice. Understanding the predictors of failure to receive pre-travel advice may help target public health prevention efforts.

Including self-reported race to improve cancer surveillance data for American Indians and Alaska Natives in Washington state.

BACKGROUND: American Indians and Alaska Natives (AI/AN) are frequently misclassified as another race in cancer surveillance systems, resulting in underestimated morbidity and mortality. Linkage methods with administrative records have been used to correct AI/AN misclassification, but AI/AN populations living in urban areas, and those who self-identify as AI/AN race, continue to be under-ascertained. The aim of this study was to evaluate racial misclassification in two cancer registries in Washington State using an urban AI/AN patient roster linked with a list of Indian Health Service (IHS) enrollees. METHODS: We conducted probabilistic record linkages to identify racial misclassification using a combined demographic dataset of self-identified AI/AN patients of a large, urban Indian health center, and administratively-identified AI/AN enrolled with the IHS. Age-adjusted incidence rates were calculated for 3 linkage populations: AI/ AN originally coded in each cancer registry, post-linkage AI/AN identified through the IHS roster alone, and post-linkage AI/AN identified through either the urban or IHS file. RESULTS: In the state and regional cancer registries, 11% and 18%, respectively, of matched cases were originally coded as a race other than AI/AN; approximately 35% of these were identified by the urban file alone. Incidence rate estimates increased after linkage with the IHS file, and further increased with the addition of urban records. Matches identified by the urban patient file resulted in the largest relative incidence change being demonstrated for King County (which includes Seattle); the all-site invasive cancer rate increased 8.8%, from 443 to 482 per 100,000. CONCLUSIONS: Inclusion of urban and self-identified AI/AN records can increase case ascertainment in cancer surveillance systems beyond linkage methods using only administrative sources.