Driveline infections in left ventricular assist devices-Incidence, epidemiology, and staging proposal.

BACKGROUND: Driveline infections (DLI) are a serious complication in patients with left ventricular assist devices (LVAD). Apart from the differentiation between superficial and deep DLI, there is no consensus on the classification of the severity of DLI. Little is known about risk factors and typical bacteria causing DLI in centrifugal-flow LVADs. METHODS: In this single-center study with 245 patients, DLI were classified by their local appearance using a modification of a score suggested by the Sharp Memorial group. The driveline exit site was inspected routinely every 6 months. RESULTS: Severe DLI were detected in 34 patients (15%) after 6 months and in 24 patients (22%) after 24 months. The proportion of patients with DLI increased significantly during the follow-up (p = 0.0096). The most common bacteria in local smears were Corynebacterium, coagulase-negative Staphylococcus, and Staphylococcus aureus. Fifty-nine patients were hospitalized more than once for DLI. In these patients, S. aureus was the most common bacterium. It was also the most common bacterium in blood cultures. Higher BMI, no partnership, and a HeartMate 3 device were identified as risk factors for DLI in a multivariable cause-specific Cox regression. CONCLUSION: This study is a standardized analysis of DLI in a large cohort with centrifugal-flow LVADs.

Effects of long-term incarceration: a statistical comparison of two expert assessments of two experts at the beginning and the end of incarceration.

Several studies have been conducted on the effects of long-term imprisonment on mental health but only few with a longitudinal study design. Those with longitudinal design often have a very short observation period. In this study the data of 87 long-term prisoners have been compared over an average period of 14.6 years. A statistical comparison of two expert assessments of two experts at the beginning and the end of incarceration was made. Changes of mental disorders, of personality and intelligence tests and of physical diseases amongst others have been included in the analysis. The overall rate of psychological disorders decreased. Adjustment disorder had been initially identified in 25.2%. Personality test results described a stabilization of traits like depressive attitude, emotional instability and a decrease of hostility. Neither significant changes on the outcomes of the intelligence test nor significant changes of physical health were found. Though a decrease of psychological morbidity is described, the overall numbers of psychological disorders remain high compared to the non incarcerated population. A damaging effect of long-term imprisonment could not be proven by this study.