Annual Update Research Articles

Nursing students' experience of clinical supervision and contributing factors in Jordan

BackgroundAlthough clinical supervision is a vital component of nursing education, data on students' experiences of clinical supervision and contributing factors remain limited. AimThe study explores nursing students' experience of clinical supervision and contributing factors in Jordan. Design/methodsAn explorative design with a qualitative approach using focus group discussions (n = 6) was used. A convenient sample consisting of 48 participants was recruited from second, third and fourth year nursing students. Data were thematically analysed using N VIVO 12. ResultsThe analysis revealed two overlapping experiences. First, the empowering supervision experience comprising: “being willing and patient” and “working hand-in-hand” with students. Second, the disempowering supervision experience, including: abuse of power and grade obsession, incompetent supervision and lack of time detected for students. While the former has positivity which enhanced students' clinical learning, the latter reduced their motivation for gaining knowledge and skills and negatively impacted their self-confidence. ConclusionStudents' experience of clinical supervision is multifaceted. Thus, there is a pressing need for establishing a preparation programme for newly employed supervisors focusing on annual training updates, identifying their competency level and understanding the way their supervisory role is operationalised.

The creative path of academician of the russian academy of sciences A.V. Reshetnikov at the department of sociology of medicine, health economics and health insurance

The article presents a brief history of the formation of the Department of Sociology of Medicine, Health Economics and Health Insurance, created at Sechenov University by Academician of the Russian Academy of Sciences A.V. Reshetnikov. The forward-looking vision of the scientific and educational process of the permanent head of the department helps the team to develop, creatively grow, and discover new areas of work. Actualization of socio-humanitarian knowledge, annual updating of bachelors and masters degree programs for more than twenty years has attracted generations of young researchers in the field of sociology of medicine, health economics, and intelligent systems in sociology to the department.

Improvement of borehole heat exchanger model performance by calibration using measured data

ABSTRACT Planning the operation of large ground source heat pump (GSHP) systems requires accurate models of borehole heat exchangers (BHEs) that are not computationally intensive. In this paper, we propose parameter estimation using measured data as a method to improve the analytical models of BHE. The method was applied to a GSHP system operating for over 3 years. The deviation between modelled and measured load of the BHE reduced from 22% to 14%. Influence of the calibration data set was tested by changing time resolution and season of the calibration data. We concluded that the time resolution must be high enough to differentiate among the effects of different parameters and that different model parameters must be used for injection and extraction (seasons). The method was also applied to a GSHP that has been monitored for 10 years, which showed that accuracy of the model can be improved by annual updates of parameters.

Remote Sensing and Multi-Criteria Evaluation for Malaria Risk Mapping to Support Indoor Residual Spraying Prioritization in the Central Highlands of Madagascar

The National Malaria Control Program (NMCP) in Madagascar classifies Malagasy districts into two malaria situations: districts in the pre-elimination phase and districts in the control phase. Indoor residual spraying (IRS) is identified as the main intervention means to control malaria in the Central Highlands. However, it involves an important logistical mobilization and thus necessitates prioritization of interventions according to the magnitude of malaria risks. Our objectives were to map the malaria transmission risk and to develop a tool to support the Malagasy Ministry of Public Health (MoH) for selective IRS implementation. For the 2014–2016 period, different sources of remotely sensed data were used to update land cover information and substitute in situ climatic data. Spatial modeling was performed based on multi-criteria evaluation (MCE) to assess malaria risk. Models were mainly based on environment and climate. Three annual malaria risk maps were obtained for 2014, 2015, and 2016. Annual parasite incidence data were used to validate the results. In 2016, the validation of the model using a receiver operating characteristic (ROC) curve showed an accuracy of 0.736; 95% CI [0.669–0.803]. A free plugin for QGIS software was made available for NMCP decision makers to prioritize areas for IRS. An annual update of the model provides the basic information for decision making before each IRS campaign. In Madagascar and beyond, the availability of the free plugin for open-source software facilitates the transfer to the MoH and allows further application to other problems and contexts.

