The accessibility and utilization of genetic testing for inherited heart rhythm disorders: a Canadian cross-sectional survey study.

The genetic basis of many sudden death-related conditions has been elucidated. These include inherited arrhythmias and arrhythmogenic cardiomyopathies, termed inherited heart rhythm disorders (IHRD). Advising on and interpreting genetic testing is challenging for the general cardiologist. This has led to the development of interdisciplinary clinics for IHRD in varying stages of establishment in Canada. We sought the viewpoints and patterns of practice of Canadian IHRD experts, and assessed their ability to access genetic testing for IHRD using a national cross-sectional survey. Of 56 participants, most were physicians (68%) or genetic counselors (19%). Despite working collaboratively, most genetic counselors (59%) were either not satisfied or only somewhat satisfied with their relationships with physicians. Ninety percent of participants were involved in offering genetic evaluation, including 80% who felt that testing was usually/always accessible. Most offered genetic testing to confirm clinical diagnosis and/or direct family screening. Post-mortem genetic analysis was sought by 69% of respondents; however, a lack of retained tissue and/or poor tissue preparation hindered this process. Family screening was usually recommended in the setting of a pathogenic/likely pathogenic variant. The most commonly perceived barrier to genetic testing was cost to the healthcare system. More than a quarter of patients waited ≥ 6 months for funding. An ability to engage at-risk relatives was rated as limited/poor by 34% of participants. Despite the establishment of several interdisciplinary clinics, timely access to affordable testing, supported by strong team communication, continues to be a barrier to genetic testing in Canada.

Development of an Academic Professional Behaviors Assessment for Health Professions Faculty.

PURPOSE: An important component in educating health professionals is developing professional behaviors, which includes appropriate modeling by faculty. The purposes of this study were to: 1) determine examples of behaviors that faculty identify as important in measuring professional behaviors in themselves and colleagues, and 2) develop a tool that could be used in self- and peer-assessment for faculty. METHODS: Part I of this two-part study was a survey to determine which behaviors are considered valuable in seven categories of professional behaviors. Part II surveyed 113 faculty members across seven disciplines in one College of Health Professions to rank behaviors identified in Part I. Behaviors scored more than 2 SD below the mean were eliminated, and one-way ANOVA calculations were used to assess differences in rankings between professions. RESULTS: In Part I, 95 of 154 total behaviors were identified as most important at the end of round one; in round two, that number was reduced to 54. In Part II, 46 of the 54 behaviors were ranked as most important with no significant differences among programs. The Academic Faculty Professional Behavior Assessment was developed from these behaviors. CONCLUSION: Results of this study led to the development of an assessment tool which can be used across various health professions faculty.

Prevalence of Staphylococcus, including Methicillin-Resistant Staphylococcus aureus, in a Physical Therapy Education Facility.

UNLABELLED: The purpose of this study was to assess the prevalence of Staphylococcus species, including methicillin-resistant Staphylococcus aureus (MRSA), in a physical therapy (PT) education facility. The PT laboratory classrooms were routinely used by graduate PT students and faculty, undergraduate anatomy students, and licensed practitioners for continuing education purposes. METHODS: A total of 88 swab samples were collected from plinths and other equipment and plated onto mannitol salt agar (MSA). Suspected S. aureus colonies were confirmed by Staphyloslide latex testing. S. aureus isolates were plated to HardyCHROM agar to identify MRSA. VITEK antibiotic susceptibility testing confirmed MRSA isolates. RESULTS: Forty-seven samples showed growth (47/88, 53%), and 7 tested positive for S. aureus (7/47, 15%). Of those 7, one demonstrated oxacillin resistance and was confirmed as MRSA (1/7, 2%). Remaining samples grew other species of Staphylococcus and gram-negative bacilli. DISCUSSION: Given high classroom utilization, staphylococci environmental prevalence would be expected. However, the presence of MRSA was unexpected. Results demonstrate the potential for easily transmissible and potentially harmful organisms to be present in multi-use classrooms utilized by health professions students where frequent skin-to-skin contact occurs. Strict, routine cleaning of plinths and other equipment is imperative in reducing exposure risk.

The importance of integumentary knowledge and skill in physical therapist entry-level education: are they prepared for practice?

UNLABELLED: Physical therapist practice is grounded in patient management principles encompassing all body systems and focuses on prevention, education, and functional outcomes. As such, management of the integumentary system crosses all practice settings, emphasizing the importance that basic integumentary content be adequately addressed during entry-level education. PURPOSE: The purpose of this qualitative study was to compare the self-reported integumentary knowledge and skill of recent graduates to profession-determined expectations for education. SUBJECTS: Participants were 7 licensed physical therapists experienced in wound management. METHODS: Semi-structured interview data were recorded, transcribed, and coded. A matrix compiling professional expectations for integumentary education was utilized to identify topics as absent, covered only briefly, or covered only during clinical rotations. RESULTS: Compression, vascular screening, infection, factors impacting healing, modalities, dressings, wound measurements, topicals, and sutures/staples were among the most commonly reported areas of deficiency. DISCUSSION: While integumentary care makes up a small percentage of physical therapy practice, it is a significant part of a comprehensively educated therapist. This study found participants did not perceive themselves to have received the minimum entry-level integumentary knowledge and skill deemed necessary by the profession. Study results are supported by current literature and demonstrate the need for integumentary curriculum review in entry-level programs.

