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Abstract
Purpose: To assess pharmacists' mental well-being, perceptions of safety, and willingness to administer vaccines before and during the COVID-19 pandemic. Methods: An electronic survey was administered to a convenient sample of practicing pharmacists working in Alabama, Tennessee and Texas. The 33-item survey examined pharmacists' beliefs about the pandemic's impact on their mental well-being, their perceptions of safety in vaccine administration, and their willingness to vaccinate. Responses were assessed on a 5-point Likert scale, ranging from strongly disagree (1) to strongly agree (5). A recruitment email with the survey link was sent to pharmacists, with periodic reminders over a 4-week period. Descriptive statistics and bivariate analyses were utilized to evaluate survey responses. Results: A total of 387 responses were analyzed, with an estimated response rate of 3.93%. Most respondents were women (65%) and had at least 6 to 10 years of practice experience (28%). Overall, participants felt that the pandemic worsened their mental well-being, with women reporting a more negative mental well-being compared with men (P < .001). They reported having less time during workflow to apply personal protective equipment (PPE) (P = .0074) compared to before the pandemic. They also reported a decrease in willingness to vaccinate adult patients during the pandemic (P < .0001), and that concern about contracting COVID-19 prevented them from giving vaccinations (P < .0001). Conclusions: Pharmacists felt their mental well-being and willingness to vaccinate patients suffered as a result of the COVID-19 pandemic. Future research and initiatives that focus on improving vaccination rates should also consider pharmacists' concerns and well-being.
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Affiliation(s)
| | - Chinelo C. Orji
- Health Outcomes Division, College
of Pharmacy, The University of Texas at
Austin, Austin, TX, USA
| | | | | | | | - Carolyn M. Brown
- Health Outcomes Division, College
of Pharmacy, The University of Texas at
Austin, Austin, TX, USA
| | - Nathan Pope
- Health Outcomes Division, College
of Pharmacy, The University of Texas at
Austin, Austin, TX, USA
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Gould J. How a young physicist's job move helped Argentina join the ATLAS collaboration. Nature 2024:10.1038/d41586-024-01050-3. [PMID: 38622297 DOI: 10.1038/d41586-024-01050-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
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3
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Gould J. How to plug the female mentoring gap in Latin American science. Nature 2024:10.1038/d41586-024-01024-5. [PMID: 38589656 DOI: 10.1038/d41586-024-01024-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
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4
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Gould J. 'Maybe I was never meant to be in science': how imposter syndrome seizes scientist mothers. Nature 2024:10.1038/d41586-024-00953-5. [PMID: 38565905 DOI: 10.1038/d41586-024-00953-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
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Gould J. 'Hopeless, burnt out, sad': how political change is impacting female researchers in Latin America. Nature 2024:10.1038/d41586-024-00885-0. [PMID: 38528156 DOI: 10.1038/d41586-024-00885-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
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Gould J. Connecting girls in Brazil to inspiring female scientists. Nature 2024:10.1038/d41586-024-00804-3. [PMID: 38499802 DOI: 10.1038/d41586-024-00804-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
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Gould J. 'There is no cookie cutter female scientist'. Nature 2024:10.1038/d41586-024-00703-7. [PMID: 38459341 DOI: 10.1038/d41586-024-00703-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
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Gould J. How to create compelling scientific data visualisations. Nature 2023:10.1038/d41586-023-03393-9. [PMID: 38040900 DOI: 10.1038/d41586-023-03393-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
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Gould J. Sanitary products made from plants could help tackle period poverty. Nature 2023:10.1038/d41586-023-03802-z. [PMID: 38036677 DOI: 10.1038/d41586-023-03802-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
