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Aims To systematic review and meta-analyse the association and mechanistic links between atrial fibrillation (AF) and cognitive impairment. Methods and results PubMed, EMBASE, and Cochrane Library were searched up to 27 March 2021 and yielded 4534 citations. After exclusions, 61 were analysed; 15 and 6 studies reported on the association of AF and cognitive impairment in the general population and post-stroke cohorts, respectively. Thirty-six studies reported on the neuro-pathological changes in patients with AF; of those, 13 reported on silent cerebral infarction (SCI) and 11 reported on cerebral microbleeds (CMB). Atrial fibrillation was associated with 39% increased risk of cognitive impairment in the general population [n = 15: 2 822 974 patients; hazard ratio = 1.39; 95% confidence interval (CI) 1.25–1.53, I2 = 90.3%; follow-up 3.8–25 years]. In the post-stroke cohort, AF was associated with a 2.70-fold increased risk of cognitive impairment [adjusted odds ratio (OR) 2.70; 95% CI 1.66–3.74, I2 = 0.0%; follow-up 0.25–3.78 years]. Atrial fibrillation was associated with cerebral small vessel disease, such as white matter hyperintensities and CMB (n = 8: 3698 patients; OR = 1.38; 95% CI 1.11–1.73, I2 = 0.0%), SCI (n = 13: 6188 patients; OR = 2.11; 95% CI 1.58–2.64, I2 = 0%), and decreased cerebral perfusion and cerebral volume even in the absence of clinical stroke. Conclusion Atrial fibrillation is associated with increased risk of cognitive impairment. The association with cerebral small vessel disease and cerebral atrophy secondary to cardioembolism and cerebral hypoperfusion may suggest a plausible link in the absence of clinical stroke. PROSPERO CRD42018109185.

It is important to carry out the assessment of students correctly and in an unbiased way; but more importantly, the assessment decisions should also be conveyed to the students in an unbiased manner, even if the decisions are negative ones. But here lies the catch – many a times, assessors tend to shy away from conveying such negative decisions properly to the students due to various reasons. This article is an effort to identify such reasons and their implications in the education scenario.

IntroductionAtrial fibrillation (AF) is associated with increased risk of stroke, heart failure and death. Health literacy, an aspect that falls within precision health, has been recognised as an important factor. We will be focusing on the impact of these interventions specifically to AF and its health outcomes.Methods and analysisThis protocol is informed by the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols. The results will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to determine the impacts of health literacy interventions on AF outcomes. Searches will be carried out on databases including MEDLINE, EMBASE, Web of Science, CINAHL, Emcare, Cochrane Library and Google Scholar. Citations will be collected via Endnote 20, then into Covidence for duplicate removal, and article screening. Extraction will occur using a standardised extraction tool and studies will be synthesised using best evidence synthesis. Downs and Black’s checklist will be used for risk of bias and assessment of overall quality of evidence will use the Grading of Recommendations, Assessment, Development and Evaluation approach.Ethics and disseminationApproval from human research ethics committee is not required. Dissemination will occur in peer-reviewed journals and conference presentations.PROSPERO registration numberCRD42022304835.

Objectives: The present study was conducted to evaluate the effect of Team Idea Mapping (TIM) sessions on the problem solving skills of postgraduate (PG) students of Biochemistry, as deduced from retro-pre self-efficacy questionnaire. Materials and Methods: The study was conducted enrolling students pursuing PG-MD course in Medical Biochemistry in a premier medical college. First TIM session was preceded by sensitization of PG students and departmental faculty. In total, four TIM sessions were conducted. Retro-pre self efficacy questionnaire was administered 3 months after the last session. Feedback from the students was collected immediately after last session and satisfaction index was also calculated. Results: The satisfaction index was highest (100) for items stating that TIM sessions promoted interactivity and participatory behaviorand lowest (78) for item stating that TIM sessions promoted reflective behavior respectively. The students expressed enhanced self-efficacy in understanding Biochemistry concepts, clinical application of Biochemistry, problem solving skills in Biochemistry, interpreting laboratory reports, participation in group works and clarifying problems with peers and seniors. However, the sessions were not as effective in instilling technical skills like trouble shooting for analyzer breakdowns. Conclusion: TIM is an effective tool for instilling problem solving skills in medical PG students, additionally fortifying their attitude to work in groups.

