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Associations between body mass index (BMI) and the cardiovascular (CV) and kidney efficacy of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in patients with type 2 diabetes (T2D) are uncertain; therefore, data analysed separately from the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) trial and the Trial to Evaluate Cardiovascular and Other Long-term Outcomes with Semaglutide in Subjects with Type 2 Diabetes (SUSTAIN 6) were examined. These international, randomized, placebo-controlled trials investigated liraglutide and semaglutide (both subcutaneous) in patients with T2D and at high risk of CV events. In post hoc analyses, patients were categorized by baseline BMI (

It is unknown if the cardioprotective and renal effects of glucagon-like peptide-1 receptor agonists are consistent across blood pressure (BP) categories in patients with type 2 diabetes and at high risk of cardiovascular events. Using data from the LEADER (9340 patients) and SUSTAIN 6 (3297 patients) trials, we evaluated post hoc the cardiorenal effect of liraglutide and semaglutide on major adverse cardiovascular events (MACE) and nephropathy by baseline BP categories using a Cox proportional hazards model (treatment and subgroup as factors; adjusted for cardiorenal risk factors). Data from the two trials were analysed separately. In the LEADER and SUSTAIN 6 trials, the prevalence of stage 1 hypertension was 30% and 31%, respectively, and of stage 2 hypertension 41% and 43%, respectively. There was no statistical heterogeneity across the BP categories for the effects of liraglutide (P = .06 for MACE; P = .14 for nephropathy) or semaglutide (P = .40 for MACE; P = .27 for nephropathy) versus placebo. This implies that liraglutide and semaglutide may be beneficial for patients with type 2 diabetes, irrespective of their baseline BP.

As COVID-19 testing is rolled out increasingly widely, the use of a range of alternative testing methods will be beneficial in ensuring testing systems are resilient and adaptable to different clinical and public health scenarios. Here, we compare and discuss the diagnostic performance of a range of different molecular assays designed to detect the presence of SARS-CoV-2 infection in people with suspected COVID-19. Using findings from a systematic review of 103 studies, we categorised COVID-19 molecular assays into 12 different test classes, covering point-of-care tests, various alternative RT-PCR protocols, and alternative methods such as isothermal amplification. We carried out meta-analyses to estimate the diagnostic accuracy and clinical utility of each test class. We also estimated the positive and negative predictive values of all diagnostic test classes across a range of prevalence rates. Using previously validated RT-PCR assays as a reference standard, 11 out of 12 classes showed a summary sensitivity estimate of at least 92% and a specificity estimate of at least 99%. Several diagnostic test classes were estimated to have positive predictive values of 100% throughout the investigated prevalence spectrum, whilst estimated negative predictive values were more variable and sensitive to disease prevalence. We also report the results of clinical utility models that can be used to determine the information gained from a positive and negative test result in each class, and whether each test is more suitable for confirmation or exclusion of disease. Our analysis suggests that several tests exist that are suitable alternatives to standard RT-PCR and we discuss scenarios in which these could be most beneficial, such as where time to test result is critical or, where resources are constrained. However, we also highlight methodological concerns with the design and conduct of many included studies, and also the existence of likely publication bias for some test classes. Our results should be interpreted with these shortcomings in mind. Furthermore, our conclusions on test performance are limited to their use in symptomatic populations: we did not identify sufficient suitable data to allow analysis of testing in asymptomatic populations.

Associations between body mass index (BMI) and the cardiovascular (CV) and kidney efficacy of glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) in patients with type 2 diabetes (T2D) are uncertain; therefore, data analysed separately from the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) trial and the Trial to Evaluate Cardiovascular and Other Long‐term Outcomes with Semaglutide in Subjects with Type 2 Diabetes (SUSTAIN 6) were examined. These international, randomized, placebo‐controlled trials investigated liraglutide and semaglutide (both subcutaneous) in patients with T2D and at high risk of CV events. In post hoc analyses, patients were categorized by baseline BMI (