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Gould J. How ChatGPT and sounds from space brought a 'luminous jelly' to life. Nature 2023:10.1038/d41586-023-03392-w. [PMID: 38001275 DOI: 10.1038/d41586-023-03392-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
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Gould J. Scientific illustration: striking the balance between creativity and accuracy. Nature 2023:10.1038/d41586-023-03391-x. [PMID: 37978277 DOI: 10.1038/d41586-023-03391-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
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Gould J. The unexpected outcomes of artist-scientist collaborations. Nature 2023:10.1038/d41586-023-03390-y. [PMID: 37949986 DOI: 10.1038/d41586-023-03390-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
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Gould J. Art and science: close cousins or polar opposites? Nature 2023:10.1038/d41586-023-03389-5. [PMID: 37923952 DOI: 10.1038/d41586-023-03389-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
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Gould J, Leeming J. A funder's guide to tackling setbacks and winning grants. Nature 2023:10.1038/d41586-023-02754-8. [PMID: 37653098 DOI: 10.1038/d41586-023-02754-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Gould J. Showing the love as a science leader: the emotional side of empowering and inspiring others. Nature 2023:10.1038/d41586-023-00417-2. [PMID: 36765252 DOI: 10.1038/d41586-023-00417-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Gould J. Leadership in science: "There is nothing wrong with being wrong". Nature 2023:10.1038/d41586-023-00348-y. [PMID: 36739342 DOI: 10.1038/d41586-023-00348-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Gould J. Why empathy is a key quality in science leadership. Nature 2023:10.1038/d41586-023-00256-1. [PMID: 36707710 DOI: 10.1038/d41586-023-00256-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Gould J. Mastering the art of saying no should be part of a research leader's toolkit. Nature 2023:10.1038/d41586-023-00130-0. [PMID: 36670259 DOI: 10.1038/d41586-023-00130-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Gould J. Leadership in science: how female researchers are breaking up the boys' club. Nature 2023:10.1038/d41586-023-00061-w. [PMID: 36639448 DOI: 10.1038/d41586-023-00061-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Gould J. More support needed to survive the mid-career stage in science. Nature 2022:10.1038/d41586-022-03443-8. [PMID: 36289420 DOI: 10.1038/d41586-022-03443-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Gould J. Mid-career scientists: advice to our younger selves. Nature 2022:10.1038/d41586-022-03340-0. [PMID: 36266582 DOI: 10.1038/d41586-022-03340-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Gould J. Why the mid-career stage in science can feel like a second puberty. Nature 2022:10.1038/d41586-022-03237-y. [PMID: 36224366 DOI: 10.1038/d41586-022-03237-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Gould J. Burnout and breakdowns: how mid-career scientists can protect themselves. Nature 2022:10.1038/d41586-022-03164-y. [PMID: 36198817 DOI: 10.1038/d41586-022-03164-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Gould J. When life gets in the way of scientists' mid-career plans. Nature 2022:10.1038/d41586-022-03049-0. [PMID: 36171304 DOI: 10.1038/d41586-022-03049-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Gould J. Muddle of the middle: why mid-career scientists feel neglected. Nature 2022:10.1038/d41586-022-02780-y. [PMID: 36131057 DOI: 10.1038/d41586-022-02780-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Gould J. Podcast: The Higgs Boson, Ten Years After. Physics 2022. [DOI: 10.1103/physics.15.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Gould J. Podcast: Life as an LGBTQ+ Physicist. Physics 2022. [DOI: 10.1103/physics.15.