German Heart Surgery Report 2019: The Annual Updated Registry of the German Society for Thoracic and Cardiovascular Surgery.

Based on a longtime voluntary registry, founded by the German Society for Thoracic and Cardiovascular Surgery (GSTCVS) in 1980, well-defined data of all cardiac, thoracic, and vascular surgery procedures performed in 78 German heart surgery departments during the year 2019 are analyzed. For this period, a total of 175,705 procedures were submitted to the registry, 100,446 summarized as heart surgery procedures in a classical sense. The unadjusted in-hospital survival rate for the 34,224 isolated coronary artery bypass grafting procedures (relationship on-/off-pump 3.8:1) was 97.3%. For the 36,650 isolated heart valve procedures (16,625 transcatheter interventions included), it was 96.4%. Concerning short- and long-term circulatory support, a total of 2,716 extracorporeal life support/extracorporeal membrane oxygenation implantations, resp. 953 assist device implantations (L-/ R-/ BVAD, TAH) were registered. In 2019, the number of isolated heart transplantations increased to 333, a rise of 6.7% compared to the previous year. The isolated lung transplantations amounted to 311, a decrease of 8.5%. This annually updated registry of the GSTCVS represents voluntary public reporting by accumulating actual information for nearly all heart surgical procedures in Germany, constitutes advancements in heart medicine, and represents a basis for quality management for all participating institutions. In addition, the registry demonstrates that the provision of cardiac surgery in Germany is up to date, appropriate, and nationwide patient treatment is guaranteed all the time.

Base de Datos para la Investigación Farmacoepidemiológica en Atención Primaria (BIFAP): A data resource for pharmacoepidemiology in Spain.

Base de Datos para la Investigación Farmacoepidemiológica en Atención Primaria (BIFAP) is a population based database administered by the AEMPS (Spanish Agency for Medicines) of longitudinal electronic medical records (EMR) of patients attended in primary care. Its main purpose is to serve as source of information for independent studies on drug safety and support of medicines regulation activities. This article aim is to describe the characteristics of BIFAP, how to access the database and a summary of its potential for research. Health problems are registered by primary care physicians as episodes of care and include socio-demographic data, results of diagnostic procedures, lifestyle data, general data, and interventions. A proportion of data on hospitalizations and specialist care are currently available through linkage with other data sources. EMRs of the Spanish healthcare system are provided by the regional administrations. Specific data extraction and standardization processes are performed. BIFAP includes data from 12 million patients starting in 2001 and updated annually. Validation of drug and diagnosis definitions has been ascertained. Participation in international collaborative projects and a number of articles in peer reviewed journals reflect its contribution to the knowledge of the risks associated with medicines and drug utilization patterns. BIFAP is a useful tool for generating scientific evidence on medicines related issues, helping regulatory decision making in Europe. The main strengths of BIFAP are related to large sample size, population-based, longitudinal nature and annual update of data. BIFAP shares common challenges with similar data sources including accurate and efficient identification of health outcomes and of treatment exposure.

The Population Census in Austria

Based on the Constitution, the Population Census in Austria is a matter of the central state, serving many political-administrative, planning, research, and other purposes. After its start as a systematic operation in the middle of the 18th century, it developed further by a modern legal basis in 1857 and advances in statistical technology in 1890 (punch cards) and 1971 (machinereadable questionnaires). In the second half of the 20th century, the Population Census became a comprehensive operation, including dwellings, buildings, and workplaces. The communes organized the classical method of on the spot household data collection on behalf of the state. The register-based Census replaced the household collection in 2011. Following a government decision of 2000, which aimed at the sole use of available micro-data, the first steps for creatingthe necessary administrative and statistical registers took place in conjunction with the last traditional census of 2001. With new provisions for linking the records, the Register Census Act of 2006, and a full test census in the same year, the new methodology was established and evaluated in a short period. The first regular Register Census “took place” with reference date 31 October 2011. It is described in the central part of this communication, featuring the advantages, strengths, and weaknesses, the backbone registers, the “comparison registers,” and the redundancy principle, which help to ensure high data quality and the fit of the census into the international framework. Current developments include the annual update of results,changes and improvements in the data sources, and a short outlook on the next census of 2021.