Introduction Successful pulmonary vein isolation (PVI) for atrial fibrillation (AF) depends on the formation of durable transmural lesions. Recently, novel indices have emerged to guide lesion delivery. The aim of the systematic review of literature was to determine AF recurrence following ablation guided by indices incorporating force, power and time, and compare acute procedural outcomes and 12-month AF recurrence with ablation guided by contact force (CF) guided only. Methods PubMed, EMBASE, and Web of Science Core Collection databases were searched on 27 January 2020 using the keywords; catheter ablation, ablation index (AI), lesion size index (LSI), contact force, atrial fibrillation. Results After exclusions, seven studies were included in the analysis. AI-guided catheter ablation was associated with a 91% (n=5, 0.91 95% CI; 0.88–0.93) and 80% (n=5, 0.80, 95% CI; 0.77–0.84) freedom from AF at 12 months with and without the use of anti-arhythmic drugs respectively. As compared to CF guided ablation, AI-guided catheter ablation was associated with a 49% increase in successful first pass isolation (n=3; RR: 1.49, 95% CI; 1.38, 1.61), a 50% decrease in number of acute reconnections (n=4; RR: 0.50, 95% CI; 0.39–0.65) and a 22% (n=4, RR: 1.22, 95% CI; 1.10–1.35) increase in AF freedom without anti-arrhythmic drugs at 12 months. Conclusions Radiofrequency ablation guided by AI was associated with higher successful first pass isolation and lower rates of acute reconnection which translates to greater freedom from AF at 12 months [CRD42019131469].

The epidemiology of atrial fibrillation (AF) amongst Indigenous populations remains poorly characterised. We studied hospitalisations for AF in Central Australia, the most populous Indigenous region in the country.Patients with a diagnosis of AF admitted to Alice Springs Hospital, the only secondary health care facility and provider of cardiac care in remote Central Australia, were identified from 2006 to 2016. Age and gender-specific hospitalised AF prevalence, comorbidities, and CHAOf 57,056 admitted patients over the study period, 1,210 (2.1%; 46% Indigenous) had a diagnosis of AF. For Indigenous and non-Indigenous individuals45 years, hospitalised AF prevalence per 10,000 population was 105 (CI 84-131) and 50 (CI 36-68) in males (ratio=2.10), and 98 (CI 77-123) and 12 (CI 6-23) in females (ratio=7.92), respectively. For Indigenous and non-Indigenous individuals ≥65 years, hospitalised AF prevalence per 10,000 was 1,577 (CI 1,194-2,026) and 2,326 (CI 2,047-2,623) in males (ratio=0.68), and 1,713 (CI 1,395-2,069) and 1,897 (1,623-2,195) in females (ratio=0.90). Indigenous individuals had higher rates of cardiometabolic comorbidities, particularly at younger ages. CHAThe prevalence of hospitalised AF amongst Indigenous people in remote Central Australia was significantly higher than in non-Indigenous individuals, particularly in younger age groups and females. Indigenous individuals with hospitalised AF also had a markedly greater prevalence of cardiometabolic comorbidities and elevated stroke risk. These data suggest that AF may be contributing to the gap in morbidity and mortality experienced by Indigenous Australians.

Objectives: The objective of the study was to evaluate the perception of the undergraduate students about the online platform developed, through a long-term, qualitative study. COVID-19 enforced initial lockdown and later closing of educational institutes, including medical colleges in India. The circumstances lead to adoption of online means of teaching for teaching the medical undergraduate students. An interactive dual-mode online platform was introduced for teaching and assessment of undergraduate students in our institute also. Materials and Methods: Narrative experiences and reflections of students while attending online classes through the designed and delivered “interactive dual-mode online platform” were collected through open ended, anonymous Google forms. Results: Students were satisfied with the online learning as a stop-gap arrangement. Although they were facing technical snags and internet issues, they were happy that their syllabus was being covered and they were receiving formative assessment, in whatever quantity and mode possible. However, they were concerned about the lack of clinical training. Conclusion: To tide over crisis period, online teaching can be used, but one should shift to onsite teaching as soon as possible, particularly for medical students.