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Gould J. The Dutch city where industry-academia collaborations flourish. Nature 2022:10.1038/d41586-022-00617-2. [PMID: 35236947 DOI: 10.1038/d41586-022-00617-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Gould J. Beyond academia: how to select your first scientific role in industry. Nature 2022:10.1038/d41586-022-00329-7. [PMID: 35173318 DOI: 10.1038/d41586-022-00329-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Gould J. Beyond academia: debunking the industry-academia barrier myth. Nature 2022:10.1038/d41586-022-00291-4. [PMID: 35140369 DOI: 10.1038/d41586-022-00291-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Gould J. Beyond academia: Planning the perfect exit strategy for a scientific career move. Nature 2022:10.1038/d41586-022-00198-0. [PMID: 35110704 DOI: 10.1038/d41586-022-00198-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Gould J. How to keep the scientific-mentoring magic alive. Nature 2021:10.1038/d41586-021-02798-8. [PMID: 34650241 DOI: 10.1038/d41586-021-02798-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Gould J. The many mentoring types explained. Nature 2021:10.1038/d41586-021-02730-0. [PMID: 34616093 DOI: 10.1038/d41586-021-02730-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Gould J. Mentoring, coaching, supervising: what's the difference? Nature 2021:10.1038/d41586-021-02656-7. [PMID: 34588650 DOI: 10.1038/d41586-021-02656-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Gould J. The mentoring messages that can get lost in translation. Nature 2021:10.1038/d41586-021-02471-0. [PMID: 34526687 DOI: 10.1038/d41586-021-02471-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Gould J. Why science needs strong mentors. Nature 2021:10.1038/d41586-021-02440-7. [PMID: 34497409 DOI: 10.1038/d41586-021-02440-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Deerenberg C, Gould J, Andrews R. A call for better training in restless legs syndrome. Lancet Neurol 2021; 20:700-701. [PMID: 34418391 DOI: 10.1016/s1474-4422(21)00244-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/21/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Charlotte Deerenberg
- Groningen Institute for Evolutionary Life Sciences, University of Groningen, Netherlands.
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Elliott MK, Strocchi M, Sidhu BS, Mehta V, Porter B, Gould J, Niederer S, Rinaldi CA. Acute hemodynamic response of epicardial and endocardial cardiac resynchronization therapy, His bundle pacing and left bundle branch pacing. Europace 2021. [DOI: 10.1093/europace/euab116.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Medtronic
Background / Introduction
Endocardial pacing and conduction system pacing are emerging as alternative methods to deliver cardiac resynchronization therapy (CRT) and have been shown to achieve superior acute hemodynamic response (AHR) compared to conventional epicardial pacing. However, a direct comparison of all the methods of delivering CRT has not yet been performed.
Purpose
To directly compare the AHR of conventional CRT (BiV Epi), endocardial pacing (BiV Endo), His bundle pacing (HBP) and left bundle branch pacing (LBBP) during a temporary CRT study.
Methods
4 patients underwent a temporary CRT and hemodynamic study. Temporary pacing was achieved using quadripolar catheters in the right atrium and coronary sinus, and roving decapolar catheters in the right ventricle (RV) and left ventricle (LV) via retrograde aortic access. Hemodynamic assessment was performed with a PressureWire X (Abbott, CA, USA) in the LV cavity. AHR was calculated as the percentage improvement in LV dP/dtmax from baseline AAI or RV pacing (if underlying complete heart block).
Results
The patients had a mean age of 67.5 ±5.8 years and all had non-ischemic cardiomyopathy with severe LV impairment (mean ejection fraction 22.5 ±7.4%). 3 patients had left bundle branch block and 1 patient had complete heart block with an RV paced rhythm (mean QRS duration 157 ±24 ms). All methods of delivering CRT achieved a mean AHR of >10%, which is considered clinically significant and is predictive of LV remodelling at 6 months. Mean AHR during BiV Epi pacing was 12.6 ±5.0%. There was a trend towards higher AHR for BiV Endo pacing (23.6 ±7.6%), HBP (17.4 ± 9.5%) and LBBP (16.1 ±7.8%) as shown in figure 1, however there was no significant difference between groups on one-way analysis of variance (p = 0.348).
Conclusions
All methods of delivering CRT achieved an AHR >10%. The AHR during BiV Endo pacing, HBP and LBBP was higher than for BiV Epi pacing, but this did not reach statistical significance. Further investigation with larger studies is required to determine which method of delivering CRT achieves the best hemodynamic response.