A Survey of Perceptions of Surgical Trainees on Feedback During Training in West Africa.

Feedback has become an integral part of learning within the medical profession, particularly as training becomes more trainees'-centered. Feedback from the trainees about their training and trainers is essential for effective and high-quality training. The purpose of this survey was to evaluate trainees' perceptions on feedback on their postgraduate training and trainers in West Africa. Cross-sectional self-administered written survey of junior and senior registrar attending the annual revision and update course of the West African College of Surgeons. Information sought included sociodemographic variables, perception on feedback, opportunity to give feedback, trainee-trainers relationship and their opinion on different aspects of the postgraduate program where they would like to give feedback. The response rate was 81.5% (66/81). Median age was 33years. Sixty trainees (90.9%) were junior registrars. Sixty-four (97%) trainees would like to give feedback about their training and trainers. Only 18 (27.3%) trainees have had opportunity of giving feedback about their training. Most trainees (90.9%) would like to give feedback on patient care and learning environment; 89.4% would like to give feedback on their training curriculum and 87.9% would like to give feedback on their operating room experiences. Most trainees (81.8%) believed trainee feedback is of critical importance to training. With regard to trainees-trainer relationship, 39 (59.1%) trainees were either unsatisfied or reported just a fair relationship. This study has shown that many of the trainees lack opportunity of giving feedback on their training but considered feedback critical to their training. Trainees would like to give feedback on patient care, curriculum, learning environment and operative room experience. Trainee feedback should be encouraged in surgical training in West Africa.

Applications of interannual-to-decadal climate prediction: An exploratory discussion on rainfall in the Sahel region of Africa

This perspective explores how climate services may potentially incorporate information emerging from the new science of interannual-to-decadal (I2D) climate prediction. The geographic focus is the Sahel region of West Africa, which has demonstrated prediction advances for rainfall on the I2D timescale, and vulnerability to climate hazards. The perspective draws on reviews of predictability and applications in the region and a national workshop in Sudan to explore applications. Decadal prediction is an emerging capability, to date being undertaken primarily as a learning process. However, for the multi-year forecast information, we identify a number of new dimensions that challenge product design and user uptake. Current experiments often present forecasts as the average conditions for a target first year, and then subsequent set of years raising a question of what a forecast of mean average conditions for years 2–5 represents in terms of climate to expect, and how annual updates to multi-year forecasts may be produced and communicated. Stakeholder consultations highlighted some of the concerns noted for existing seasonal forecasts, but now translated into terms for multi-year information, such as confidence in information, need for research on temporal downscaling (which may now include information on the risks of climate anomalies in the individual years that make up the forecast period), capacity development, and that communities would need to be convinced about effectiveness, alongside careful communication, especially in the context of multi-year planning. This perspective captures one of the first learning case studies on how I2D prediction may be explored in a given region, a first step towards climate services development that integrate I2D information.

Copernicus Global Land Cover Layers—Collection 2

In May 2019, Collection 2 of the Copernicus Global Land Cover layers was released. Next to a global discrete land cover map at 100 m resolution, a set of cover fraction layers is provided depicting the percentual cover of the main land cover types in a pixel. This additional continuous classification scheme represents areas of heterogeneous land cover better than the standard discrete classification scheme. Overall, 20 layers are provided which allow customization of land cover maps to specific user needs or applications (e.g., forest monitoring, crop monitoring, biodiversity and conservation, climate modeling, etc.). However, Collection 2 was not just a global up-scaling, but also includes major improvements in the map quality, reaching around 80% or more overall accuracy. The processing system went into operational status allowing annual updates on a global scale with an additional implemented training and validation data collection system. In this paper, we provide an overview of the major changes in the production of the land cover maps, that have led to this increased accuracy, including aligning with the Sentinel 2 satellite system in the grid and coordinate system, improving the metric extraction, adding better auxiliary data, improving the biome delineations, as well as enhancing the expert rules. An independent validation exercise confirmed the improved classification results. In addition to the methodological improvements, this paper also provides an overview of where the different resources can be found, including access channels to the product layer as well as the detailed peer-review product documentation.