Introduction Once-weekly semaglutide is a new glucagon-like peptide-1 (GLP-1) analogue administered at a 1.0 or 0.5 mg dose. As head-to-head trials assessing once-weekly semaglutide as an add-on to 1–2 oral anti-diabetic drugs (OADs) vs other GLP-1 receptor agonists (GLP-1 RAs) are limited, a network meta-analysis (NMA) was performed. The objective was to assess the relative efficacy and safety of once-weekly semaglutide vs GLP-1 RAs in patients with type 2 diabetes (T2D) inadequately controlled on 1–2 OADs. Methods A systematic literature review (SLR) was conducted in order to identify trials of GLP-1 RAs in patients inadequately controlled on 1–2 OADs. Data at 24 ± 4 weeks were extracted for efficacy and safety outcomes (feasible for analysis in a NMA), which included the key outcomes of change from baseline in glycated hemoglobin (HbA1c), systolic blood pressure (SBP), and weight, as well as discontinuation due to adverse events (AEs). Data were synthesized using a NMA and a Bayesian framework. Results In total, 26 studies were included across the base case analyses. Once-weekly semaglutide 1.0 mg was associated with significantly greater reductions in HbA1c and weight vs all GLP-1 RA comparators. Once-weekly semaglutide 0.5 mg also achieved significantly greater reductions in HbA1c and weight compared with the majority of other GLP-1 RAs. Both doses of once-weekly semaglutide were associated with similar odds of discontinuation due to AEs compared with other GLP-1 RAs. Conclusion Overall, once-weekly semaglutide 1.0 mg as an add-on to 1–2 OADs is the most efficacious GLP-1 RA in terms of the reduction of HbA1c and weight from baseline after 6 months of treatment. In addition, the analysis suggests that once-weekly semaglutide is well tolerated and not associated with an increase in discontinuations due to AEs compared with other GLP-1 RAs. Funding Novo Nordisk. Electronic supplementary material The online version of this article (10.1007/s13300-018-0424-2) contains supplementary material, which is available to authorized users.

Introduction Once-weekly semaglutide is a glucagon-like peptide-1 (GLP-1) analogue that is currently available as 1.0 mg and 0.5 mg dose for the treatment of type 2 diabetes (T2D). Currently, no head-to-head trial investigating once-weekly semaglutide as an add-on to basal insulin vs other GLP-1 receptor agonists (GLP-1 RAs) is available. The aim of this study was to conduct a network meta-analysis (NMA) to assess the efficacy and safety of once-weekly semaglutide vs other GLP-1 RAs in patients with T2D inadequately controlled on basal insulin. Methods A systematic literature review was performed to identify all trials of GLP-1 RAs as an add-on to basal insulin in patients with T2D. Data at 24 ± 4 weeks were extracted for efficacy and safety outcomes (feasible for analysis in an NMA), including the change from baseline in glycated hemoglobin (HbA1c), body weight, and systolic blood pressure, and the incidence of nausea, vomiting, and diarrhea. Data were synthesized using a NMA and a Bayesian framework. Results In total, eight studies were included across the base-case analyses. The results demonstrate that once-weekly semaglutide 1.0 mg was associated with significantly greater reductions in HbA1c (− 0.88% to − 1.39% vs comparators) and weight (− 1.49 to − 4.69 kg vs comparators) and similar odds of experiencing nausea, vomiting, or diarrhea vs all GLP-1 RA comparators. Once-weekly semaglutide 1.0 mg was also equally effective at reducing systolic blood pressure compared with liraglutide 1.8 mg. Once-weekly semaglutide 0.5 mg significantly reduced HbA1c vs the majority of other GLP-1 RAs, except liraglutide 1.8 mg QD. The odds of experiencing nausea were significantly lower with once-weekly semaglutide 0.5 mg compared with all GLP-1 RA comparators. Conclusion Once-weekly semaglutide 1.0 mg as an add-on to basal insulin is likely to be the most efficacious GLP-1 RA for reducing HbA1c and weight from baseline after 6 months of treatment. The efficacy of once-weekly semaglutide is not associated with a significant increase in the incidence of gastrointestinal side-effects vs other GLP-1 RAs. Funding Novo Nordisk. Electronic supplementary material The online version of this article (10.1007/s13300-018-0428-y) contains supplementary material, which is available to authorized users.