Figure 1. Box plot of acute hemodynamic response (AHR) for conventional cardiac resynchronization therapy (BiV Epi), endocardial pacing (BiV Endo), His bundle pacing (HBP) and left bundle branch pacing (LBBP). Data displayed as median (solid line), mean (+), 1st and 3rd quartiles (box) and minimum and maximum values (whiskers). Abstract Figure 1
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Affiliation(s)
- MK Elliott
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - M Strocchi
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - BS Sidhu
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - V Mehta
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - B Porter
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - J Gould
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - S Niederer
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - CA Rinaldi
- King"s College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
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Mehta VS, Elliott MK, Sidhu BS, O"brien H, Gould J, Razavi R, Niederer S, Rinaldi CA. Assessing survival and re-hospitalisation following transvenous lead extraction in cardiac resynchronisation therapy devices depending on reimplantation timing: a propensity score matched analysis. Europace 2021. [DOI: 10.1093/europace/euab116.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Among patients undergoing transvenous lead extraction (TLE), differences in complication rate and 1-year mortality has been explored in patients with cardiac resynchronisation therapy (CRT) devices. Longer term outcomes and the influence of timing of reimplantation of device, with respect to rehospitalisation and longer-term mortality is poorly understood.
Purpose
The purpose of this study was to evaluate whether early reimplantation following TLE in patients with CRT devices influenced survival and rehospitalisation.
Methods
Clinical data from consecutive patients undergoing TLE in the reference centre between the years 2000 to 2019 were prospectively collected. Patients surviving to discharge who were re-implanted with the same device were included. The cohort was split depending on whether or not they had a CRT device at time of explant. The association between TLE in CRT patients and all-cause mortality and re-hospitalisation was assessed by Kaplan Meier estimates in a 1:1 propensity-score matched cohort, with a calliper of 0.10. Early reimplantation was defined as reimplantation within 7 days of TLE, and late reimplantation as reimplantation after greater than 7 days of TLE.
Results
Of 1005 patients included in the analysis, 285 (25%) had a CRT device. After matching, 192 CRT patients were compared with 192 non-CRT patients. Propensity scores were calculated using 39 baseline characteristics, including age, gender, co-morbidities, TLE indication, left ventricular ejection fraction, baseline creatinine and technical extraction data. Mean follow up was 53.5 ± 38.3 months, mean age at explant was 67.7 ± 12.1 years, 83.3% were male and 54.4% had an infective indication for TLE. In the matched cohort, there was no significant difference between the CRT and non-CRT group with respect to long-term mortality (hazard ratio [HR] = 1.01, 95% confidence interval [CI] [0.74-1.39], p = 0.093) or rehospitalisation (HR = 1.2 [0.87-1.66], p = 0.265). A similar proportion of patients were reimplanted within 7 days in the CRT and non-CRT groups (59.4% vs 61.5%, p = 0.754). In the matched non-CRT group, late reimplantation was associated with similar mortality to early reimplantation (HR = 1.33 [0.86-2.05], p = 0.208) and rehospitalisation (HR = 0.88 [0.53-1.45], p = 0.603). In the matched CRT group, late reimplantation was associated with higher mortality (HR = 1.64 [1.04-2.57], p = 0.032) and rehospitalisation (HR = 1.57 [1.00-2.46], p = 0.049] (see figure).
