Effect of amiodarone on the number of ICD-therapies

Hauptergebnis der vorliegenden Arbeit, ist der vorhandene Effekt von prophylaktisch verordnetem Amiodaron. Im Vergleich zu der erst kürzlich veröffentlichten SHIELD-Studie, die die gleiche Dauer der Nachverfolgung hatte, erhielten unsere Patienten weniger Schocks (ungefähr 0,8 zu 4 Schocks pro Patientenjahr). Dieser Unterschied kann aufgrund der Einschlußkriterien zustande kommen. In unserer Patientenpopulation wurden Patienten sowohl mit primär-, als auch mit sekundärprophylaktischer Indikation eingeschlossen. Im Vergleich dazu war mindestens ein stattgehabter ICD-Schock ein Einschlusskriterium der SHIELD-Studie. In dieser Hoch-Risiko-Gruppe hat Azimilide deutlich eine signifikante Reduktion der Anzahl der ICD-Schocks gezeigt. Der Anteil der Patienten, die einen Schock erhielten, konnte nur von 48% auf 45% gesenkt werden. Im Gegensatz, erhielten nur 16% unserer Patienten einen Schock während einer mittleren Nachverfolgung von über 2 Jahren. Trotz des insgesamt sehr geringen Arrhythmie-Risikos, konnte ein signifikanter Effekt von Amiodaron in unserer Studie nachgewiesen werden. Eine weitere mögliche Ursache für die relativ niedrige Inzidenz von ICD-Therapien kann durch die optimale pharmakologische Herzinsuffizienztherapie als auch durch zusätzliche Koronarangiographien zur Verbesserung der Revaskularisation, um das Risiko von Arrhythmien zu reduzieren, erklärt werden. Das Auftreten eines elektrischen Sturmes konnte in unserer Studie durch die prophylaktische Gabe von Amiodaron reduziert werden. Allerdings bei wenigen Ereignissen ohne Signifikanz. Dies müsste in weiteren Studien mit größerer Patientenzahl weitergehend untersucht werden. Obwohl Amiodaron also eine gute antiarrhythmische Wirkung hat und das Auftreten von malignen Herzrhythmusstörungen reduziert, wurde auch in der vorliegenden Studie die vorhandene Mortalität nicht beeinflusst. Die in dieser Studie nachgewiesenen antiarrhythmischen Effekte von Amiodaron würden eine generelle Prophylaxe zur Reduzierung der Schockhäufigkeit rechtfertigen. Jedoch erfordern die bekannten Nebenwirkungen der Amiodaronbehandlung ein häufiges Absetzen des Medikaments. Es beendeten 12% unserer Patienten die Therapie mit Amiodaron. Allerdings kam es zu keiner gefährlichen Nebenwirkung, wie einer Thyreotoxikose, Lungenfibrose o.ä.. Wie in der nicht-randomisierten Vergleichsgruppe gezeigt, konnten einige Patienten zu Studienbeginn keiner Therapie mit Amiodaron unterzogen werden. Eine Beobachtung der Nebenwirkungen von Amiodaron würde den behandelnden Arzt zusätzliche Maßnahmen kosten und eine intensivere Nachbetreuung erfordern. Insgesamt zeigt sich ein gut sichtbarer Effekt von prophylaktischem Amiodaron in dieser Patientenpopulation. Allerdings ist wie bisher zu diskutieren, ob die Einnahme von Amiodaron erst nach dem ersten Schock oder sogar nach multiplen Schocks indiziert ist, da die Patienten insgesamt weniger Schocks erhalten als in einer sekundärprophlyaktischen Population.The main result of this work is the prophylactic effect of amiodarone. Compared to the recently published SHIELD Study, which had the same duration of follow-up, our patients received fewer shocks (about 0.8 to 4 shocks per patient-year). This difference may be due to the inclusion criteria. In our patient population we included patients with primary and secondary prophylactic indication. By comparison, at least one ICD shock was needed to be included in the SHIELD study. In this high-risk group Azimilide clearly showed a significant reduction in the number of ICD shocks. The proportion of patients who received a shock could be reduced only from 48% to 45%. In contrast, only 16% of our patients received a shock during a mean follow up of over 2 years. Despite the generally very low risk of arrhythmia, a significant effect of amiodarone could be detected in our study. The occurrence of an electrical storm could be reduced by prophylactic administration of amiodarone. Even though only in a few events without significance. This would need further investigation in more studies with larger patient numbers. Although amiodarone has a good antiarrhythmic effect and reduces the incidence of malignant arrhythmias, it showed no effect in mortality. The antiarrhythmic effects of amiodarone seen in this study would justify a general therapy to reduce the shock frequency. However, do the known side effects often lead to a discontinuation of the therapy. 12% of our patients stopped taking amiodarone. However, there was no dangerous side effects, such as a thyrotoxicosis, pulmonary fibrosis, etc.. Overall, the study showed a good effect of prophylactic amiodarone in this patient population. However, it is still unclear whether patients should take amiodarone after the first shock or after multiple shocks

