Screening and Follow Up for Postpartum Depression: How to Improve Practice

Postpartum depression (PPD) is one of the most common mental health conditions, affecting one in seven women during their reproductive years (American College of Obstetricians and Gynecologists [ACOG], 2018). The purpose of this evidence-based practice (EBP) project was to improve screening and management of PPD using the Edinburgh Postnatal Depression Scale (EPDS) screening tool and a protocol for appropriate treatment and follow up care for PPD. A protocol was created by the project leader with information on screening and diagnosis, follow up, and treatment for PPD. The protocol also included information on how to assess for suicidal and/or homicidal ideation in women with PPD. Women who were seen for a 2- or 6-week postpartum visit (n = 18) were recruited at a women’s health clinic in Northwest Indiana to participate in the project. Data collection was done on a pre-intervention group to determine if the EPDS was used prior to implementation of the project. The post-intervention group (n = 18) received screening with the EPDS at their postpartum visit. The number of participants screened with the EPDS comprised the primary outcome and was measured as a frequency. The secondary outcome of detection rates of PPD was measured by EPDS scores of 10 or greater. Data were analyzed using a Mann-Whitney test, chi-square test, and a simple linear regression to determine if demographic variables had an impact on EPDS scores as another secondary outcome. The primary outcome was met with a 50.3% increase in screening rates using the EPDS. The secondary outcome was also met with a 100% increase in detection rates of postpartum depression from using the EPDS. The data analysis concluded that the variable of age was statistically significant and had an impact on EPDS scores. Findings from this project may be used in practice to ensure appropriate screening and management for PPD is being implemented

Electrocardiography and cardiac magnetic resonance imaging in the detection of left ventricular hypertrophy : the impact of indexing methods

Background: Discrepancies between increased left ventricular mass (LVM) and electrocardiographic (ECG) criteria for the diagnosis of left ventricular hypertrophy (LVH) are described in the literature. Aims: This study aimed to evaluate the usefulness of ECG criteria in the diagnosis of LVH, as determined by cardiac magnetic resonance (CMR) imaging, using various LVM indexing methods. Methods: We included 53 patients who underwent CMR imaging and had electrocardiograms of appropriate quality available in their medical records. The majority of the study patients had cardiovascular diseases. We defined CMR‑LVH as increased LVM, also assessed after LVM indexing to body surface area (LVM/BSA), height1.7, height2.7, or as the percentage of predicted LVM (%pLVM). To determine ECG‑LVH, 10 different ECG-LVH criteria were used. Results: The prevalence of CMR‑LVH ranged from 11% (for %pLVM) to 72% (for LVM/BSA). At the same time, for a single criterion, the prevalence of ECG‑LVH ranged between 1.9% (for R wave amplitude in lead V5 / V6 greater than 2.6 mV, Sokolow–Lyon product, and Gubner–Ungerleider criterion) and 45.3% (for Peguero–Lo Presti criterion), showing high sensitivity, from 55.3% (95% CI, 38.3–71.4) to 100% (95% CI, 54.1–100). The sensitivity of ECG‑LVH criteria when all criteria were applied together ranged from 57.9% (95% CI, 40.8–73.7) to 100% (95% CI, 63.1–100). The best performance regarding the endpoint of CMR‑LVH diagnosis after LVM indexing was achieved by the Peguero–Lo Presti and Cornell criteria (area under the curve, 0.621–0.876; P, 0.001–0.17). Conclusions: Thediagnosis of LVH strongly depends on ECG- and CMR‑based definitions. ThePeguero–Lo Presti criterion and the Cornell criteria, which are sex‑specific, may provide the highest level of diagnostic accuracy and should be considered when screening patients with cardiovascular diseases for LVH

Ischemic and non-ischemic patterns of late gadolinium enhancement in heart failure with reduced ejection fraction

Background: Late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) may revealmyocardial fibrosis which is associated with adverse clinical outcomes in patients undergoing implantablecardioverter-defibrillator (ICD) placement. At the same time, transmural LGE in the posterolateral wall isrelated to nonresponse to conventional cardiac resynchronization therapy (CRT). Herein, the aim was toassess the presence and determinants of LGE in CMR in heart failure (HF) with reduced ejection fraction.Methods: Sixty-seven patients were included (17.9% female, aged 45 [29–60] years), who underwentLGE-CMR and had left ventricular ejection fraction (LVEF) as determined by echocardiography.Results: In HF patients with LVEF ≤ 35% (n = 29), ischemic and non-ischemic patterns of LGE wereobserved in 51.7% and 34.5% of patients, respectively. In controls (n = 38), these patterns were noted in23.7% and 42.1% of patients, respectively. HF patients with LVEF ≤ 35% and transmural LGE in theposterolateral wall (31.0%) were characterized by older age, coronary artery disease (CAD) and previousmyocardial infarction (MI) (61 ± 6 vs. 49 ± 16 years, p = 0.008, 100% vs. 40%, p = 0.003 and 78%vs. 25%, p = 0.014, respectively). In patients with LVEF ≤ 35%, LGE of any type, diagnosed in 86.2%of patients, was associated with CAD (68% vs. 0%, p = 0.02), while only trends were observed for itsassociation with older age and previous MI (p = 0.08 and p = 0.12, respectively).Conclusions: Among HF patients with LVEF ≤ 35%, clinical factors including older age, CAD, andprevious MI are associated with transmural LGE in the posterolateral wall, while CAD is associated with LGE. This data may have potential implications for planning ICD and CRT placement procedures

3D TV: A Scalable System for Real-Time Acquisition, Transmission, and Autostereoscopic Display of Dynamic Scenes

Three-dimensional TV is expected to be the next revolution in the history of television. We implemented a 3D TV prototype system with real-time acquisition, transmission, and 3D display of dynamic scenes. We developed a distributed, scalable architecture to manage the high computation and bandwidth demands. Our system consists of an array of cameras, clusters of network-connected PCs, and a multi-projector 3D display. Multiple video streams are individually encoded and sent over a broadband network to the display. The 3D display shows high-resolution (1024 × 768) stereoscopic color images for multiple viewpoints without special glasses. We implemented systems with rear-projection and front-projection lenticular screens. In this paper, we provide a detailed overview of our 3D TV system, including an examination of design choices and tradeoffs. We present the calibration and image alignment procedures that are necessary to achieve good image quality. We present qualitative results and some early user feedback. We believe this is the first real-time end-to-end 3D TV system with enough views and resolution to provide a truly immersive 3D experience.Engineering and Applied Science