A Review of Transcatheter Ablation for the Treatment of AVNRT in Children

Background: Atrioventricular nodal reentrant tachycardia (AVNRT) is an arrhythmia due to re-entrant rhythm within the region of the atrioventricular (AV) node, which accounts for most supraventricular tachycardia (SVT) cases in children. There are two main pathways involved for the re-entrant rhythm, slow and fast pathways, with different anatomic locations and involvement in the circuit associated with AVNRT. AVNRT is rare in newborns, but an increase of prevalence throughout childhood was previously reported.Study Objective/Purpose: Currently, Radiofrequency (RF) ablation is the primary method for the treatment of AVNRT in pediatrics. However, multiple modalities with varying efficacies can also be utilized. In this study, we attempt to review indications and complications of the gold-standard use of RF compared to newer modalities for the ablation treatment of AVNRT in the pediatric population. Results/Discussion: Currently there are two transcatheter ablations methods widely applied as AVNRT treatment: RF ablation and Cryoablation (Cryo). Indications for these methods vary with blood flow in the target area, duration of procedure, and risk of recurrence of AVNRT. Both methods have success rates \u3e90% in AVNRT children, with a 3% complication rate. AV block is the most common complication of RF ablation cases, while Cryo, being a newer technology, requires further investigation. Factors that complicate ablation in AVNRT include anatomical and electrophysiological variations between individuals. Fluoroscopic visualization and 3D-voltage mapping of pathways can provide markers for catheter ablation in AVNRT cases to expedite ablation success and enhance safety. Other predictors of success include: reduced fluoroscopy time, lower patient weight, the ability to induce junctional rhythm in the patient during the procedure, and the utilization of image-based guidance and ice-mapping during the ablation. Conclusion: Radiofrequency catheter ablation remains the highly successful gold standard for the treatment of AVNRT in children, with low complication rates. Cryoablation and other advanced techniques are emerging as new methods tailored to the accessory pathways and more sophisticated structural variations underlying AVNRT in children

Assessing the Utility of the Healthwise Program in Substance Abuse and Mental Health Service Programs

Introduction Increasing recognition is being given to comorbidities in individuals with severe mental illness. A report from Kalamazoo Community Mental Health and Substance Abuse Services (KCMHSA) has shown that, compared to the general population, there is a higher prevalence of comorbidities among those with mental illness in Kalamazoo county, Michigan. In addition, this population is less likely to visit a primary care provider and receive preventative care. To improve provision of health information to clients and enhance appropriate use of health care, KCMHSA has recently considered the use of Healthwise, a health information database. Purpose of Study The purpose of the study is to assess the utility of the Healthwise program in providing medical information to participants in substance abuse and mental health service programs. Methodology This is an observational study conducted at the Kalamazoo Community Mental Health and Substance Abuse Services. Five medical students assigned to this service center examined the utility of the Healthwise application among clients with mental illness who were receiving care at the center. Students’ reflections during this period were compiled. The reflections include time spent with patient; utility of app in addressing patient level of engagement, accessibility, patient satisfaction and barriers to implementation of the application. A thematic analysis was conducted. Results Findings from the thematic analysis show that clients were generally satisfied with the process of using Healthwise to provide health information. The estimated time, based on observation, for using the application ranged from 30 minutes to one hour. Also, the reflections showed that clients were highly engaged during the process as rated by the interviewers and the application was easy to use. Some of the observed barriers that may impact implementation were population vulnerability, support for client access to app, inconsistent and small client population, and limited medical knowledge. No overt effects of gender and race were observed. Discussion Findings from this study suggest that the Healthwise application is a useful tool for providing relevant medical information among populations with mental illness. Study participants were satisfied with the process of using this application. However, some limitations identified with the process include unstable client population, nonsupport for client access to application, limited medical knowledge and number of encounters

Incidence of Retained Biopsy Specimens After Esophagogastroduodenoscopy and Colonoscopy

Background and Aims: In GI endoscopy, biopsies must transit through the accessory channel and cap presenting an opportunity for loss of tissue. We sought to determine the incidence of specimen retention in the accessory channel or cap and identify procedure characteristics associated with specimen retention. Methods: After completion of standard endoscopic procedures in which biopsies were obtained, the biopsy cap and accessory channel were inspected, brushed and irrigated for any retained biopsy specimens according to a standard protocol. For controls the same protocol was applied to procedures in which biopsies were not obtained. Specimen bottles from the recovery protocol were sent for pathological examination regardless if any visible tissue was present. Results: 216 outpatient procedures were included: 55 EGDs and 50 colonoscopies in which biopsies were obtained and 56 EGDs and 55 colonoscopies in the control group. Retained specimens were found in either the cap or channel in 50/105 (48%). In 20/105 (19%) retained specimens were found just in the cap, in 6/105 (5.7%) retained specimens were found just in the channel, while in 24/105 (23%) retained specimens were found in both the cap and channel. Retained specimens were more likely to be found in EGDs compared to colonoscopies (58% vs. 36%, p=0.031). No retained specimens were found in the control group. Conclusion: Retained specimens are startingly common in standard GI endoscopic procedures and could potentially change diagnoses and management. Quality improvement measures should be instituted to monitor prevalence of retained biopsies and methods to prevent them should be developed