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Biomedical subjects

Susan S Kim

Publications and source records attributed to Susan S Kim.

9 recordsLinked to original sources
PubMed2006

Rapid assessment of left ventricular systolic function in a pacemaker clinic using a hand-carried ultrasound device.

OBJECTIVE: Pacemaker recipients with left ventricular (LV) dysfunction are potential candidates for upgrades to implantable defibrillators or cardiac resynchronization devices. This study sought to determine if a hand-carried ultrasound (HCU) device could be used for rapid, inexpensive identification of LV dysfunction in a busy pacemaker clinic. MATERIALS AND METHODS: Eighty patients undergoing routine pacemaker check were enrolled. Patients underwent HCU imaging in the sitting position during device interrogation, by an internist who had 20 h of didactic training and 20 practice examinations. LV dysfunction was defined as ejection fraction (EF) <40%. Patients also underwent echocardiography limited to EF assessment by a sonographer using a full-feature platform. RESULTS: The mean age was 75 +/- 13 years; 49% were female. Coronary artery disease was present in 29%; 82% were NYHA class I or II. At the time of HCU imaging, 48% of patients were receiving RV pacing. HCU images were interpretable in 91% (73/80) and required 3.7 +/- 0.9 min to complete. Based on the full-feature echo, LV dysfunction prevalence was 17/80 (21%); 25% of these patients were NYHA class I. The sensitivity of the HCU exam was 75%, specificity was 91%, negative predictive value was 93%, positive predictive value was 71%, and accuracy was 88%. CONCLUSIONS: HCU screening in a pacemaker clinic by a non-cardiologist can rapidly and accurately identify pacemaker recipients with at least moderate LV dysfunction who might be candidates for device upgrades. Ventricular dyssynchrony associated with RV pacing does not limit HCU identification of LV dysfunction.

Aged↗
PubMed2006

Slow pathway ablation for atrioventricular nodal reentry using a right internal jugular vein approach: a case series.

BACKGROUND: Inferior venous access to the right heart is not possible in some patients due to congenital or acquired obstruction of the inferior vena cava (IVC). Although right-sided electrophysiology procedures have been performed successfully in patients with a previously placed IVC filter by direct placement of catheters through the filter, an alternative approach is necessary in some patients. METHODS: This case series describes three patients with an IVC filter who underwent successful ablation of the slow pathway for typical atrioventricular (AV) nodal reentrant tachycardia using a superior vena cava (SVC) approach via the right internal jugular (IJ) vein. Two separate introducer sheaths were placed into the IJ vein using separate punctures. This permitted placement of a standard deflectable ablation catheter and an additional catheter in the right atrium to monitor for ventriculoatrial conduction during the junctional rhythm associated with ablation of the slow AV nodal pathway. RESULTS: Catheter ablation was successful in each patient. The number of radiofrequency current applications was 7, 17, and 27. There were no procedural complications and no patient had recurrent tachycardia during follow-up. CONCLUSIONS: Catheter ablation of the slow AV nodal pathway can be performed successfully and safely in patients with inferior venous barriers to the right heart using an SVC approach via the right IJ vein.

Catheter Ablation↗
PubMed2005

Defibrillation energy requirements using a left anterior chest cutaneous to subcutaneous shocking vector: implications for a total subcutaneous implantable defibrillator.

BACKGROUND: Subcutaneous implantable defibrillators (ICDs) are being developed to facilitate ICD implantation. OBJECTIVE: The purpose of this study was to estimate the human defibrillation energy requirement (DER) using a left chest cutaneous (Q) to subcutaneous (SQ) shocking vector. METHODS: Twenty patients undergoing implantation of an indicated ICD were enrolled (15 males, age = 63 +/- 12 years; ejection fraction = 0.27 +/- 0.14). Defibrillation testing was performed using an investigational system consisting of an external defibrillator and a constructed connector to deliver a shock between a pectoral SQ can and a cardiac apical Q electrode. Two attempts at defibrillation using this configuration were allowed. Stage 1 testing started at 70 J with a step-down/step-up to 50 or 100 J, respectively. Stage 2 testing began at 50 J with a step-down/step-up to 30 or 70 J. RESULTS: During stage 1, a 70-J shock was successful in 7/9 (78%) patients. A second attempt was successful in 7/7 patients using a 50-J shock. In the two remaining patients, a second attempt using a 100-J shock was successful. During stage 2, a 50-J shock was successful in 10/11 (91%) patients. The protocol could not be completed in 2/11 patients. Of the remaining nine patients, a second defibrillation was successful in seven (78%) using a 30-J shock. CONCLUSIONS: The defibrillation energy requirement (DER) of this study vector was 50 J or less in most patients. This low DER supports further investigation of a totally SQ-ICD. However, the DER of 100 J in two patients indicates that further investigation is needed regarding DER variability and safety margins.