Persistent and changing job strain and risk of coronary heart disease. A population-based cohort study of 1.6 million employees in Denmark.

Objectives:This study aimed to examine the association between job strain and incident coronary heart disease (CHD) in Denmark, while accounting for changes of job strain.Methods:We included all employees residing in Denmark in 2000, aged 30–59 years with no prevalent CHD (N=1 660 150). We determined exposure to job strain from 1996–2009 using a job exposure matrix (JEM) with annual updates. Follow-up for incident CHD was from 2001–2010 via linkage to health records. We used Cox regression to calculate hazard ratios (HR) and 95% confidence intervals (CI) for the association between job strain and incident CHD.Results:During 16.1 million person-years, we identified 24 159 incident CHD cases (15.0 per 10 000 person-years). After adjustment for covariates, job strain in 2000 predicted onset of CHD during a mean follow-up of 9.71 years (HR 1.10, 95% CI 1.07–1.13). When analyzing changes in job strain from one year to the next and CHD in the subsequent year, persistent job strain (HR 1.07, 95% CI 1.03–1.10), onset of job strain (HR 1.20, 95% CI 1.12–1.29) and removal of strain (HR 1.20, 95% CI 1.12–1.28) were associated with higher CHD incidence compared to persistent no job strain. Associations were similar among men and women.Conclusions:Job strain is associated with a higher risk of incident CHD in Denmark. As we used a JEM, we can rule out reporting bias. However, under- or overestimation of associations is possible due to non-differential misclassification of job strain and residual confounding by socioeconomic position.

Factors Associated with Missed and Cancelled Appointments in the Endoscopy Unit: Descriptive Study.

Background and aimCanceled and missed appointments at the endoscopy unit affect the quality of the provided services and can negatively impact patient outcomes. Assessing the association between the various factors relating to nonattendance will show whether the defective aspects are organizational or personal, which is essential to improve the quality of the healthcare system. Moreover, this study will be of value in our region due to the current scarcity of studies in the Middle East.MethodsA descriptive study was conducted at King Khaled University Hospital in Riyadh, Saudi Arabia. A database of participants was established from those who missed/canceled their outpatient endoscopy clinic appointment; purposive sampling was applied, excluding those who are under 14 years old. Demographic data and organizational factors (e.g., referred clinic and the lead time) were collected from the patients’ files and a structured interview done by phone within 7-14 days of the missed/canceled appointment. ResultsA total of 919 endoscopy procedures were scheduled in an eight-week period, and 179 procedures were missed/canceled (19.48%); 84% were missed, and 16% were canceled. The highest percentage of the population had a high-school diploma or less. The results showed that roughly half of the patients were unemployed. More than two-thirds of the patients had undergone an endoscopy within the past year or less. The majority stated that they underwent the procedure in a different facility, which might be due to various reasons, one of which could be justified as long lead time. ConclusionAn annual update of patients’ files is suggested. Text messages can help serve as a reminder in addition to clear appointment instructions that will aid in minimizing the absence rates. Overbooking is recommended to decrease the lead time and increase clinic efficiency. Raising patients’ awareness regarding the effect of missing appointments as well as upgrading the communication methods will assist in decreasing the rate of missed appointments.

Annual report to the nation on the status of cancer, part I: National cancer statistics.