Conclusion
In this closely matched population, TLE in CRT patients resulted in similar long-term outcomes compared with non-CRT patients. Early reimplantation post CRT explant was associated with reduced long-term mortality and rehospitalisation. This suggests a longer duration without biventricular pacing post TLE may induce negative reverse-remodelling and should be avoided in a CRT population. Abstract Figure. Kaplan-Meier survival curves
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Affiliation(s)
- VS Mehta
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - MK Elliott
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - BS Sidhu
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - H O"brien
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - J Gould
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - R Razavi
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Niederer
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - CA Rinaldi
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
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Mehta VS, Elliott MK, Sidhu BS, Gould J, Vergani V, Kadiwar S, Niederer S, Razavi R, Rinaldi CA. Long-term survival following transvenous lead extraction: importance of indication and comorbidities. Europace 2021. [DOI: 10.1093/europace/euab116.489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background/Introduction:
The significant rise in cardiac implantable electronic devices (CIED) has been paralleled by an increase in the number of procedures required for the removal of such devices and their associated leads. High procedural success rates with low rates of major in hospital complications is well recognised. Longer term mortality following transvenous lead extraction (TLE) is less well characterised. Long term outcomes are important as they should inform the decision making and consent process, especially in non-infected cases where there may not be a class I indication for lead removal.
Purpose
The purpose of this study was to evaluate the factors influencing survival in patients undergoing TLE depending on extraction indication.
Methods
Clinical data from consecutive patients undergoing TLE in the reference centre between the years 2000 to 2019 were prospectively collected. Only patients surviving to discharge were included. The total cohort was divided into groups depending on whether there was an infective or non-infective indication for TLE. We evaluated the association of demographic, clinical, device related and procedure-related factors on mortality.
Results
A total of 1151 patients were included in the analysis. 632 (54.9%) and 519 patients (45.1%) were for infective and non-infective indications respectively. Analysis of long-term outcomes on the total cohort (mean 66-month follow-up) revealed a mortality of 34.1% (392 deaths). A higher proportion of patients died in the infection vs the non-infection group (38.6% vs 28.5%, p < 0.001). Local infection (hazard ratio [HR] = 1.4, 95% confidence interval [CI] [1.12-1.75]) was associated with similar long-term mortality risk as systemic infection (HR = 1.3, CI[0.99-1.72]). Multivariate analysis demonstrated increased risk of mortality with higher age (HR = 1.05, CI[1.04-1.07]), eGFR < 60ml/min/1.73m2 (HR = 1.55, CI[11.22-1.97]), higher cumulative co-morbidity burden (HR = 1.15, CI [1.06-1.23], and reduced risk per percentage increase in LVEF (HR = 0.98, CI[0.96-1.00]). Kaplan-Meier survival analysis demonstrated statistically worse prognosis in patients with a higher number of leads extracted and increasing co-morbidities.
Conclusion
Long-term mortality for patients undergoing TLE remains high. Consensus guidelines recommend evaluating risk for major complications when determining whether to proceed with TLE. This study suggests assessing longer-term outcomes when considering TLE, particularly for non-infective indications. Abstract Figure.
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Affiliation(s)
- VS Mehta
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - MK Elliott
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - BS Sidhu
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - J Gould
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - V Vergani
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Kadiwar
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Niederer
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - R Razavi
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - CA Rinaldi
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
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Gould J. The postdoc career journeys that date back to kindergarten. Nature 2020. [DOI: 10.1038/d41586-020-03111-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Gould J. Why life as a postdoc is like a circling plane at LaGuardia Airport. Nature 2020. [DOI: 10.1038/d41586-020-03106-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Mendonca Costa C, Neic A, Gillette K, Porter B, Gould J, Sidhu B, Chen Z, Elliott M, Mehta V, Plank G, Rinaldi CA, Bishop MJ, Niederer SA. P532Endocardial pacing is less arrhythmogenic than conventional epicardial pacing when pacing in proximity to scar in patients with ischemic heart failure. Europace 2020. [DOI: 10.1093/europace/euaa162.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
WT 203148/Z/16/Z; MR/N011007/1; RE/08/003; PG/15/91/31812; PG/16/81/32441
Background
Endocardial pacing has been shown to improve response to cardiac
resynchronization therapy (CRT) in comparison to conventional epicardial pacing and the
physiological activation, endocardium to epicardium, is proposed to make it less arrhythmogenic.
