Explore the vast range of titles available.

Background Longitudinal wall motion of the right ventricle (RV), generally quantified as tricuspid annular systolic excursion (TAPSE), has been well studied in pulmonary hypertension (PH). In contrast, transverse wall motion has been examined less. Therefore, the aim of this study was to evaluate regional RV transverse wall motion in PH, and its relation to global RV pump function, quantified as RV ejection fraction (RVEF). Methods In 101 PH patients and 29 control subjects cardiovascular magnetic resonance was performed. From four-chamber cine imaging, RV transverse motion was quantified as the change of the septum-free-wall (SF) distance between end-diastole and end-systole at seven levels along an apex-to-base axis. For each level, regional absolute and fractional transverse distance change (SFD and fractional- SFD) were computed and related to RVEF. Longitudinal measures, including TAPSE and fractional tricuspid-annulus-apex distance change ( fractional -TAAD) were evaluated for comparison. Results Transverse wall motion was significantly reduced at all levels compared to control subjects (p < 0.001). For all levels, fractional -SFD and SFD were related to RVEF, with the strongest relation at mid RV (R 2 = 0.70, p < 0.001 and R 2 = 0.62, p < 0.001). For TAPSE and fractional -TAAD, weaker relations with RVEF were found (R 2 = 0.21, p < 0.001 and R 2 = 0.27, p < 0.001). Conclusions Regional transverse wall movements provide important information of RV function in PH. Compared to longitudinal motion, transverse motion at mid RV reveals a significantly stronger relationship with RVEF and thereby might be a better predictor for RV function.

To determine the diagnostic accuracy of ultrasound for detecting distal forearm fractures. A systematic review and diagnostic meta-analysis was performed according to the PRISMA statement. We searched MEDLINE, Web of Science and the Cochrane Library from inception to September 2015. All prospective studies of the diagnostic accuracy of ultrasound versus radiography as the reference standard were included. We excluded studies with a retrospective design and those with evidence of verification bias. We assessed the methodological quality of the included studies with the QUADAS-2 tool. We performed a meta-analysis of studies evaluating ultrasound to calculate the pooled sensitivity and specificity with 95% confidence intervals (CI95%) using a bivariate model with random effects. Subgroup and sensitivity analysis were used to examine the effect of methodological differences and other study characteristics. Out of 867 publications we included 16 studies with 1,204 patients and 641 fractures. The pooled test characteristics for ultrasound were: sensitivity 97% (CI95% 93-99%), specificity 95% (CI95% 89-98%), positive likelihood ratio (LR) 20.0 (8.5-47.2) and negative LR 0.03 (0.01-0.08). The corresponding pooled diagnostic odds ratio (DOR) was 667 (142-3,133). Apparent differences were shown for method of viewing, with the 6-view method showing higher specificity, positive LR, and DOR, compared to the 4-view method. The present meta-analysis showed that ultrasound has a high accuracy for the diagnosis of distal forearm fractures in children when used by proper viewing method. Based on this, ultrasound should be considered a reliable alternative, which has the advantages of being radiation free.

Background Because of high demand on hospital beds, hospitals seek to reduce patients’ length of stay (LOS) while preserving the quality of care. In addition to usual intermittent vital sign monitoring, continuous monitoring might help to assess the patient’s risk of deterioration, in order to improve the discharge process and reduce LOS. The primary aim of this monocenter randomized controlled trial is to assess the effect of continuous monitoring in an acute admission ward (AAW) on the percentage of patients who are discharged safely. Methods A total of 800 patients admitted to the AAW, for whom it is equivocal whether they can be discharged directly after their AAW stay, will be randomized to either receive usual care without (control group) or with additional continuous monitoring of heart rate, respiratory rate, posture, and activity, using a wearable sensor (sensor group). Continuous monitoring data are provided to healthcare professionals and used in the discharge decision. The wearable sensor keeps collecting data for 14 days. After 14 days, all patients fill in a questionnaire to assess healthcare use after discharge and, if applicable, their experience with the wearable sensor. The primary outcome is the difference in the percentage of patients who are safely discharged home directly from the AAW between the control and sensor group. Secondary outcomes include hospital LOS, AAW LOS, intensive care unit (ICU) admissions, Rapid Response Team calls, and unplanned readmissions within 30 days. Furthermore, facilitators and barriers for implementing continuous monitoring in the AAW and at home will be investigated. Discussion Clinical effects of continuous monitoring have already been investigated in specific patient populations for multiple purposes, e.g., in reducing the number of ICU admissions. However, to our knowledge, this is the first Randomized Controlled Trial to investigate effects of continuous monitoring in a broad patient population in the AAW. Trial registration https://clinicaltrials.gov/ct2/show/NCT05181111 . Registered on 6 January 2022. Start of recruitment: 7 December 2021.