Assessing the knowledge of sudden unexpected death in the young among Canadian medical students and recent graduates: a cross-sectional study.

OBJECTIVE: To determine the level of knowledge concerning Sudden Unexpected Death in the Young (SUDY) among Canadian medical students and recent graduates (≤5 years after graduating). DESIGN: A cross-sectional study was conducted by distributing a standardised, multiple choice, online questionnaire which assessed basic knowledge of SUDY. SETTING: Canadian medical schools and residency training programmes. PARTICIPANTS: 614 Canadian medical students (in either their penultimate or final year) and recent graduates (≤5 years after graduating) completed an anonymous online questionnaire. PRIMARY AND SECONDARY OUTCOME MEASURES: The level of knowledge regarding molecular aetiology, clinical presentation, pharmacological management and modes of inheritance of six of the commonest conditions causing SUDY, including hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia (CPVT), long QT syndrome (LQT) and Wolff-Parkinson White syndrome (WPW), were compared between medical students and recent graduates. Questions were broken down into basic knowledge and advanced categories and analysed as a secondary outcome measure. RESULTS: Of 614 responses, approximately two-thirds were answered by recent graduates, who generally scored 10% higher on all subject categories than medical students. Overall, questions regarding HCM were best answered (40%), followed by WPW syndrome (32%), CPVT (30%), ARVC (23%), Brugada syndrome (21%) and LQT syndrome (17%). Questions categorised as basic knowledge were answered 30% and 39% correctly in medical student and recent graduate groups, respectively, and those in the advanced category were answered 20% and 25% correctly. CONCLUSIONS: Survey respondents fared poorly when answering questions regarding SUDY, which may be a reflection of inadequate medical education regarding these disorders. Standardised teaching regarding SUDY needs to occupy a stronger focus in Canadian medical curricula in order to prevent more unnecessary deaths by these syndromes in the future.

The study of antiarrhythmic medications in infancy (SAMIS): a multicenter, randomized controlled trial comparing the efficacy and safety of digoxin versus propranolol for prophylaxis of supraventricular tachycardia in infants.

BACKGROUND: Supraventricular tachycardia (SVT) is one of the most common conditions requiring emergent cardiac care in children, yet its management has never been subjected to a randomized controlled clinical trial. The purpose of this study was to compare the efficacy and safety of the 2 most commonly used medications for antiarrhythmic prophylaxis of SVT in infants: digoxin and propranolol. METHODS AND RESULTS: This was a randomized, double-blind, multicenter study of infants <4 months with SVT (atrioventricular reciprocating tachycardia or atrioventricular nodal reentrant tachycardia), excluding Wolff-Parkinson-White, comparing digoxin with propranolol. The primary end point was recurrence of SVT requiring medical intervention. Time to recurrence and adverse events were secondary outcomes. Sixty-one patients completed the study, 27 randomized to digoxin and 34 to propranolol. SVT recurred in 19% of patients on digoxin and 31% of patients on propranolol (P=0.25). No first recurrence occurred after 110 days of treatment. The 6-month recurrence-free status was 79% for patients on digoxin and 67% for patients on propranolol (P=0.34), and there were no first recurrences in either group between 6 and 12 months. There were no deaths and no serious adverse events related to study medication. CONCLUSIONS: There was no difference in SVT recurrence in infants treated with digoxin versus propranolol. The current standard practice may be treating infants longer than required and indicates the need for a placebo-controlled trial. Clinical Trial Registration Information- http://clinicaltrials.gov; NCT-00390546.

Clonidine-induced hypertension in a patient with a spinal lesion.

OBJECTIVE: To report a case of possible clonidine-induced hypertension (by Naranjo score) in a patient with a C4 spinal lesion. BACKGROUND: Clonidine is a medication long used to treat hypertension, and it is still used in the treatment of refractory hypertension. Although effective, clonidine use is hindered by adverse effects and its dual mechanism of action. CASE SUMMARY: A 39-year-old white, quadriplegic man with poorly controlled pain displayed many characteristics consistent with autonomic dysfunction (e.g., C4 spinal lesion, orthostatic hypotension, hypertension). The patient was routinely receiving transdermal clonidine and also received transdermal nitroglycerin paste as needed for control of acute hypertensive episodes. On the recommendation of the home healthcare pharmacists, clonidine was discontinued. Since that time, the patient's blood pressure and the use of emergent antihypertensive treatment have decreased significantly (maximum systolic and diastolic BP by approximately 50 and 25 mm Hg, respectively). CONCLUSIONS: Many of the characteristics of autonomic dysfunction, such as refractory hypertension, can seem selective for the use of clonidine and, because of its reliance on central alpha(2)-activity for its hypotensive effects, clonidine may induce hypertension in patients with autonomic dysfunction. Clonidine should be used with great caution when autonomic dysfunction is suspected.