ObjectiveTo determine the comparative efficacy of once-weekly semaglutide relative to sodium-glucose cotransporter 2 inhibitors (SGLT-2is) licensed in Europe and North America among patients with type 2 diabetes (T2D) inadequately controlled with 1–2 oral antidiabetics (OADs), using a network meta-analysis (NMA). Design systematic review and network meta-analysis. Data Sources EMBASE, MEDLINE and CENTRAL were searched from January 1994 to August 2017.MethodsRandomised controlled trials with ≥20 weeks of treatment evaluating once-weekly semaglutide or SGLT-2is. Primary outcomes included change from baseline in: HbA1c, weight, systolic blood pressure, postprandial blood glucose and fasting plasma glucose. Fixed-effect and random-effect Bayesian NMA were used to indirectly compare treatment effects at 26 (±4) weeks. Metaregression and sensitivity analyses were conducted. Model selection was performed using the deviance information criterion and consistency was assessed by comparing indirect (edge-splitting) to direct evidence.ResultsForty-eight publications representing 21 trials were included. The mean differences (MD) in change from baseline in HbA1c of once-weekly semaglutide 1.0 mg versus SGLT-2is ranged from −0.56% for canagliflozin 300 mg (95% credible interval (CrI): −0.76 to −0.33%), to −0.95% for dapagliflozin 5 mg (95% CrI: −1.20 to −0.69%). The MD in change from baseline in weight of once-weekly semaglutide 1.0 mg versus SGLT-2is ranged from −1.35 kg for canagliflozin 300 mg to −2.48 kg for dapagliflozin 5 mg, while change from baseline in fasting plasma glucose ranged from −0.41 mmol/L for canagliflozin 300 mg to −1.37 mmol/L for dapagliflozin 5 mg. Once-weekly semaglutide was not statistically differentiable than all SGLT-2is in reducing systolic blood pressure. NMA was not feasible for postprandial blood glucose and safety outcomes.ConclusionOnce-weekly semaglutide demonstrated statistically significant and clinically meaningful reductions in HbA1c and body weight in T2D patients inadequately controlled with 1–2 OADs compared to all SGLT-2is licensed in Europe and North America.

Economic modeling of type 2 diabetes (T2D) relies on sets of risk equations (e.g., UKPDS 68) to predict cardiovascular (CV) events and mortality as mediated through changes in risk factors (e.g., HbA1c). Recent CV outcomes trials (CVOTs) have shown significant benefits in events over a short time period (between 2-4 years), along with beneficial changes in risk factors such as blood pressure, HbA1c, and weight. The contributions of these changes to the observed outcomes within these CVOTs are unclear. In patients with high CV risk, the SUSTAIN 6 trial of once-weekly semaglutide+standard of care (SoC) reported a statistically significant reduction in stroke (HR=0.61) after 104 weeks vs. placebo+SoC. We sought to establish the contribution of risk factor changes to this observed outcome, by evaluating the performance of traditional risk equations in predicting outcome benefits seen with once-weekly semaglutide. As a secondary objective, the impact of incorporating the stroke benefit on estimated long term health benefits was assessed. The IQVIA Core Diabetes Model was used to assess predictive accuracy of the UKPDS 68 risk equations on the observed stroke benefit. Secondly, the model was calibrated to preserve the ratio of the observed cumulative incidence of stroke between treatment arms. Finally, results were extrapolated over 50 years. The UKPDS 68 equations were able to predict 64% of the observed 2-year stroke risk reduction, suggesting a drug-mechanistic effect other than changes in risk factors. Calibration results indicate that a relative risk of stroke of 0.83 (17% reduction) applied to once-weekly semaglutide was required to preserve the cumulative incidence ratio. Results of extrapolation increased quality-adjusted life-years by 0.18 and life-years by 0.29 vs. placebo+SoC. Results of this analysis may have implications on future approaches assessing the long term economic impact of new therapies in T2D in this era of multiple CVOTs. Disclosure M. Evans: Advisory Panel; Self; Novo Nordisk A/S. Consultant; Self; Novartis AG, Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc., Merck Sharp & Dohme Corp. P. Johansen: Consultant; Self; Janssen Global Services, LLC.. Employee; Self; Novo Nordisk A/S. H. Vrazic: Employee; Self; Novo Nordisk A/S.