The American Cancer Society, the Centers for Disease Control and Prevention, the National Cancer Institute, and the North American Association of Central Cancer Registries collaborate to provide annual updates on cancer occurrence and trends in the United States. Data on new cancer diagnoses during 2001 through 2016 were obtained from the Centers for Disease Control and Prevention-funded and National Cancer Institute-funded population-based cancer registry programs and compiled by the North American Association of Central Cancer Registries. Data on cancer deaths during 2001 through 2017 were obtained from the National Center for Health Statistics' National Vital Statistics System. Trends in incidence and death rates for all cancers combined and for the leading cancer types by sex, racial/ethnic group, and age were estimated by joinpoint analysis and characterized by the average annual percent change during the most recent 5years (2012-2016 for incidence and 2013-2017 for mortality). Overall, cancer incidence rates decreased 0.6% on average per year during 2012 through 2016, but trends differed by sex, racial/ethnic group, and cancer type. Among males, cancer incidence rates were stable overall and among non-Hispanic white males but decreased in other racial/ethnic groups; rates increased for 5 of the 17 most common cancers, were stable for 7 cancers (including prostate), and decreased for 5 cancers (including lung and bronchus [lung] and colorectal). Among females, cancer incidence rates increased during 2012 to 2016 in all racial/ethnic groups, increasing on average 0.2% per year; rates increased for 8 of the 18 most common cancers (including breast), were stable for 6 cancers (including colorectal), and decreased for 4 cancers (including lung). Overall, cancer death rates decreased 1.5% on average per year during 2013 to 2017, decreasing 1.8% per year among males and 1.4% per year among females. During 2013 to 2017, cancer death rates decreased for all cancers combined among both males and females in each racial/ethnic group, for 11 of the 19 most common cancers among males (including lung and colorectal), and for 14 of the 20 most common cancers among females (including lung, colorectal, and breast). The largest declines in death rates were observed for melanoma of the skin (decreasing 6.1% per year among males and 6.3% among females) and lung (decreasing 4.8% per year among males and 3.7% among females). Among children younger than 15years, cancer incidence rates increased an average of 0.8% per year during 2012 to 2016, and cancer death rates decreased an average of 1.4% per year during 2013 to 2017. Among adolescents and young adults aged 15 to 39years, cancer incidence rates increased an average of 0.9% per year during 2012 to 2016, and cancer death rates decreased an average of 1.0% per year during 2013 to 2017. Although overall cancer death rates continue to decline, incidence rates are leveling off among males and are increasing slightly among females. These trends reflect population changes in cancer risk factors, screening test use, diagnostic practices, and treatment advances. Many cancers can be prevented or treated effectively if they are found early. Population-based cancer incidence and mortality data can be used to inform efforts to decrease the cancer burden in the United States and regularly monitor progress toward goals.

Annual report to the nation on the status of cancer, part II: Progress toward Healthy People 2020 objectives for 4 common cancers.

The Centers for Disease Control and Prevention, the American Cancer Society, the National Cancer Institute, and the North American Association of Central Cancer Registries collaborate to provide annual updates on cancer occurrence and trends in the United States and to address a special topic of interest. Part I of this report focuses on national cancer statistics, and part 2 characterizes progress in achieving select Healthy People 2020 cancer objectives. For this report, the authors selected objectives-including death rates, cancer screening, and major risk factors-related to 4 common cancers (lung, colorectal, female breast, and prostate). Baseline values, recent values, and the percentage change from baseline to recent values were examined overall and by select sociodemographic characteristics. Data from national surveillance systems were obtained from the Healthy People 2020 website. Targets for death rates were met overall and in most sociodemographic groups, but not among males, blacks, or individuals in rural areas, although these groups did experience larger decreases in rates compared with other groups. During 2007 through 2017, cancer death rates decreased 15% overall, ranging from -4% (rural) to -22% (metropolitan). Targets for breast and colorectal cancer screening were not yet met overall or in any sociodemographic groups except those with the highest educational attainment, whereas lung cancer screening was generally low (<10%). Targets were not yet met overall for cigarette smoking, recent smoking cessation, excessive alcohol use, or obesity but were met for secondhand smoke exposure and physical activity. Some sociodemographic groups did not meet targets or had less improvement than others toward reaching objectives. Monitoring trends in cancer risk factors, screening test use, and mortality can help assess the progress made toward decreasing the cancer burden in the United States. Although many interventions to reduce cancer risk factors and promote healthy behaviors are proven to work, they may not be equitably applied or work well in every community. Implementing cancer prevention and control interventions that are sustainable, focused, and culturally appropriate may boost success in communities with the greatest need, ensuring that all Americans can access a path to long, healthy, cancer-free lives.