However, the relative arrhythmic risk of endocardial and epicardial pacing has not been
systematically investigated. Pacing in proximity to scar increases susceptibility to arrhythmogenesis
during epicardial pacing. Whether this is also the case during endocardial pacing is currently
unknown.
Purpose
We investigate 1) whether endocardial pacing is less arrhythmogenic than epicardial
pacing, 2) whether pacing location relative to scar plays a role in arrhythmogenesis during
endocardial pacing, and 3) whether these findings could be explained by the direction of the
transmural action potential duration (APD) gradient.
Methods
We used computational models of ischemic heart failure and patient-specific (n = 24) left ventricular anatomy and scar morphology to simulate repolarization during endocardial and
epicardial pacing. Pacing locations were selected 0.2-3.5cm from a scar. We ran simulations with a
20ms transmural APD gradient, as found in heart failure, from the epicardium to endocardium
(physiological) and with this gradient inverted. We computed the volume of high
(>3ms/mm) repolarization gradients (HRG) within 1cm around a scar, as a surrogate for arrhythmia
risk, and analysed these with ANOVA and Tukey-Kramer post-hoc tests.
Results
Simulations with a physiological APD gradient predict that endocardial pacing creates a
smaller (34%) volume of HRG around (1cm) a scar compared to epicardial pacing when
pacing 0.2cm from scar (Figure 1-A). The volume of HRG decreases (P < 0.05) with distance
from scar for epicardial pacing but not endocardial pacing (Figure 1-A). Inverting the
transmural APD gradient, inverts the trend observed with a physiological gradient. In this case, the
volume of HRG is unaffected by pacing location during epicardial pacing, whereas it decreases (19%)
with the distance from scar for endocardial pacing. This is illustrated
in the regions highlighted in yellow in Figure 1 for endocardial pacing at 0.2 and 3.5cm from a scar
with a physiological (B) and an inverted (C) gradient.
Conclusions
Endocardial pacing is less arrhythmogenic (purpose 1) than conventional epicardial
pacing when pacing in proximity to scar and is also less susceptible to pacing location relative to scar
(purpose 2). The direction of the transmural APD gradient offers a mechanistic explanation for
reduced susceptibility to arrhythmogenesis during endocardial pacing compared to epicardial pacing
(purpose 3). Endocardial pacing is an attractive alternative to conventional epicardial pacing in
patients with scar, as it allows pacing in proximity to scar while avoiding increasing arrhythmogenic
risk in patients with ischemic heart failure.
Abstract Figure.
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Affiliation(s)
- C Mendonca Costa
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - A Neic
- Medical University of Graz, Graz, Austria
| | - K Gillette
- Medical University of Graz, Graz, Austria
| | - B Porter
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - J Gould
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - B Sidhu
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - Z Chen
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - M Elliott
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - V Mehta
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - G Plank
- Medical University of Graz, Graz, Austria
| | - C A Rinaldi
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - M J Bishop
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - S A Niederer
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
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Jecmen D, King R, Gould J, Mitchell J, Ralston K, Burns AI, Bullock A, Grandner MA, Alkozei A, Killgore WD. 0038 The Effects of Morning Blue Light Therapy on Insomnia Severity and PTSD Symptoms in a Clinical Sample. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Individuals with Post Traumatic Stress Disorder (PTSD) often present with insomnia, which may exacerbate other symptoms of the disorder. Morning Blue Light Therapy (BLT) can regulate circadian rhythms and may even improve sleep and mood in individuals with major depressive disorder. However, it is unclear whether morning BLT could also be an effective treatment for the insomnia associated with PTSD. We investigated whether 6 weeks of daily morning BLT would improve insomnia severity and symptom presentation in individuals with PTSD in comparison to a placebo condition of amber light (ALT). We hypothesized that changes in insomnia severity would correlate with improvement in PSTD symptom severity.