Objective: Treatment intensification with additional anti-diabetic agents is recommended in type 2 diabetes (T2D) for patients inadequately controlled on metformin monotherapy. The present network meta-analysis (NMA) evaluated comparative efficacy and safety of once-weekly semaglutide and sodium-glucose co-transporter 2 inhibitors (SGLT-2is) in T2D patients inadequately controlled with metformin. Methods: Randomized controlled trials with ≥20 weeks duration were searched in EMBASE, MEDLINE, and CENTRAL. Primary efficacy outcomes were: change from baseline in HbA1c, weight, systolic blood pressure (SBP), post-prandial blood glucose (PPG), and fasting blood glucose (FPG). Treatment effects at 26 (±4) weeks were compared using Bayesian NMAs. Meta-regression and sensitivity analysis were used to address the trial heterogeneity. Results: Eight trials were found eligible for this NMA. Statistically significant reductions in HbA1c were observed with both 1.0 mg and 0.5 mg doses of once-weekly semaglutide when compared to SGLT-2is. The mean differences in change from baseline in HbA1c for once-weekly semaglutide 1.0 mg vs SGLT-2is ranged from −0.66% for canagliflozin 300 mg (95% Credible Intervals [CrI]: −0.82, −0.50%) to −1.11% for dapagliflozin 5 mg (95% CrI: −1.37, −0.85%). Once-weekly semaglutide 1.0 mg performed significantly better than all SGLT-2is of interest in reducing weight and improving FPG levels: however, SBP reduction was not statistically differentiable. Results of sensitivity analysis and meta-regressions aligned with base-case results. NMAs were not possible for PPG and safety outcomes, due to lack of data. Conclusion: Once-weekly semaglutide treatment is significantly better compared to SGLT-2is in achieving adequate glycemic control in T2D patients inadequately controlled with metformin monotherapy.

Electrocardiographic (ECG) identification of prior myocardial infarction (MI) during right ventricular (RV) pacing is of clinical importance. Proposed ECG criteria have been evaluated only during apical pacing. We evaluated the effect of pacing site on the predictive performance of ECG signs of prior MI.The present study is a secondary analysis of a prospective, multicenter study which randomized recipients of an implantable cardioverter defibrillator to an apical versus septal RV lead positioning. ECGs of patients with or without prior MI were analyzed for the presence of the following criteria: Cabrera sign, Chapman sign, QR pattern in leads I, aVL, V5 or V6, QR in inferior leads and notching in the descending slope of the QRS complex in inferior leads.The MI group included 89 patients (55.1% apically paced), while 99 patients had no prior MI (50.5% apically paced). In the total population, the Cabrera sign presented the highest specificity (97%) and diagnostic accuracy (62.2%), with a sensitivity of 23.6%. The Cabrera sign was the only significant predictor of a prior MI [OR=9.9, (95%CI:2.8-34.5), p0.001], among all ECG markers. Pacing site did not significantly influence the sensitivity and specificity of the Cabrera sign for detection of prior MI.In our study, the Cabrera sign was the only ECG marker that predicted the presence of prior MI during ventricular paced rhythm. Septal RV lead positioning did not affect the predictive performance of the Cabrera sign.

Background The use of cardiac implantable electronic devices (CIED) has risen steadily, yet the rate of cardiac device infections (CDI) has disproportionately increased. Amongst all cardiac device infections, the pocket infection is the most challenging diagnosis. Therefore, we aimed to improve diagnosis of such pocket infection by identifying relevant biomarkers. Methods We enrolled 25 consecutive patients with invasively and microbiologically confirmed pocket infection. None of the patients had any confounding conditions. Pre-operative levels of 14 biomarkers were compared in infected and control (n = 50) patients. Our selected biomarkers included white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), lipopolysaccharide binding protein, high-sensitivity C-reactive protein (HS-CRP), polymorphonuclear-elastase, presepsin, various interleukins, tumor necrosis factor α (TNF-α), and granulocyte macrophage colony-stimulating factor (GM-CSF). Results Of the 25 patients with isolated pocket infection (70±13years, 76% male, 40% ICDs), none presented with leukocytosis. In contrast, they had higher serum levels of HS-CRP (p = 0.019) and PCT (p = 0.010) than control patients. Median PCT-level was 0.06 ng/mL (IQR 0.03–0.07 ng/mL) in the study group versus 0.03 ng/mL (IQR 0.02–0.04 ng/mL) in controls. An optimized PCT cut-off value of 0.05 ng/mL suggests pocket infection with a sensitivity of 60% and specificity of 82%. In addition TNF-α- and GM-CSF-levels were lower in the study group. Other biomarkers did not differ between groups. Conclusion Diagnosis of isolated pocket infections requires clinical awareness, physical examination, evaluation of blood cultures and echocardiography assessment. Nevertheless, measurement of PCT- and HS-CRP-levels can aid diagnosis. However, no conclusion can be drawn from normal WBC-values. Clinical trial registration clinicaltrials.gov identifier: NCT01619267