An Assessment of Production Trends on the Great Plains from 1984 to 2017

Throughout the Great Plains, aboveground annual net primary productivity (ANPP) is a critical ecosystem service supporting billions of dollars of commerce and countless stakeholders. Managers and producers struggle with high interannual change in ANPP, which often varies 40% between years due to fluctuating precipitation and drought. To quantify ANPP trends and evaluate interannual and spatial variation, we created the Rangeland Production Monitoring Service (RPMS), a spatially explicit database with automatic annual updates of ANPP for all rangelands in the conterminous United States. The RPMS establishes relationships between normalized difference vegetation index (NDVI) from remote sensing data and ANPP from soil ecological site descriptions. These relationships were applied to NDVI data in each year from 1984 to present, although the present assessment focuses on the period from 1984 to 2017. Validation metrics include an r2 of 89% between predicted and observed ANPP at three locations in the Great Plains. For this special issue, we assess data from the RPMS to quantify trends and variation of ANPP in the Great Plains region for four major grassland types, smaller-scale ecological subsections, and national grassland units. Significant (α ≤ 0.05) increases in ANPP since 1984 were observed across all major grassland types in the Great Plains, particularly the northern mixed-grass prairie, which also had the greatest interannual variation (21%) from 1984 to 2017. Corresponding significant increases (P < 0.1) in growing season precipitation were found in all grassland types except the shortgrass steppe. Spatial variation decreases from west to east and tallgrass prairie exhibited the lowest temporal and spatial variation of 8% and 21%, respectively, from 1984 to 2017. Grazing allotments in the National Grasslands exhibit differential recovery after drought ranging from about 15% to 350%.

Unprecedented challenges from climate change to human health will require an unprecedented global response

Given the threats that anthropogenic climate change would pose to human health, tackling climate change is identified to be the greatest global health opportunity of the 21st century by the 2015 Lancet Commission on Health and Climate Change. The Lancet Countdown was then initiated, as an international and multidisciplinary collaboration dedicated to monitoring the evolving health profile of climate change, and providing an independent assessment of the delivery of commitments made by governments worldwide under the Paris Agreement. The 2019 report of the Lancet Countdown on health and climate change presents an annual update of 41 indicators across five key domains: climate change impacts, exposures, and vulnerability; adaptation, planning, and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. The report represents the findings and consensus of 35 leading academic institutions and UN agencies from every continent. The report warns that current progress is inadequate, and warming is occurring faster than governments are able, or willing to respond. The report concludes that meeting the unprecedented challenge of climate change will require an unprecedented global response, with bold, new approaches to policy making, research, and business. China is the global hotspot in both climate change mitigation and human health protection. Therefore, in addition to the Lancet Countdown global reports, experts from Department of Earth System Science, Tsinghua University who have been involved in the series of global reports, have been invited to prepare the China policy brief annually to provide a unique national analysis and policy recommendations for health and climate change to the policymakers and the public in China since 2017. The 2019 edition of China policy brief, jointly prepared by experts from Tsinghua University and Sun Yat-sen University, reviewed three indicators mostly related to China’s national conditions, i.e. health impacts of heat, coal phase-out and media coverage of health and climate change, and proposed the following policy recommendations. (1) Conduct vulnerability mapping to understand which populations are most at risk, and implement interventions to safeguard against the acute effects of extreme heat on human health. Curb greenhouse gas emissions to avoid intensification of heatwaves in the longer term. (2) Incorporate the close linkages between climate change, current and future air quality and human health into coal phase-out policymaking. Further enhance the ambition of coal phase-out policy to prevent climate change-driven mete-orological conditions that might worsen air pollution. (3) Media outlets present a key channel for the communication of health risks associated with climate change, spread-ing knowledge of adaptation measures to these adverse impacts, and shaping public perceptions of necessary interven-tions. Health professionals are trusted by the public and should engage with media to further raise awareness of the link-ages between health and climate change and of actionable ways to bring about positive change. (4) With updated Nationally Determined Contributions under the Paris Agreement due to be submitted by 2020, health considerations should be integrated throughout proposed interventions, with particular consideration of heat adaptation measures, coal and energy policy, and health sector engagement where relevant.