HUMAN RESOURCES PRACTICES AND CORPORATE EDUCATION WITHIN THE BIGGEST AND SMALLEST COMPANIES FROM THE RESEARCH"150 BEST COMPANIES TO WORK FOR IN BRASIL" (2007- 2010)

Over the recent years, organizations have considered the issue of investing in the management of people as an important one. Both corporate education and the strategic management of human resources have become fundamental aspects for organizations that understand the role of people in performance and innovation. With this in mind, this study intends to verify the differences the size of a company makes in corporate education and human resources practices. In order to look for evidence to justify what is in the academic literature, information was used from the following research: 150 Best Companies to Work For in Brasil , conducted for the period 2007-2010 by two leading publications, namely Exame and Você S/A . Results were found confirming the impact of company revenue in aspects such investment in corporate education and human resources, volume of training for management levels and the rest of the employees.Universidade Federal FluminenseCada vez mais, as organizações passaram a priorizar o investimento em gestão de pessoas. A educação corporativa e a gestão estratégica de recursos humanos se tornaram temas de relevância para as organizações que compreendem o papel das pessoas para o desempenho e a inovação. Este estudo tem como objetivo verificar as práticas em educação corporativa e recursos humanos a partir do porte da empresa. A fim de confrontar esta literatura, foram analisados os dados da pesquisa As 150 Melhores Empresas para Você Trabalhar no Brasil , realizada pela revista Você S/A e Exame no período de 2007 a 2010. Foram encontradas evidências de que o faturamento da empresa impacta em aspectos como o investimento em educação corporativa e recursos humanos, e no volume de treinamento oferecido aos níveis gerenciais e aos demais empregados

105 Inappropriate ICD Shocks in a Patient with Dilated Cardiomyopathy and Broca’s Aphasia

With a growing number of ICD recipients, device complications are seen more frequently in the clinical setting and outpatient departments. Among the most severe are ICD infections and inappropriate therapies caused by oversensing of atrial tachycardias or lead fracture. We report on a 76-year-old female patient with dilative cardiomyopathy and Broca’s aphasia after stroke, who experienced 105 consecutive inappropriate ICD shocks due to cluster missensing of her fractured ICD lead. The diagnosis was complicated and delayed by patient’s aphasia emphasizing the need for intensified remote monitoring along with regular in-person visits, especially in people with intellectual or communication disabilities

Longitudinal Studies of Plasmodium falciparum Malaria in Pregnant Women Living in a Rural Cameroonian Village with High Perennial Transmission

A prospective longitudinal study of Plasmodium falciparum in pregnant women was conducted in the rural village of Ngali II, where malaria is hyperendemic and individuals receive ~0.7 infectious mosquito bites/person/day throughout the year. Pregnant women (N = 60; 19 primigravidae, 41 multigravidae) were enrolled early in pregnancy (median 14 wk) and were followed monthly, with 38 women followed through term (5.7 ± 1.1 prenatal visits and delivery). The total number of times primigravidae were slide-positive during pregnancy was higher than multigravidae (3.3 ± 1.1 versus 1.3 ± 1.3 times; P < 0.001), but no difference in the number of polymerase chain reaction-positive cases (4.6 ± 1.7 and 3.4 ± 1.7 times, P = 0.106) or total genotypes they harbored (8.9 ± 3.2 and 7.0 ± 2.9) was found. Only 7.9% women developed symptomatic infections. All primigravidae and 38% multigravidae were placental malaria-positive at delivery (P = 0.009). Genotyping showed that 77% of placental parasites were acquired ≥ 30 wks in pregnancy. These results help identify the extent of malaria-associated changes women experience during pregnancy

Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study

Purpose: The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear. Methods: We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (&gt; 2-h duration and postoperative intensive care unit (ICU) or high dependency unit admission). The primary endpoint was the occurrence of PO-AKI within 72&nbsp;h of surgery defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included PO-AKI severity and duration, use of renal replacement therapy (RRT), mortality, and ICU and hospital length of stay. Results: We studied 10,568 patients and 1945 (18.4%) developed PO-AKI (1236 (63.5%) KDIGO stage 1500 (25.7%) KDIGO stage 2209 (10.7%) KDIGO stage 3). In 33.8% PO-AKI was persistent, and 170/1945 (8.7%) of patients with PO-AKI received RRT in the ICU. Patients with PO-AKI had greater ICU (6.3% vs. 0.7%) and hospital (8.6% vs. 1.4%) mortality, and longer ICU (median 2 (Q1-Q3, 1-3) days vs. 3 (Q1-Q3, 1-6) days) and hospital length of stay (median 14 (Q1-Q3, 9-24) days vs. 10 (Q1-Q3, 7-17) days). Risk factors for PO-AKI included older age, comorbidities (hypertension, diabetes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and aminoglycosides administration. Conclusion: In a comprehensive multinational study, approximately one in five patients develop PO-AKI after major surgery. Increasing severity of PO-AKI is associated with a progressive increase in adverse outcomes. Our findings indicate that PO-AKI represents a significant burden for health care worldwide