Background Emergency Departments (EDs) increasingly manage patients in acute psychiatric crisis, often facing delays due to limited on-site psychiatric specialists. Telepsychiatry offers a potential solution, but its feasibility and acceptance in Dutch EDs remain underexplored. This pilot study aimed to assess the feasibility, technical aspects, and acceptance of telepsychiatry consultations in a Dutch ED setting. Methods This two-phase observational pilot study was conducted at a large hospital ED in the Netherlands. During a three-month baseline-phase (Aug–Oct 2024), eligible adult patients received standard in-person psychiatric consultations. In the subsequent three-month pilot-phase (Nov 2024–Jan 2025), patients were evaluated via secure video consultation with a remote psychiatrist. To assess feasibility and technical execution, lead times, including consult request and consult start time, time until disposition decision and ED length of stay, were recorded. To further evaluate technical execution and acceptance, patients and ED staff were asked to complete satisfaction questionnaires, after each telepsychiatry consult. Results Eleven patients were included during the baseline-phase and 17 during the pilot-phase. All telepsychiatry consultations were completed successfully, with only minor technical issues. Patient satisfaction was high, and psychiatrists and ED staff rated the consultations as effective and efficient. Furthermore, mean time from consult request to disposition decision was about an hour less during the telepsychiatry phase (approximately 45 vs. 106 min in the baseline phase). Conclusion Telepsychiatry in the ED appears feasible, technically reliable, and well accepted by both patients and ED staff. This pilot study supports further exploration of telepsychiatry as a tool to enhance emergency psychiatric care delivery in the Netherlands.

Interventricular mechanical dyssynchrony is a characteristic of pulmonary hypertension. We studied the role of right ventricular (RV) wall stress in the recovery of interventricular dyssynchrony, after pulmonary endarterectomy (PEA) in chronic thromboembolic pulmonary hypertension (CTEPH). In 13 consecutive patients with CTEPH, before and 6 months after pulmonary endarterectomy, cardiovascular magnetic resonance myocardial tagging was applied. For the left ventricular (LV) and RV free walls, the time to peak (Tpeak) of circumferential shortening (strain) was calculated. Pulmonary Artery Pressure (PAP) was measured by right heart catheterization within 48 hours of PEA. Then the RV free wall systolic wall stress was calculated by the Laplace law. After PEA, the left to right free wall delay (L-R delay) in Tpeak strain decreased from 97 ± 49 ms to -4 ± 51 ms (P < 0.001), which was not different from normal reference values of -35 ± 10 ms (P = 0.18). The RV wall stress decreased significantly from 15.2 ± 6.4 kPa to 5.7 ± 3.4 kPa (P < 0.001), which was not different from normal reference values of 5.3 ± 1.39 kPa (P = 0.78). The reduction of L-R delay in Tpeak was more strongly associated with the reduction in RV wall stress (r = 0.69,P = 0.007) than with the reduction in systolic PAP (r = 0.53, P = 0.07). The reduction of L-R delay in Tpeak was not associated with estimates of the reduction in RV radius (r = 0.37,P = 0.21) or increase in RV systolic wall thickness (r = 0.19,P = 0.53). After PEA for CTEPH, the RV and LV peak strains are resynchronized. The reduction in systolic RV wall stress plays a key role in this resynchronization.