Heart rate reserve (HRR) is used to guide exercise training in patients with cardiovascular disease, primarily as a surrogate for oxygen uptake reserve (VOinf2/infR) as a marker of metabolic demand. However, the relationship between HRR and VOinf2/infR in patients with atrial fibrillation (AF) is not well described. We aimed to assess the validity of HRR as a surrogate for VOinf2/infR to guide exercise intensity in AF patients.One hundred one patients with non-permanent AF undertaking a cardiopulmonary exercise test (CPET) were prospectively enrolled. HR and VOinf2/infvalues were recorded throughout exercise to determine HRR and VOinf2/infR at each workload. Linear regression was used to calculate the slope and y-intercept for HRR versus VOinf2/infR with an equivalent slope defined as 1 and y-intercept of 0. The impact of rhythm during exercise, beta blockers and chronotropic incompetence (CI) on the HRR-VOinf2/infR relationship was also assessed.The slope of HRR-VOinf2/infR was 0.79±0.4, indicating a significant difference from an assumed slope of 1.0 (mean difference: -0.21, 95% CI: -0.30 to -0.12, P0.001). The mean y-intercept slope was 20.1±41.6, differing significantly from 0 (mean difference: 20.1, 95% CI: 11.9-28.3, P0.001). The presence of AF during CPET, beta-blockers or chronotropic incompetence did not independently alter the association between VOinf2/infR and HRR.HRR is not equivalent to VOinf2/infR in AF patients. There was no significant effect of rhythm status, chronotropic incompetence or beta-blockers on this relationship. These findings highlight that the HR prescription of exercise intensity in AF patients should be guided by an individualised HRR-VOinf2/infR relationship.

An 8 ton per year manufacturing facility is described based on the framework for integrated and continuous bioprocessing (ICB) common to all known biopharmaceutical implementations. While the output of this plant rivals some of the largest fed‐batch plants in the world, the equipment inside the plant is relatively small: the plant consists of four 2000 L single‐use bioreactors and has a maximum flow rate of 13 L/min. The equipment and facility for the ICB framework is described in sufficient detail to allow biopharmaceutical companies, vendors, contract manufacturers to build or buy their own systems. The design will allow the creation of a global ICB ecosystem that will transform biopharmaceutical manufacturing. The design is fully backward compatible with legacy fed‐batch processes. A clinical production scale is described that can produce smaller batch sizes with the same equipment as that used at the commercial scale. The design described allows the production of as little as 10 g to nearly 35 kg of drug substance per day., An 8 ton per year manufacturing facility is described based on the framework for integrated and continuous bioprocessing (ICB) common to all known biopharmaceutical implementations. The equipment and facility for the ICB framework is described in sufficient detail to allow biopharmaceutical companies, vendors, contract manufacturers to build or buy their own systems. The design will allow the creation of a global ICB ecosystem that will transform biopharmaceutical manufacturing.

Objectives This study sought to evaluate the effect of weight loss on the atrial substrate for atrial fibrillation (AF). Background Whether weight loss can reverse the atrial substrate of ...

Prior studies have demonstrated that anticoagulation underutilisation for atrial fibrillation (AF) and elevated stroke risk is common. However, there is little data on factors associated with appropriate anticoagulation, particularly in Indigenous Australians who face a disproportionate burden of AF and stroke. We thus sought to determine factors associated with anticoagulation use in Australians with AF.Administrative, clinical, prescriptive and laboratory data were linked and aggregated over a 12-year period.Single tertiary teaching hospital.19,305 (98%) and 308 (2%) consecutive non-Indigenous and Indigenous Australians with AF identified from administrative databases.Associations of anticoagulation use according to ethnicity.Significant independent predictors of anticoagulation use included hypertension (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.17-1.34; p0.001), diabetes (OR 1.14, 95% CI 1.05-1.24; p=0.002), heart failure (OR 1.54 95% CI 1.43-1.66; p0.001) and prior stroke or transient ischaemic attack (OR 2.07, 95% CI 1.84-2.33; p0.001). In contrast, increasing age (OR 0.99, 95% CI 0.98-0.99; p0.001), female gender (OR 0.88, 95% CI 0.82-0.93; p0.001), and vascular disease (OR 0.72, 95% CI 0.64-0.80; p0.001) were significant predictors of no anticoagulation. Hypertension was associated with less anticoagulation use in Indigenous compared to non-Indigenous Australians (p=0.02).Anticoagulation for AF was suboptimal in both Indigenous and non-Indigenous Australians. Older age, female gender, and comorbid vascular disease were found to be negatively associated with anticoagulation. Importantly, hypertension may also be under-recognised as a stroke risk factor in Indigenous Australians. Future efforts to encourage anticoagulation use in accordance with guideline recommendations is likely to reduce the burden of AF-related stroke in both Indigenous and non-Indigenous populations.

