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Background: Lung parenchyma lesions present a range of potential differential diagnoses, necessitating a comprehensive evaluation for appropriate treatment. However, when it comes to definitive confirmation, tissue histopathology or culture remains the gold standard. Objective: This study was conducted with the objective of assessing the safety of ultrasound-guided Tru-cut biopsy when performed by pulmonologists. Methodology: Patients with underlying peripheral lung lesion underwent CT chest with iv contrast then they underwent tru cut biopsy by using 18G Dr. J needle under ultrasound guidance using convex probe 2-5 MHz. Histopathology reports were collected and then retrospective analysis of data was done. Results: Out of 50 patients 36 (72%) were male and 14 (28%) were female ranging from 16 years to 73 years. Squmaous Cell Carcinoma was found in 17 cases (34%), most common tumour in our study and most common site of lung tumor was right lower lobe (22%). Conclusion: Pulmonologists can efficiently performtru cut lung biopsies under ultrasound guidance with minimal to no complications. [ABSTRACT FROM AUTHOR]

Background: COPD is one of the biggest causes of mortality all around the world. This disease represents significant and potentially rising burden on health services on global level. COPD is thought to rise to fourth rank the list of diseases with highest mortality. It is also expected to rise to 7th number among the diseases with highest burden on the health system by 2030. COPD is the cause of mortality in 2.5 million people all over the world. COPD is commonly associated with cardiovascular diseases, and CVD is the commonest cause of mortality among COPD patients. Objective: To determine the frequency of deep vein thrombosis (DVT) among the patients with COPD presenting at a tertiary care hospital. Methodology: This was a cross sectional study conducted at Department of Pulmonology, Nishtar Hospital Multan, from August 2019 to January 2020. Total 211 patients were selected for the study. Mean and standard deviation were calculated for continuous data while frequencies and percentages were calculated for the nominal data Effect modifiers such as age, gender, obesity, diabetes, dyslipidemia, hypertension, duration of disease, smoking, residential status, and socioeconomic status were controlled by stratification and chi-square test was applied, keeping p=0.05 as statistically significant. Results: Of these 211 study cases, 133 (63%) patients were male while 78 (37%) patients were female. Mean age of the patients was 53.81±9.90 years. Diabetes was present in 54 (25.6%), and hypertension was present in 93 (44.1%) of all the patients. Mean BMI was 25.19±2.34 kg/m2 and 32 (15.2%) patients were obese. Of these 211 study cases, 71 (33.6%) were smokers. Dyslipidemia was present in 55 (26.1%) of patients. Deep vein thrombosis was present in 23 (10.9%) of all the patients included in study. Conclusion: High prevalence of deep vein thrombosis was observed in current study in the patients with COPD. Deep vein thrombosis was highly associated with poor control of hypertension, smoking, obesity, and long duration of the disease. [ABSTRACT FROM AUTHOR]

Background: Insertable cardiac monitors (ICMs) are essential for ambulatory arrhythmia diagnosis. However, definitive diagnoses still require time‐consuming, manual adjudication of electrograms (EGMs). Objective: To evaluate the clinical impact of selecting only key EGMs for review. Methods: Retrospective analyses of randomly selected Abbott Confirm Rx™ devices with ≥90 days of remote transmission history were performed, with each EGM adjudicated as true or false positive (TP, FP). For each device, up to 3 "key EGMs" per arrhythmia type per day were prioritized for review based on ventricular rate and episode duration. The reduction in EGMs and TP days (patient‐days with at least one TP EGM), and any diagnostic delay (from the first TP), were calculated versus reviewing all EGMs. Results: In 1000 ICMs over a median duration of 8.1 months, at least one atrial fibrillation (AF), tachycardia, bradycardia, or pause EGM was transmitted by 424, 343, 190, and 325 devices, respectively, with a total of 95 716 EGMs. Approximately 90% of episodes were contributed by 25% of patients. Key EGM selection reduced EGM review burden by 43%, 66%, 77%, and 50% (55% overall), while reducing TP days by 0.8%, 2.1%, 0.2%, and 0.0%, respectively. Despite reviewing fewer EGMs, 99% of devices with a TP EGM were ultimately diagnosed on the same day versus reviewing all EGMs. Conclusion: Key EGM selection reduced the EGM review substantially with no delay‐to‐diagnosis in 99% of patients exhibiting true arrhythmias. Implementing these rules in the Abbott patient care network may accelerate clinical workflow without compromising diagnostic timelines. [ABSTRACT FROM AUTHOR]