Objectives were to collect information from third year medical students attending Croatian medical schools on prevalence of cigarette smoking and other tobacco use, exposure to second-hand smoke, desire to quit using tobacco, attitudes and training concerning counselling patients on tobacco cessation. Global Health Professionals Survey (GHPS) was conducted in 2005 in all four Croatian medical schools with a census of third year medical students (404 out of 409, response rate 98.5%) using an anonymous, confidential and self-reported questionnaire. More than two thirds (67.4%) of medical students in Croatia have ever smoked cigarettes, and over one third (36.6%) are smoking cigarettes currently. Half of the medical students (50.4%) report exposure to second hand smoke at home. Less than a third of current smokers (30.9%) have received cessation assistance when they tried to quit. Our findings indicate significant tobacco use among medical students in Croatia. There is an urgent need to reduce this harmful behaviour through more comprehensive public health initiatives, provision of support for cessation among health professionals who smoke and provision of training to health professionals to assist their patients with cessation.

Background The placement of an implantable cardioverter defibrillator (ICD) has become routine practice to protect high risk patients from sudden cardiac death. However, implantation-related myocardial micro-damage and its relation to different implantation strategies are poorly characterized. Methods A total of 194 ICD recipients (64±12 years, 83% male, 95% primary prevention of sudden cardiac death, 35% cardiac resynchronization therapy) were randomly assigned to one of three implantation strategies: (1) ICD implantation without any defibrillation threshold (DFT) testing, (2) estimation of the DFT without arrhythmia induction (modified “upper limit of vulnerability (ULV) testing”) or (3) traditional safety margin testing including ventricular arrhythmia induction. High-sensitive Troponin T (hsTnT) levels were determined prior to the implantation and 6 hours after. Results All three groups showed a postoperative increase of hsTnT. The mean delta was 0.031±0.032 ng/ml for patients without DFT testing, 0.080±0.067 ng/ml for the modified ULV-testing and 0.064±0.056 ng/ml for patients with traditional safety margin testing. Delta hsTnT was significantly larger in both of the groups with intraoperative ICD testing compared to the non-testing strategy (p≤0.001 each). There was no statistical difference in delta hsTnT between the two groups with intraoperative ICD testing (p = 0.179). Conclusion High-sensitive Troponin T release during ICD implantation is significantly higher in patients with intraoperative ICD testing using shock applications compared to those without testing. Shock applications, with or without arrhythmia induction, did not result in a significantly different delta hsTnT. Hence, the ICD shock itself and not ventricular fibrillation seems to cause myocardial micro-damage. Trial Registration ClinicalTrials.gov NCT01230086

The aim of this article was to investigate the prevalence of hypertension with selected anthropometric variables in a sample of hospitalized coronary heart disease (CHD) patients in Croatia. This study investigated patients hospitalized in the period of October 1st 2007 until January 7th 2010 because of acute or chronic CHD in various hospitals in Croatia (N = 1,298). Prevalence of hypertension in surveyed patient population was high: 70.1% of participants had raised blood pressure (BP) or previously diagnosed hypertension. Men had statistically significantly higher mean diastolic BP values than women (78.91 +/- 8.97 vs. 77.12 +/- 10.61 mmHg, p = 0.011). Prevalence of hypertension was statistically significantly more frequent in women (80.6% vs. 65.8%, p < 0.001). Hypertension still represents an important problem among hospitalized Croatian CHD patients. Its prevalence, unfortunately, continues to increase in this population, suggesting that there is still great potential for improvement of preventive cardiology standards and measures that have already been undertaken.

With great interest we read the article “Sedation and Analgesia in the Cardiac Electrophysiology Laboratory: A National Survey of Electrophysiologists Investigating the Who, How, and Why?” by Gaitan et al.1 The authors report that an anesthesiologist exclusively performed the conduction of deep sedation during electrophysiologic interventions in only 16% of cases. Furthermore, the authors suspected that patients were transitioned into deep sedation (or even general anesthesia) without supervision by an anesthesiologist.

Tobacco use is the single largest preventable cause of death worldwide. Every year, nearly 5 million people die from tobacco-related illnesses.1 In its preamble, the World Health Organization Framework Convention on Tobacco Control (FCTC) emphasizes the special contribution and vital importance of participation of health professional bodies and academic and healthcare institutions in national and international tobacco control efforts.2 Health authorities, rather than the legislature, are largely responsible for designing, regulating and implementing specific tobacco control policies.3 Non-government organizations, medical societies, public health advocates and other entities can provide advocacy and technical assistance in many areas, including science and policy formulation. Medical students have an important role to play in these efforts, as they represent the future health authorities; this puts them in a position to influence social norms regarding smoking.4 However, few data regarding the knowledge and attitudes of medical students about general and specific tobacco control policies and legislations are available. As such, this study investigated third year medical students’ attitudes towards banning smoking and other tobacco control measures, and their knowledge of general and specific tobacco control policies in Croatia and in medical schools and clinics.