Select Abstracts From Cardiology 2020: 23rd Annual Update on Pediatric and Congenital Cardiovascular Disease.

Select Abstracts From Cardiology 2020: 23rd Annual Update on Pediatric and Congenital Cardiovascular Disease.

Abstract WP435: Post Procedural Monitoring Tool Improves the Joint Commission Comprehensive Stroke Center Standard Compliance

Background: The Joint Commission (TJC) Comprehensive Stroke Center standard requires monitoring of patients after IV tPA administration, diagnostic angiography, aneurysm coiling, carotid angioplasty and stenting, mechanical endovascular reperfusion (MER) and carotid endarterectomy. Meeting 100% compliance of the standard is challenging. In 2018, monitoring and documentation were among the TJC’s top ten cited survey findings. Purpose: To determine if an electronic tool can improve documentation compliance and reduce delays in monitoring of vital signs, and neurologic, pedal pulse and skin site assessments. Methods: The initiative was implemented in 2018 with the objective for all patients to have 100% of their post procedural monitoring completed. A documentation tool was created and introduced to nursing units via annual stroke education updates. The tool was added to an online nursing resource SharePoint website and application, which was accessible to all nurses within the hospital. The procedure end time was entered in the tool, which automatically calculated the documentation times. Data was compared 12 months pre and post intervention. Analysis and reporting of data were conducted monthly via the program’s quality oversight committee. Data was analyzed using T-Test. Results: In post-IV tPA patients, more patients had 100% complete documentation (79% post vs. 29% pre-implementation; p=0.006). For all post neuro-interventional radiology procedures, more patients had 100% complete documentation (68% post vs. 17% pre-implementation; p&lt;0.001). For post carotid endarterectomy revascularization, there was a trend toward more patients with 100% complete documentation (83% vs 38%; p=0.07). Conclusion: Utilization of an electronic monitoring tool for post procedural documentation adherence can improve the percentage of patients who have 100% completed assessments and help meet the TJC standard.

Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association.

The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Long-term follow-up of patients with tetralogy of Fallot and implantable cardioverter defibrillator

Ventricular arrhythmias and sudden death are potential late complications in patients with tetralogy of Fallot. Data regarding the value of implantable cardioverter defibrillators (ICD) are scarce in this population. To assess long-term rates of appropriate ICD therapies and ICD-related complications in a large registry. The DAI-T4F study is an ongoing national French registry including all patients with tetralogy of Fallot and ICD ( NCT03837574 ). Information has been collected prospectively since 2010 with annual update. Cox proportional hazard models were used to identify factors associated with appropriate ICD therapies and complications. A total of 134 patients (median age 41.7 years, 70.7% males) were enrolled, including 47 (35.1%) for primary prevention. The median (IQR) follow-up duration was 6.1 (2.7–10.2) years. Overall, 14 (29.8%) and 45 (51.7%) patients received at least one appropriate ICD therapy in primary and secondary prevention, respectively, giving annual incidences of 5.5% and 7.1% ( P = 0.06). Patients with altered left ventricle ejection fraction (LVEF) at inclusion ≤ 35% experienced less appropriate ICD therapies (HR = 0.31, 95% CI: 0.11-0.86, P = 0.02), whereas a history of sustained or non-sustained ventricular arrhythmia (HR = 2.7, 95% CI: 1.2–3.9, P = 0.03) was positively associated with appropriate therapies. Fifty-seven (42.5%) patients had ICD-related complications, including 32 (24.2%) inappropriate ICD shocks. During follow-up, 7 (5.2%) patients underwent cardiac transplantation and 12 (9.0%) patients died, mainly from progressive heart failure ( n = 5). Only one sudden death due to electrical storm was recorded ( Fig. 1 ). Appropriate therapies are frequent in patients with tetralogy of Fallot and ICDs, including in primary prevention. The relatively important proportion of ICD-related complication highlights the need for improving risk stratification in this population.