Background: Since its inception, the Neonatal Resuscitation Program (NRP) has been in quest of evidence-based strategies that promises the best outcome specifically in developing regions. Hence, the present study aims to investigate the efficacy of pedagogical framework versus traditional method of education on knowledge and self-efficacy of nursing students regarding neonatal resuscitation. Methods: A randomized controlled trial was conducted between November 2020 to March 2021. The 60 nursing students were randomly assigned to experimental and control groups taught through traditional method (Learn, Practice), and LSPPDM Pedagogical (Learn, see, practice, prove, do, maintain) steps respectively. Students were assessed at the baseline and after the intervention using validated questionnaires. Masking of data assessment was provided by assigning a code to each student. ClinicalTrials.gov registration number (NCT04748341). Results: Both knowledge and self-efficacy had been significantly improved (p <0.001) after the intervention. However, the posttest mean change in knowledge scores was significantly higher (p <0.001) in the experimental group (13.3±1.30) as compared to the control (9.97±1.22) with an insignificant difference (p =0.655) in mean self-efficacy level. Conclusion: Both methods are effective in improving knowledge and self-efficacy. Yet, education through integrating diverse strategies under the umbrella of LSPPDM pedagogy is a more effective approach in enhancing knowledge regarding neonatal resuscitation. [ABSTRACT FROM AUTHOR]

Exceptional precautionary measures have been adopted to stop the transmission and control of COVID-19 through the world and Pakistan is facing lockdown in this scenario. Public loyalty to precautionary measures is affected by their knowledge, attitude, risk factors and practices (KAP) towards COVID-19. The present study was conducted among the Pakistani residents to observe the knowledge, attitude, practices and risk factors towards COVID-19 outbreak in Pakistan. A questionnaire was designed, and a cross-sectional survey was conducted among participants of the study area. Participants were asked the questions regarding knowledge, attitude, practices and risk factors towards COVID-19. Data were analyzed by SPSS and t/F test and correlation was applied among the knowledge, attitude, risk factors and practices. A total of 1060 questionnaires were received. 1004 were included while 56 were excluded. The highest representation was from Punjab province (65.6%), female (63%) and age group of 21–30 years (62.1%). Most participants were single (85%), Muslim (99.4%), Urdu speaking (45.6%) and were graduates (51.5%). Most of the participants were students (52.9%) and were from economically middle-class families (40.8%). The knowledge was positively correlated with attitude and practices whereas negatively correlated with risk factors (P < 0.05). The attitude was negatively correlated with risk factor and positively correlated with practices. The risk factors and practices were positively correlated with each other. Health education program to improve the COVID-19 knowledge, attitude, practices and risk factors should be initiated to combat current health challenge. [ABSTRACT FROM AUTHOR]

Background: The leadless Micra transcatheter‐pacing system (Micra‐TPS) is implanted via a femoral approach using a 27‐French introducer sheath. The Micra Transcutaneous Pacing Study excluded patients with inferior vena cava (IVC) filters. Objective: To examine the feasibility and safety of Micra‐TPS implantation through an IVC filter. Methods: This multicenter retrospective study included patients with an IVC filter who underwent a Micra‐TPS implantation. Data for clinical and IVC filter characteristics, preprocedure imaging, and procedural interventions were collected. The primary outcome was a successful leadless pacemaker (LP) implantation via a femoral approach in the presence of an IVC filter. Periprocedural and delayed clinical complications were also evaluated. Results: Of the 1528 Micra‐TPS implants attempted, 23 patients (1.5%) had IVC filters. The majority (69.6%) of IVC filters were permanent. Six (26.1%) patients underwent preprocedural imaging to assess for filter patency. One patient's filter was retrieved before LP implantation. The primary outcome was achieved in 21 of 22 patients (95.5%) with an existing IVC filter. An occluded IVC precluded LP implantation in one patient. Difficulty advancing the stiff guidewire or the 27‐Fr sheath was encountered in five patients. These cases required repositioning of the wire (n = 2), gradual sheath upsizing (n = 2), or balloon dilation of the filter (n = 1). Postprocedure fluoroscopy revealed intact filters in all cases. During a median 6‐month follow‐up, there were no clinical complications related to the filter or the Micra‐TPS. Conclusion: This multicenter experience demonstrates the feasibility and safety of Micra‐TPS implantation via an IVC filter without acute procedural or delayed clinical complications. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to determine the association of high‐commitment human resource practices (HCHRPs) with nurses' compassionate care behaviour. Background: The extant research highlights the key role of compassionate care behaviour in achieving quality health services. However, scant attention has been paid to identifying the factors that augment compassionate care behaviour among health care professionals. Methods: This study took place from September 2018 to March 2019, collecting data from 340 nurses of either gender aged 24–60 years with at least 1 year experience. The study follows a cross‐sectional research design by collecting data through a personally administered survey. Results: A statistically significant association was found between the four dimensions of HCHRPs and organisational commitment. Moreover, organisational commitment positively related to compassionate care behaviour and mediated the relationship between HCHRPs and compassionate care behaviour. Conclusion: The findings reveal that four dimensions of HCHRPs positively influence nurses' compassionate care behaviour via the indirect path of organisational commitment. Implications for Nursing Management: The study marks the first attempt to delineate the role of HCHRPs in enhancing the compassionate care behaviour. The hospital administration and human resource managers should use HCHRPs as strategic imperative to attract competent employees and enhance compassionate care behaviour. [ABSTRACT FROM AUTHOR]