Methods
Forty-one participants with a clinical diagnosis of PTSD were randomized to receive 6 weeks of either daily morning BLT (n=22) or ALT (n=19). Insomnia and PTSD symptom severity were evaluated at pre- and post-treatment using the Insomnia Severity Index (ISI) and the Clinician-Administered PTSD Scale (CAPS) for DSM-5, respectively.
Results
Both groups showed a significant decrease in their PTSD symptom severity (p<0.001) and insomnia severity (p<0.001) over the 6-week treatment period. However, improvement in insomnia severity significantly predicted improvements in PTSD symptom severity for the BLT group only (BLT: r =0.542, p=0.009; ALT: r=-0.095, p=0.699). The difference between the two correlation coefficients was significant (Z=-2.07, p=0.039).
Conclusion
The results suggest that morning BLT may be effective in improving PTSD symptoms by regulating the circadian rhythm and improving sleep. While ALT also led to improved PTSD symptom severity, it appears that those changes cannot be explained by improved sleep and may have other underlying mechanisms (e.g., placebo effect). Morning BLT may be a promising adjunctive method to bolster current treatment approaches for PTSD. Because of its ease of administration, it could be easily added to ongoing treatment as usual. This approach warrants further research.
Support
US Army Medical Research and Materiel Command: W81XWH-14-1-0570
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Affiliation(s)
- D Jecmen
- University of Arizona, Tucson, AZ
| | - R King
- University of Arizona, Tucson, AZ
| | - J Gould
- University of Arizona, Tucson, AZ
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King R, Jecmen D, Mitchell J, Ralston K, Gould J, Burns A, Bullock A, Grandner MA, Alkozei A, Killgore WD. 0081 Habitual Sleep Duration is Negatively Correlated with Emotional Reactivity within the Rostral Anterior Cingulate Cortex in Individuals with PTSD. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Sleep difficulties, such as insomnia, are highly prevalent in individuals with Post-Traumatic Stress Disorder (PTSD). However, sleep deprivation can also increase emotional reactivity to positive (as well as negative) stimuli. While the effects of sleep loss on emotional perception healthy individuals has been documented, it remains unclear how lack of sleep in individuals with PTSD may affect their emotional reactivity to positive stimuli. We hypothesized that lower habitual sleep duration would be associated with greater functional brain activation changes in response to subliminally presented happy faces in brain areas of the reward network, such as the rostral anterior cingulate cortex (rACC).
Methods
Thirty-nine individuals with DSM-5 confirmed PTSD were administered the Pittsburgh Sleep Quality Index (PSQI) as a measure of their average nightly sleep duration over the past month. Participants then underwent fMRI imagining while viewing subliminal presentations of faces displaying happiness, using a backward masked facial affect paradigm to minimize conscious awareness of the expressed emotion. Brain activation to masked happy expressions was regressed against sleep duration in SPM12.
Results
There was a negative correlation between habitual sleep duration and activation within the rACC in response to the masked happy faces (x=14,y=40,z=0; k=102, pFWE-corr= 0.008).
Conclusion
Individuals with PTSD who average less sleep at night showed greater emotional reactivity, as indexed by greater functional brain activation changes within an area of the reward network, than individuals who obtained more sleep per night. Future research involving actual sleep duration manipulation will be necessary to determine whether this finding reflects the well-known antidepressant effect of sleep deprivation or a form of greater emotional expression error monitoring among traumatized patients when lacking sleep. Regardless, these findings suggest that insufficient sleep could affect unconsciously perceived emotion in faces and potentially affect social and emotional responses among individuals with PTSD.
Support
US Army Medical Research and Materiel Command: W81XWH-14-1-0570
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Affiliation(s)
- R King
- University of Arizona, Tucson, AZ
| | - D Jecmen
- University of Arizona, Tucson, AZ
| | | | | | - J Gould
- University of Arizona, Tucson, AZ
| | - A Burns
- University of Arizona, Tucson, AZ
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