Background To evaluate the risk for ventricular arrhythmia (VA) and sudden cardiac death (SCD) in patients with cardiac sarcoidosis (CS) and determine the prognostic factors. Methods and results PUBMED, EMBASE and SCOPUS were searched up to 14th April 2020. Studies reporting the incidence of SCD, appropriate ICD therapy in CS patients, or relevant prognostic information in patients having undergone MRI, PET, or programmed electrical stimulation (PES) were included. Nineteen studies consisting of 1247 patients, reported the risk of ICD therapies or SCD over a follow-up period of 1.7–7 years. 22.7% (n = 9; 22.7, 95%CI [16.10–29.36]) of patients in primary and 58.4% (n = 9; 58.42, 95% CI [38.61–78.22]) in secondary prevention cohorts experienced appropriate device therapy or SCD events. 18% (n = 2; 18, 95%CI [14–23]) of patients received ≥5 appropriate therapies. 9 out of 664 patients with confirmed cardiac sarcoidosis but without implanted ICDs died suddenly. 17.9% of patients (n = 4; 17.9, 95%CI [10.80–25.03]) experienced inappropriate device therapy. Positive LGE-MRI and PES were associated with an 8.6-fold (n = 6; RR = 8.60, 95%CI [3.80–19.48]) and 9-fold (n = 5; RR = 9.07, 95%CI [4.65–17.68]) increased risk of VA respectively. Positive LGE-MRI and PET with associated with a 6.8-fold (n = 12; RR = 6.82, 95%CI [4.57–10.18]) and 3.4-fold (n = 7; RR = 3.41, 95%CI [2.03–5.74]) respectively for increased risk of major adverse cardiac events. Conclusions The risk of appropriate ICD therapy or sudden cardiac death is high in patients with CS. The presence of LGE-MRI and positive electrophysiology study identify patients at increased risk of ventricular arrhythmias. [CRD42019124220]

Obesity and metabolic syndrome are both associated with atrial fibrillation (AF). Recent research has revealed new insights into the effects of cardiac and noncardiac adipose tissue in mediating these associations. Cardiac adipose tissue, such as epicardial fat, is a powerful predictor of AF and leads to myocardial fatty infiltration and adipokine-induced fibrosis. Increases in noncardiac adipose tissue cause deleterious metabolic, neurohormonal, hemodynamic, and structural changes. Weight loss leads to a regression of adiposity-related fibrosis, structural abnormalities, conduction abnormalities, and reduction in AF burden. As a result, weight loss and risk factor treatment is now an established pillar of AF management.

Background Anaemia frequently co-exists with atrial fibrillation (AF) and has been variably associated with worse outcomes. We performed a systematic review and meta-analysis to comprehensively assess the effect of anaemia on mortality, stroke/systemic thromboembolism and bleeding events in patients with AF. Methods MEDLINE and Embase were searched from inception until May 2020. Studies examining associations of anaemia with the above outcomes in AF patients were included, and maximally adjusted hazard ratios (HRs) meta-analysed. PROSPERO registration number CRD42020171113. Results Twenty-eight studies involving 365,484 patients (41% female, mean age 74.7 years) were included. The average study follow-up ranged from 0.2 to 4.0 years, and prevalence of anaemia was 16%. Anaemia was associated with a 78% increase in all-cause mortality (HR 1.78, 95% CI 1.44-2.20), 60% increase in cardiovascular mortality (HR 1.60, 95% CI 1.17-2.19), 134% increase in non-cardiovascular mortality (HR 2.34, 95% CI 1.58-3.47) 15% increase in stroke/systemic thromboembolism (HR 1.15, 95% CI 1.01-1.31), 78% increase in major bleeding (HR 1.78, 95% CI 1.54-2.05), and 77% increase in gastrointestinal bleeding (HR 1.77, 95% CI 1.23-2.55). Sensitivity analyses including studies that reported odds ratios did not result in any material change. Conclusion Anaemia is a frequently observed comorbidity in patients with AF, and is associated with an increased risk of all-cause, cardiovascular and non-cardiovascular mortality, stroke/systemic thromboembolism, and major and gastrointestinal bleeding. Future studies are required to explore the causes of anaemia in AF, and whether investigation and treatment may be clinically beneficial in affected individuals. This article is protected by copyright. All rights reserved.

