No description available.

No description available.

The management and prevention of Sudden Cardiac Death remains a great challenge in modern Cardiology. Implantable Cardioverter Defibrillators (ICDs) have been shown to reduce mortality. Despite decades of research, the mechanisms are not fully understood and ICD treatment is crude, palliative and expensive. Nonetheless, outcome studies have helped to inform national and international guidance in the implantation of these devices. Patient selection is crucial to ensure correct patients are identified and appropriately treated. More refined and stringent risk stratification is needed to identify patients at high risk. This thesis examines non-invasive, readily measureable markers to see whether they can be used to assess the risk of ventricular arrhythmia in patients with cardiomyopathy who have indications for ICD implantation. Baseline data in the form of 12 lead electrocardiograms, echocardiography, 24 hour Holter monitoring and venous blood were obtained to analyse QT dispersion, Heart Rate Variability (HRV), QT Variability Index (QTVI), ECG restitution measures and NTproBNP levels in these patients. Patients were followed up for a two year period through the ICD clinic and appropriate therapy was recorded as a surrogate marker for ventricular arrhythmia. Patients with and without appropriate therapy were then compared to look for significant differences in the examined markers. The percentage of beats with a QT/TQ ratio>1 was associated with appropriate shocks when compared with no therapy (p=0.04). However, the result was not significant when all appropriate ICD therapy was compared with no therapy (p=0.06). This possibly reflects the period of time the heart spends on the more ‘unstable portion’ of the restitution slope in patients at highest risk. Median BNP was non-significantly higher in patients with arrhythmia compared to those who were shock free. None of the other examined markers were predictive of appropriate therapy. There is thus promise in the use of some non-invasive markers in the refinement of patient selection with LVSD being considered for ICD therapy.

The ICD is currently under revision and this study is the first phase of the electronic field trials for ICD-11 for psychotic disorders. The present study compared ICD-10 and ICD-11 with regards to changes made to the diagnostic guidelines and changes amongst specific disorders. Of specific interest was clinicians’ ability to accurately diagnose disorders that can present with overlapping features. We found that both diagnostic systems were accurate in differentiating disorders that have the potential to be easily confused. For some of the diagnostic guidelines that were undergoing substantial changes from ICD-10 to ICD-11, we did find improvements in the proposed guidelines. Subsequent studies will expand on our findings prior to the release of ICD-11. However, based on our initial findings, the proposed changes do appear to be increasing clinical utility of the diagnostic guidelines.

No description available.

Der implantierbare Kardioverter-Defibrillator gehört zu der Behandlung von herzinsuffizienten Patienten. In dieser Arbeit wird eine Risikostratifizierung anhand der vorliegenden Grunderkrankung analysiert. Untersucht wurden 330 konsekutive Patienten mit ischämischer oder nicht-ischämischer dilatativer Kardiomyopathie, die zwischen 2009 und 2011 einen ICD erhalten haben. Im Rahmen des Follow-up von 19 ± 9 Monaten erlitten 29 % der Patienten adäquate ICD-Therapien. Als signifikante Risikofaktoren für adäquate Therapien waren die sekundärprophylaktische Implantation bei ICM-Patienten und die Präsenz von Vorhofflimmern bei DCM-Patienten zu beobachten. Die leitliniengerechte CRT-Implantation zeigte eine prophylaktische Wirkung bei ICM-Patienten.

No description available.

The study aimed to explore how patients with ICDs experience their quality of life with a focus on everyday life, electric shocks, and how support from the health service is perceived. The studydesign is descriptive with a qualitative approach. Semi-structured interviews were conducted with seven patients. Data collection lasted for three weeks and interviews were conducted in the participant´s homes, at the participants’ workplaces or over the phone. The study shows that most participants have learned to live with the ICD. Most participants felt that they had not made any major changes in their everyday life’s and a majority of the participants felt confidence and security regarding their ICD. Electric shocks gave feelings of stress, uncomfortability and safety. During increased physical exertion patients could be concerned about the possibility of getting an electric shock.. The support of the health care was perceived satisfactory and information about the ICD was considered good for several patients. Some participants felt that they had not received sufficient information. Conclusion: Most participants live fulfilling lives and have a positive attitude towards their ICD. Reported stress and anxiety related to the underlying heart disease more than the ICD. The ICD therapy was considered to provide security, although there were concerns about unexpected electric shocks from some of the participants. The support from the healthcare was mostly good. There is a lack of information about the treatment and psychosocial follow-up. Nurses should be sensitive and provide counseling to this group of patients.

Bakgrund: Behandling med implanterbar cardioverter defibrillator (ICD) kan ges iprimärt- eller sekundärt syfte. ICD: n har till uppgift att upptäcka och behandlaallvarliga rytmrubbningar och vid behov avge en stöt/stötar. Patienter som lever med enICD kan få svårt att acceptera sina nya liv samt att deras livssituation kan påverkas.Sjuksköterskan har en viktig roll att individanpassa omvårdnaden för dessa patienter.Syfte: Syftet var att beskriva patienters livskvalité och erfarenheter av att leva medimplanterbar cardioverter defibrillator (ICD). Syftet var också att beskriva urval ochundersökningsgrupp i de inkluderade artiklarna.Metod: En deskriptiv litteraturstudie där 11 vetenskapliga artiklar inkluderades varavsex kvalitativa, fyra kvantitativa och en artikel hade mixad metod. Artiklarna har sökts idatabasen Pubmed med begränsning på 6 år.Resultat: Patienter som lever med en ICD beskriver en oro och rädsla för att ICD: n skaavge stötar. Erfarenhet som patienter betonar är att diskussion om avaktivering av ICD ilivets slutskede ansågs vara bristfällig eller helt utesluten. Då livskvalitén påverkas ochpatienterna beskrev sig bli begränsade i vardagen så kan coping vara ett verktyg för attfinna lösningar. Tio av resultatartiklarna angav tydligt urvalsmetoden. Samtligaredogjorde för antalet deltagare och hur många som var män respektive kvinnor.Medelåldern på deltagarna redovisades tydligt i alla artiklarna.Slutsats: Livskvalitén har visats påverkad hos patienter med en ICD, även oro ochrädslor för stötar. Sjuksköterskan bör ha ett holistiskt synsätt för att se hela patientenoch dennes behov.

An electronic medical record (EMR) is “an electronic record of health-related information on an individual.” EMRs are widely used in healthcare organizations and have many advantages over traditional paper-based medical records, such as their efficiency and reduced storage needs. However, the use of EMRs has not yet reached its full potential. The numerous items of medical data are always shown with redundant and complex text contained in various monotonous forms and tables. It is hard for users to obtain useful information in a short timeframe. We propose a prototype system to intuitively and interactively visualize patients’ medical records. Navigation is improved through graphics-based and interaction-based visualization. Our interface features clickable two-dimensional (2D) images of a human body, on which the symptom locations are the starting point of the navigation. In addition, interactive and classified history visualization is also provided. Finally, some pertinent suggestions and comments from medical professionals are discussed.