This report presents a case of pulmonary air embolism during implantation of a cardiac resynchronisation therapy system. For left ventricular pacing the thinnest available coronary sinus lead was used in association with a standard subclavian vein introducer sheath. It is hypothesised that the difference of size between the small lead diameter and the subclavian vein introducer sheath may have predisposed to air entry into the venous system.

The aim of the study was to analyze the evidence-based use of antibiotic therapy in the treatment of acute pancreatitis and to identify factors influencing the introduction of antibiotic therapy in the setting of transitional country clinical hospital. This retrospective study was conducted at Department of Internal Medicine at University Hospital Dubrava in Zagreb, Croatia. Data were collected from hospital records of patients treated for acute pancreatitis from January 1st, 2005 till December 31st, 2005. Data collected from patients' histories were compared with indications for antibiotic treatment and antibiotics with demonstrated therapeutic efficacy in acute pancreatitis which were obtained from published literature. Logistic regression was used to identify factors with a significant impact on deciding on the introduction of antibiotic therapy, and multivariate analysis was used to identify factors with a significant impact on the cost of treatment. Statistical significance was set at p < 0.05. Antibiotic therapy was used in 67.7% of patients with acute pancreatitis. Combination of amoxicillin plus clavulanic acid was most frequently administered, either as monotherapy or in combination with metronidazole and/or gentamicin (37.3%), followed by cefuroxime (32.8%) and cefoperazone (26.9%). The choice of antibiotic was appropriate in 35.8% of study patients ; however in 29.9% of patients who were administered antibiotics had no indication for this therapy ; and 46.9% of patients who had indications for receiving antibiotic therapy didn't receive it. In the groups of patients treated with antibiotics, the cost of treatment was significantly higher compared to groups of patients who were not treated with antibiotics (p = 0.0035 ; p = 0.0026). In addition to antibiotic therapy, the cost of treatment was significantly influenced by the length of hospital stay and treatment at intensive care unit. The use of antibiotics in the setting of transitional country university hospital in patients with acute pancreatitis is not evidence-based. Decision on the introduction of antibiotic therapy is not based on objective parameters of disease severity or evidence of therapeutic efficacy of particular antibiotics. The cost of treatment is significantly increased by the use of antibiotic therapy.

Aim was to determine students’ opinions about diagnosis disclosure to the patient and other interested parties. During 2000/2001 academic year, an anonymous survey was conducted among the first-year (200 questionnaires) and sixth-year medical students (200 questionnaires) at the Zagreb University School of Medicine. Students were asked what they would say about the diagnosis to the patient, patient’s family, friend, employer, colleague from work, health insurance agent, another physician, or medical student, if the diagnosis was inoperable lung carcinoma in a 20- and 66-year-old patient vs bacterial pneumonia in patients of the same age. The possibilities were to tell the truth, lie, or refuse to disclose the diagnosis. The response rate was 55%. Students would disclose the true diagnosis to the patient, patient’s family, friend, and employer in case of benign disease more often than in case of malignant disease (p

Background Case reports suggest that the hand-held metal detectors used for security screening generate electromagnetic fields that may interfere with pacemaker and implantable cardioverter-defibrillator (ICD) function. Objective To assess changes in function of pacemakers and ICDs after exposure to hand-held metal detectors. Design Cross-sectional study. Setting Two medical centers in Europe. Patients 388 patients (209 with pacemakers and 179 with ICDs) presenting for routine follow-up of device function between September 2009 and December 2010. Measurements Abnormalities on electrocardiography suggestive of rhythm device malfunction (pacing inhibition, loss of capture, inappropriate mode switch, ventricular oversensing, and spontaneous reprogramming) after 30 seconds of exposure to 2 widely used hand-held metal detectors with a maximal electromagnetic flux density of 6.3 µT. Results No change in device function, including pacing or sensing abnormalities or device reprogramming, was observed in any patient. Limitations The study included a convenience sample of patients, and the number of different device models tested was small. Testing was conducted in 2 clinic settings. Conclusion Hand-held metal detectors did not affect the function of pacemakers or ICDs in this sample. The use of hand-held metal detectors for security screening is probably safe for patients with pacemakers and ICDs, but these findings require confirmation. Primary funding source None.