Process of identity formation in any profession is a unique journey and is influenced by many internal and external factors. The factors which enable the development of professional identity of medical educators have been sparsely studied.The aim of this study was to identify the factors which influence the professional identity formation (PIF) of medical educators and the competencies needed to develop such identity, through their self-reflection.A descriptive exploratory study was designed and executed through self-administered Google Forms having open-ended questions. Themes were generated and concept map was designed.Internal zeal, mentoring, networking, self-directed learning, supportive workplace environment, and recognition at the workplace were some of the subthemes generated as influencing factors enabling PIF as a medical educator. Some of the competencies reported were subject knowledge, leadership skills, self-directed learning, and ability to carry out educational scholarship projects.The study elucidates various factors influencing PIF of medical educators, as reflected by medical educators themselves. Institutional policies can be framed accordingly to facilitate the process of PIF of medical educators.

Introduction: Amiodarone is a highly effective antiarrhythmic-drug with well recognized toxic side-effects. The effects of the drug late in patients with atrial fibrillation (AF) is not well described. Methods and results: We present a single centre prospectively collected series of patients with thyrotoxicosis occurring late after the cessation of amiodarone. Between 2006 and 2018, 8 patients were identified with amiodarone induced thyrotoxicosis (AIT). Amiodarone was prescribed for AF in 7 patients and ventricular tachycardia in 1 patient. Mean duration of therapy was 329 [42–1092] days, mean dose of 200 ± 103.5 mg/day. Amiodarone use was short term (

Online teaching has the potential to transcend geographical boundaries, is flexible, learner centered and can help students develop self-directed learning skills. The recently introduced competency-based curriculum has also advocated e-learning as an indispensable tool for self-directed learning. For effective online learning, good online teaching practices should be adopted. These include alignment of online teaching and learning with delivery of curriculum and objectives, synchronous, and asynchronous interaction between teacher and student, encouraging the development of higher-order thinking skills, active learning, and self-directed learning in students. In addition, good online teaching practices should have an inbuilt component of feedback and provide for effective time management, respect for diverse talents and ways of learning with continuous monitoring and mentoring of the learners. Online assessments, both formative and summative should also aim to ensure student involvement in the process. Capacity building of faculty through faculty development programs for the development of specific competencies such as social competency, pedagogical competency, managerial competency, and technical competency in the times of COVID-19 is now recognized as the need of the hour. Although online teaching and learning in medical education is new, it has the potential to become mainstream in future.

The COVID-19 pandemic poses a significant stress on health resources in Australia. The Heart Rhythm Council of the Cardiac Society of Australia and New Zealand aims to provide a framework for efficient resource utilisation balanced with competing risks when appropriately treating patients with cardiac arrhythmias. This document provides practical recommendations for the electrophysiology (EP) and cardiac implantable electronic devices (CIED) services in Australia. The document will be updated regularly as new evidence and knowledge is gained with time.

Objective To examine the potential association of atrial fibrillation (AF) to syncope and falls, we undertook a systematic review and meta-analysis given the increasing prevalence of AF in older adults as well as emerging data that it is a risk factor for dementia. Patients and Methods CENTRAL, PubMed, and EMBASE databases were searched from inception to January 31, 2019, to retrieve relevant studies. Search terms consisted of MeSH, tree headings, and keywords relating patients with "AF," "falls," "syncope," and "postural hypotension." When possible; results were pooled using a random-effects model. Results A total of 10 studies were included, with 7 studies (36,444 patients; mean ± SD age, 72±10 years) reporting an association between AF and falls and 3 studies (6769 patients; mean ± SD age, 65±3 years) reporting an association between AF and syncope. Pooled analyses demonstrate that AF is independently associated with falls (odds ratio, 1.19; 95% CI, 1.07-1.33; P=.001) and syncope (odds ratio, 1.88; 95% CI, 1.20-2.94; P=.006). There was overall moderate bias and low-moderate heterogeneity (I2=37%; P=.11) for falls and moderate bias with low statistical heterogeneity (I2=0%; P=.44) for syncope. Persistent AF, but not paroxysmal AF, was associated with orthostatic intolerance in 1 study (4408 patients; mean ± SD age, 66±6 years). Conclusion AF is independently associated with syncope and falls in older adults. Further studies are needed to delineate mechanistic links and to guide management to improve outcomes in these patients. Trial Registration PROSPERO: trial identifier: CRD4201810721.