1043 Cardiac natriuretic peptides (NP) are polypeptide hormones whose release by cardiocytes increases with cardiac hypertrophy and failure, with atrial natriuretic factor (ANF) arising primarily from the atria and brain natriuretic peptide (BNP) from the ventricles. Our previous studies showed ANF remains elevated after cardiac transplant despite normalization of filling pressures. Plasma ANF and BNP were measured in 10 consecutive pts before and after transplant at 24 hrs and at serial endomyocardial biopsies. Eight treated rejection episodes occurred in 4 pts. All rejection episodes (biopsy ISHLT grade 3-4) requiring treatment were associated with an increase in BNP > 400 pg/ml. Steadily increasing BNP levels preceded rejection and BNP dropped dramatically after treatment. Since OKT3 decreased BNP, increased BNP may be mediated by cytokine production by T-cells. Increased BNP was not always associated by increased ANF suggesting upregulation of BNP during rejection. (Figure)FigurePlasma NP pre- and post transplant in patient with rejection treated with OKT3 (BNP: black bars, ANF: shaded bars, prednisone and OKT3: arrows) BNP levels could form a sensitive screening test for rejection after cardiac transplant and BNP release during rejection may be mediated via cytokines.
A mechanical circulatory assist device for long term use outside the hospital setting has been developed. The device can be used for left, right or bi-ventricular support, and several of the developed technologies are applicable for total artificial hearts and non-pulsatile flow systems. The totally implantable device is principally designed for left ventricular support with implantation in the left hemithorax. The system utilizes transcutaneous energy and information transfer sub-systems, and has no percutaneous connections. In vitro durability testing has been conducted for periods from 1-4 years. Bovine experiments have been conducted with sustained circulation for periods form 1.5 to 96 hours. The in vitro and in vivo evaluation to date has demonstrated that the system can function effectively as a totally implantable ventricular assist device. The transcutaneous energy and information transfer sub-systems provided the ability to power, monitor and control the device, without the need for percutaneous connections. Design optimization and chronic in vivo evaluation is planned
Background and Objectives: The implementation of effective competency-based medical education (CBME) relies on building a coherent and integrated system of assessment across the continuum of training to practice. As such, the developmental progression of competencies must be assessed at all stages of the learning process, including continuing professional development (CPD). Yet, much of the recent discussion revolves mostly around residency programs. The purpose of this review is to synthesize the findings of studies spanning the last 2 decades that examined competency-based assessment methods used in family medicine residency and CPD, and to identify gaps in their current practices. Methods: We adopted a modified form of narrative review and searched five online databases and the gray literature for articles published between 2000 and 2020. Data analysis involved mixed methods including quantitative frequency analysis and qualitative thematic analysis. Results: Thirty-seven studies met inclusion criteria. Fourteen were formal evaluation studies that focused on the outcome and impact evaluation of assessment methods. Articles that focused on formative assessment were prevalent. The most common levels of educational outcomes were performance and competence. There were few studies on CBME assessment among practicing family physicians. Thematic analysis of the literature identified several challenges the family medicine educational community faces with CBME assessment. Conclusions: We recommend that those involved in health education systematically evaluate and publish their CBME activities, including assessment-related content and evaluations. The highlighted themes may offer insights into ways in which current CBME assessment practices might be improved to align with efforts to improve health care.’
During the last four decades there has been a rapid increase in the development and usage of medical devices. Currently, there are more than 500,000 devices on the market and 25,000 new devices enter the market each year. Many medical devices are now designed to be implantable (pacemakers, defibrillators, circulatory assist devices, artificial hearts, cochlear implants, neuromuscular stimulators, biosensors, etc.). Almost all of the active devices (those that perform work) and many of the passive devices (those that do not perform work) require a source of power. In addition, these devices need to be monitored and controlled, which can be accomplished by utilizing remote communication methods. A transcutaneous energy transfer system combined with a remote communications system has been developed and evaluated in vitro and in vivo (bovine, porcine, and human cadaver experiments). The energy transfer system can deliver up to 60 W with power transfer efficiencies between 60 and 83%. An automatically tuned, resonant frequency tracking method is used to obtain optimum power transfer over a range of operating conditions. The remote communications system can transfer digital data bidirectionally through intact skin at rates up to 9600 baud. The system transmits information by frequency modulating an 890 nm infrared carrier signal. The system has demonstrated satisfactory performance during multicenter evaluation with ventricular assist and total artificial heart devices. Design improvements have been identified, which will be implemented to produce an optimized system for energy transfer to and remote communications with various implantable medical devices.
The prophylactic use of anti-Rh (D) immunoglobulin has resulted in a marked decline in the incidence of Rh haemolytic disease of the newborn (HDN) since its introduction in 1968. Nevertheless, cases still occur. Those recorded in the metropolitan area of Western Australia in the 3 years, 1974 to 1976, have been studied in detail. There were 29 cases of ABO haemolytic disease, among which there were no deaths, and 56 cases of Rh haemolytic disease with 9 perinatal deaths. Nearly half of the mothers of the infants with Rh HDN were first immunised before anti-D became available; a quarter had not been given anti-D when it was required, and a few had formed Rh antibodies in their first pregnancy or despite treatment with anti-D.
As the professional society representing cardiac surgeons in Canada, the Canadian Society of Cardiac Surgeons (CSCS) recognizes the importance of maintaining a stable cardiac surgical workforce. The current reactive approach to health human resource management in cardiac surgery is inadequate and may result in significant misalignment of cardiac surgeon supply and demand. The availability of forecasting models and high quality, consistent data on productivity, workload, utilization, and demand is a prerequisite for our profession’s capacity to predict and plan for changes in health human resources. The CSCS recognizes that improved workforce management is a key component to providing optimal cardiac surgical care for Canadians in