BackgroundIn pulmonary arterial hypertension (PAH) a prolonged time interval between pulmonary valve closure and tricuspid valve opening is found. This period is interpreted as prolonged right ventricular (RV) relaxation, and thus a reflection of diastolic dysfunction. This concept recently has been questioned, since it was shown that RV contraction continues after pulmonary valve closure causing a post-systolic contraction period.ObjectivesTo investigate in PAH whether the increased RV post-systolic isovolumic period is caused by either an additional post-systolic contraction period, or an increased relaxation period (diastolic dysfunction).Methods23 patients with PAH (mean pulmonary arterial pressure 54±12 mm Hg), and 18 healthy subjects were studied using cardiac MRI. In a RV two-chamber view, times of pulmonary valve closure (TPVC) and tricuspid valve opening (TTVO) were measured, defining the total post-systolic isovolumic period. Time to peak of RV free wall contraction (TpeakRV) was determined with myocardial tagging. Post-systolic contraction and relaxation periods were defined as the time intervals between TPVC and TpeakRV and between TpeakRV and TTVO, respectively. These periods were normalised to an RR interval.ResultsThe total post-systolic isovolumic period was longer in patients than in healthy subjects (0.15±0.04 vs 0.04±0.02, p<0.001), but the relaxation period was not different (0.06±0.02 vs 0.05±0.02, p=0.09). The post-systolic contraction period in patients was strongly related to the total post-systolic isovolumic period (y=0.98x–0.05; r=0.89, p<0.001), and was associated with disease severity.ConclusionIn PAH, the prolonged post-systolic isovolumic period is caused by an additional post-systolic contraction period, rather than by an increased relaxation period.

In Acute Admission Wards, vital signs are commonly measured only intermittently. This may result in failure to detect early signs of patient deterioration and impede timely identification of patient stability, ultimately leading to prolonged stays and avoidable hospital admissions. Therefore, continuous vital sign monitoring may improve hospital efficacy. The objective of this randomized controlled trial was to evaluate the effect of continuous monitoring on the proportion of patients safely discharged home directly from an Acute Admission Ward. Patients were randomized to either the control group, which received usual care, or the sensor group, which additionally received continuous monitoring using a wearable sensor. The continuous measurements could be considered in discharge decision-making by physicians during the daily bedside rounds. Safe discharge was defined as no unplanned readmissions, emergency department revisits or deaths, within 30 days after discharge. Additionally, length of stay, the number of Intensive Care Unit admissions and Rapid Response Team calls were assessed. In total, 400 patients were randomized, of which 394 completed follow-up, with 196 assigned to the sensor group and 198 to the control group. The proportion of patients safely discharged home was 33.2% in the sensor group and 30.8% in the control group (p = 0.62). No significant differences were observed in secondary outcomes. The trial was terminated prematurely due to futility. In conclusion, continuous monitoring did not have an effect on the proportion of patients safely discharged from an Acute Admission Ward. Implementation challenges of continuous monitoring may have contributed to the lack of effect observed. Trial registration: https://clinicaltrials.gov/ct2/show/NCT05181111. Registered: January 6, 2022.

Background Missed fractures in the emergency department (ED) are common and may lead to patient morbidity. Aim To determine the rate and nature of radiographic discrepancies between ED treating physicians, radiologists and trauma/orthopaedic surgeons and the clinical consequences of delayed diagnosis. A secondary outcome measurement is the timeframe in which most fractures were missed. Methods A single-centre retrospective analysis of all missed fractures in a general teaching hospital from 2012 to 2017 was performed. Data regarding missed fractures were provided by the hospital’s complication list and related database. Additional data were retrieved from the electronic medical records as required for the study. Results A total of 25,957 fractures were treated at our ED. Initially, 289 fractures were missed by ED treating physicians (1.1%). The most frequently missed fractures were the elbow (28.6%) and wrist (20.8%) in children, the foot (17.2%) in adults and the pelvis and hip (37.3%) in elderly patients. Patients required surgery in 9.3% of missed fractures, received immobilization by a cast or brace in 45.7%, had no treatment alterations during the first week in 38.1%. Follow-up data were lacking for 6.9% of cases. 49% of all missed fractures took place between 4 PM and 9 PM. There is a discrepancy in percentages of correctly diagnosed fractures and missed fractures between 5 PM and 3 AM. Conclusion Adequate training of ED treating physicians in radiographic interpretation is essential in order to increase diagnostic accuracy. A daily multidisciplinary radiology meeting is very effective in detecting missed fractures.