AF Ablation After Watchman Background There have been an increasing number of atrial fibrillation (AF) patients with Watchman left atrial appendage occlusion (LAAO) device, requiring catheter ablation (CA) for maintenance of normal sinus rhythm. In this study, we describe our experience with the feasibility and safety of CA in patients with a preexisting Watchman LAAO device. Methods This was a retrospective multicenter AF registry of 60 patients with Watchman LAAO device who underwent CA for AF. Baseline clinical and procedural characteristics of the included subjects were retrieved from review of medical records and were analyzed. Results The mean age was 72.7 ± 4.9 years and the mean CHADS2 score was 2.3 ± 0.6. All patients had successful pulmonary vein isolation (PVI). The left atrial appendage (LAA) was electrically active in 34 (56%) while reentrant tachycardia and AF triggers were seen in 17 (28%) patients. Electrical isolation was attempted in these 17 patients with only 10 achieving complete LAA isolation. Repeat imaging showed new peri-device leaks in 30% (12/40) patients, while new significant peri-device leaks (≥5 mm) were noted in 10% (10/40) of patients after RFA, respectively, requiring continuation of oral anticoagulation. There were a higher proportion of patients with severe peri-device leaks (≥5 mm) after LAA isolation. However, >50% of those leaks sealed off on follow-up transesophageal echocardiogram. Conclusion AF ablation is a feasible and safe in patients with preexisting Watchman LAAO device. Electrical isolation of the LAA could be difficult and when attempted can result in increased risk of short-term peri-device leak and recurrence of AT/AF in almost all patients. [ABSTRACT FROM AUTHOR]

Background Recent studies have suggested that prolonged outpatient rhythm monitoring results in increased detection of atrial fibrillation (AF) in patients with cryptogenic stroke (CS). However, the best monitoring strategy and its clinical utility is debatable. Objective To compare the effectiveness of implantable loop recorder (ILR) versus wearable devices in identifying AF in patients with CS. Methods and Results Three randomized controlled trials (RCTs) and 13 observational studies were identified by database searches. Seven studies (enrolling 774 patients) employed ILR for AF detection for a median duration of 365 days (range 50-569 days). Ten studies (enrolling 996 patients) employed continuous monitoring with wearable devices for a median duration of 21 days (range 4-30 days). One study performed 7 days of monitoring with wearable device followed by implantation of ILR, thus included in both groups. Pooled odds ratio (OR) of identifying AF in RCTs showed increased detection of AF with prolonged monitoring (OR 4.54, 95% confidence interval [CI] 2.92, 7.06; P < 0.00001) compared to routine outpatient follow-up. Overall detection of AF with outpatient monitoring was 17.6% (CI: 12.5-22.7). There was significantly higher AF detection with ILR (23.3%; CI: 13.83-32.29) compared to wearable devices (13.6%; CI: 7.91-19.32; P < 0.05). Patients with AF were older in age compared to patients without AF. Conclusion AF detection in patients with CS is improved with prolonged rhythm monitoring and is better with ILR compared to wearable devices. AF was more common in older patients. The clinical significance of these findings is unknown at this point. [ABSTRACT FROM AUTHOR]

