Improving outcomes in single chamber leadless pacemakers: strategies for minimizing vascular complications.

BACKGROUND: Leadless pacemaker therapy is associated with a significant reduction in lead-related complication rate compared to conventional transvenous single chamber pacemaker therapy. However, a significant complication rate of 1.2% was observed in vascular access due to the use of large delivery femoral sheath (27Fr). The aim of this study was to evaluate the effectiveness of real-time ultrasound guidance and Z suture technique in reducing total and major vascular complications in leadless pacemaker therapy. METHOD: In this study, we performed a retrospective and prospective analysis of all adverse events associated with leadless pacemaker (Micra) implantation by two operators at a single tertiary center from December 2016 to December 2018. To mitigate the risk of vascular complications, all patients underwent real-time ultrasound-guided venipuncture for vascular access, as well as the application of a Z-suture technique for hemostasis at the end of the procedure. Data were collected on implant indications, implant procedure details, complications, and follow-up information. RESULTS: In this study, 45 patients with an age range of 24 to 94 years (mean 76 ± 14 years) were recruited, with 21 (46.6%) being female. The pacing indications for the patients included atrial fibrillation (24, 53.3%), vascular (7, 15.5%), infection (9, 20%), cognitive/frailty (3, 6.6%), and occupational (2, 4.4%). The implant procedures were performed under general anesthesia in 6 (13.3%) of the cases, and under local anesthesia and sedation in 39 (86.6%) of the cases. A single deployment was achieved in 43 (95.5%) of the patients, while 2 deployments were required in 2 (4.4%) of the patients. Notably, no vascular or major complications were reported in our cohort of patients. CONCLUSIONS: The results of this observational study indicate that incorporating real-time ultrasound guidance during venipuncture and the use of a Z-suture technique significantly reduce the occurrence of both total and major vascular complications associated with the implantation of leadless pacemaker. However, more robust and larger studies are required in order to confirm these results and implications for clinical practice.

LIMPRINT in Australia.

Background and Study Objective: Australia was one of nine participating countries in the epidemiology Phase II Lymphoedema Impact and Prevalence - International (LIMPRINT) project to determine the number of people with chronic edema (CO) in local health services. Methods and Results: Data collection occurred through questionnaire-based interviews and clinical assessment with provided LIMPRINT tools. Four different types of services across three states in Australia participated. A total of 222 adults participated with an age range from 22 to 102 years, and 60% were female. Site 1 included three residential care facilities (54% of participants had swelling), site 2 was community-delivered aged care services (24% of participants had swelling), site 3 was a hospital setting (facility-based prevalence study; 28% of participants had swelling), and site 4 was a wound treatment center (specific patient population; 100% of participants had swelling). Of those with CO or secondary lymphedema, 93% were not related to cancer, the lower limbs were affected in 51% of cases, and 18% of participants with swelling reported one or more episodes of cellulitis in the previous year. Wounds were identified in 47% (n = 105) of all participants with more than half of those with wounds coming from the dedicated wound clinic. Leg/foot ulcer was the most common type of wound (65%, n = 68). Conclusions: Distances between services, lack of specialized services, and various state funding models contribute to inequities in CO treatment. Understanding the high number of noncancer-related CO presentations will assist health services to provide timely effective care and improve referral pathways.

The verbal threat information pathway to fear in children: the longitudinal effects on fear cognitions and the immediate effects on avoidance behavior.

Verbal information has long been assumed to be an indirect pathway to fear. Children (aged 6-8 or 12-13 years) were exposed to threat, positive, or no information about 3 novel animals to see the long-term impact on their fear cognitions and the immediate impact on avoidance behavior. Their directly (self-report) and indirectly (implicit association task) measured attitudes toward the animals changed congruent with the information provided, and the changes persisted up to 6 months later. Verbal threat information also induced behavioral avoidance of the animal. Younger children formed stronger animal- threat and animal-safe associations because of threat and positive verbal information than older children, but there were negligible age effects on self-reported fear beliefs and avoidance behaviors. These results support theories of fear acquisition that suppose that verbal information affects components of the fear emotion.

The effects of verbal information on children's fear beliefs about social situations.

Two experiments explored the role of verbal information in changing children's fear-related beliefs about social situations. In Experiment 1, 118 6- to 8- and 12- to 13-year-olds heard positive, negative, or no information about individuals' experiences of three social situations. Fear beliefs regarding each situation were assessed before and after this manipulation. Verbal information had no significant influence on children's fear beliefs. In Experiment 2, the same paradigm was used with 80 12- to 13-year-olds, but the information took the form of multiple attitude statements about the situations expressed by groups of peers, older children, or adults. An affective priming task of implicit attitudes was used to complement the explicit questions about fear beliefs. Negative information influenced both explicit and implicit fear beliefs. The source of information and the child's own social anxiety did not moderate these effects. Implications for our understanding of the socialisation of childhood fears are discussed.

Individual differences in children's emotion understanding: effects of age and language.

Over the last two decades, it has been established that children's emotion understanding changes as they develop. Recent studies have also begun to address individual differences in children's emotion understanding. The first goal of this study was to examine the development of these individual differences across a wide age range with a test assessing nine different components of emotion understanding. The second goal was to examine the relation between language ability and individual differences in emotion understanding. Eighty children ranging in age from 4 to 11 years were tested. Children displayed a clear improvement with age in both their emotion understanding and language ability. In each age group, there were clear individual differences in emotion understanding and language ability. Age and language ability together explained 72% of emotion understanding variance; 20% of this variance was explained by age alone and 27% by language ability alone. The results are discussed in terms of their theoretical and practical implications.