Background Radiation exposure in the electrophysiology lab is a major occupational hazard to the electrophysiologists. A catheter localization system (MediGuide Technology, St. Jude Medical Inc., St. Paul, MN, USA) allows the integration of electroanatomical mapping and x-ray imaging, and has been shown to be effective in reducing radiation exposure during several electrophysiological procedures. We intended to evaluate the feasibility of this catheter tracking system to guide transseptal (TS) access. Methods The feasibility of performing TS puncture with MediGuide (MDG) was assessed in a prospective observational study in 16 patients undergoing radiofrequency ablation for atrial fibrillation. These patients were compared to 16 matched patients undergoing similar procedures during the same time frame using conventional approach. There were no differences in mean age, gender distribution, and body mass index between the two groups. Total duration of fluoroscopic exposure during TS puncture was compared between the two groups. Results All patients underwent successful TS puncture. Fluoroscopy time for double TS puncture using the MDG system was significantly lower than the control group (0.48 ± 0.17 minutes vs. 5.9 ± 0.65 minutes; P < 0.0001). No major complications occurred during the procedures in either group. Conclusions TS puncture can be successfully performed using MDG, and results in significant reduction in radiation exposure. [ABSTRACT FROM AUTHOR]

Pleural Effusions After the Lariat Procedure Background The Lariat procedure is increasingly used for the exclusion of the left atrial appendage (LAA) in atrial fibrillation (AF) patients. There are anecdotal reports of pleural effusions after the Lariat procedure. However, the incidence, demographics, and pathophysiology of these effusions are largely unknown. Objective Characterization of pleural effusions in patients who underwent LAA exclusion using the Lariat procedure. Methods We report the incidence, demographics, and clinical and laboratory characteristics of patients from a multicenter prospective registry who underwent the Lariat procedure and subsequently developed pleural effusions. Results A total of 10 out of 310 (3.2%) patients developed significant pleural effusions after the Lariat procedure. The mean age of these patients was 67 ± 9, ranging from 52 to 78 years and included 5 (50%) males. Nine patients had persistent AF with median CHADS2 score of 2.7 ± 1.2. The LAA was successfully ligated in all these patients. Post-Lariat procedure, 6 patients developed bilateral and 4 patients developed left-sided pleural effusions. Pleural tap revealed transudative in 2 and exudative in 6 patients. The remaining 2 patients responded to active diuresis and behaved clinically like transudative effusions. There is a statistically significant difference between the onset of pleural effusion after the Lariat procedure between tPLE versus ePLE groups (14 ± 1.2 vs. 6 ± 6, P = 0.05). Conclusion Incidence of clinically significant pleural effusion is uncommon after the Lariat procedure and can be either exudative or transudative in nature depending on the underlying mechanisms. More prospective studies are needed to study the pathophysiologic basis of development of pleural effusions after the Lariat procedure. [ABSTRACT FROM AUTHOR]

Background: Haptic control is a useful therapeutic option in rehabilitation featuring virtual reality interaction. As with visual and vibrotactile biofeedback, kinesthetic haptic feedback may assist in postural control, and can achieve balance control. Kinesthetic haptic feedback in terms of body sway can be delivered via a commercially available haptic device and can enhance the balance stability of both young healthy subjects and stroke patients. Method: Our system features a waist-attached smartphone, software running on a computer (PC), and a dedicated Phantom Omni® device. Young healthy participants performed balance tasks after assumption of each of four distinct postures for 30 s (one foot on the ground; the Tandem Romberg stance; one foot on foam; and the Tandem Romberg stance on foam) with eyes closed. Patient eyes were not closed and assumption of the Romberg stance (only) was tested during a balance task 25 s in duration. An Android application running continuously on the smartphone sent mediolateral (ML) and anteroposterior (AP) tilt angles to a PC, which generated kinesthetic haptic feedback via Phantom Omni®. A total of 16 subjects, 8 of whom were young healthy and 8 of whom had suffered stroke, participated in the study. Results: Post-experiment data analysis was performed using MATLAB®. Mean Velocity Displacement (MVD), Planar Deviation (PD), Mediolateral Trajectory (MLT) and Anteroposterior Trajectory (APT) parameters were analyzed to measure reduction in body sway. Our kinesthetic haptic feedback system was effective to reduce postural sway in young healthy subjects regardless of posture and the condition of the substrate (the ground) and to improve MVD and PD in stroke patients who assumed the Romberg stance. Analysis of Variance (ANOVA) revealed that kinesthetic haptic feedback significantly reduced body sway in both categories of subjects. Conclusion: Kinesthetic haptic feedback can be implemented using a commercial haptic device and a smartphone. Intuitive balance cues were created using the handle of a haptic device, rendering the approach very simple yet efficient in practice. This novel form of biofeedback will be a useful rehabilitation tool improving the balance of stroke patients. [ABSTRACT FROM AUTHOR]

The article discusses a study on an adaptive semantic based mediation system for data interoperability among health information systems. Topics covered include the background information needed to understand the proposed system, an overview of smart clinical decision support system (CDSS), and CDSS projects for interoperability.