Aged↗
PubMed2005

A systems approach to identifying inappropriate use of controlled substances: the need for balance.

BACKGROUND: The diversion, abuse, and inappropriate use of controlled substances remain of concern among health care practitioners, insurers, and policy makers in the United States. The principle of "balance" represents a need to establish a system of control to prevent abuse, trafficking, and diversion of controlled substances, while ensuring their medical availability for legitimate patients. ADMINISTRATIVE DATABASES TO STUDY OUTCOMES AND QUALITY OF CARE: Some models employ pattern recognition within administrative health databases, for example, to examine outcomes and quality of medical care and monitor fraudulent behaviors and inappropriate medical care. Patients' use of resources or variations in practitioners' practice patterns can be examined. A SYSTEMS APPROACH TO ADDRESS INAPPROPRIATE USE OF CONTROLLED SUBSTANCES: A systems approach would require collaboration with medical and pharmacy directors, systems analysts, coding experts, legal experts, and clinicians to develop the claims-based model. Once a patient and/or practitioner with possible diversion or abuse are identified, a second step is required to distinguish inappropriate and appropriate behaviors and medical care. CONCLUSION: Programs to detect misuse of controlled substances must be validated through clinical research, and a consensus should be reached as to what constitutes a breach of accepted medical practice.

Databases as Topic↗
PubMed2004

Identifying controlled substance patterns of utilization requiring evaluation using administrative claims data.

OBJECTIVES: To develop a systems approach to identify, for further evaluation, patients with potential controlled substance misuse or mismanagement using software queries applied to administrative health claims data. STUDY DESIGN: Retrospective validation of the system using insurance claims. PATIENTS AND METHODS: Data from administrative health claims databases representing nearly 7 million individuals younger than 65 years were used by multidisciplinary expert panels to develop and validate controlled substance patterns of utilization requiring evaluation (CS-PURE) criteria. RESULTS: Thirty-four CS-PURE queries were developed in SAS and applied to administrative claims records to identify patients with potential controlled substance misuse or mismanagement. From these, we identified 10 CS-PURE with the highest expert agreement that intervention was warranted. Expert panel agree, ment that CS-PURE correctly identified cases ranged from 48% to 100%, with at least 50% agreement in 9 of 10 CS-PURE. The prevalence rates for CS-PURE ranged from 0.001% to 0.252%. This translates to identifying between 5 and 1116 patients for individual CS-PURE in a 500 000-member health plan. CONCLUSIONS: We developed and empirically validated a group of queries using CS-PURE to identify patients with potential controlled substance misuse or mismanagement that would warrant further evaluation by the treating physician, a quality assurance function, or the medical director. Claims-based CS-PURE identification is generalizable to most health insurers with access to medical and pharmaceutical claims records. Although CS-PURE are not direct measures of misuse, they can direct attention to potential problems to determine if intervention is needed.

Adolescent↗
PubMed2003

Care management for persistent pain: an introduction.

Persistent pain is a frequently occurring condition with significant economic, clinical, and humanistic implications, for both individuals and society. Current literature, however, points to unresolved issues with regard to its identification, assessment, diagnosis, and treatment, and a number of suggestions have been made for improving the quality of care for pain sufferers. Because persistent pain shares many of the salient features of other chronic conditions such as diabetes and congestive heart failure, it is reasonable to believe that the adoption of a coordinated approach to care management could substantially improve the quality of care. Several strategies--including identification, appropriate referral, education, and planning--can and should be implemented to offer comprehensive, individualized treatment alternatives that are not currently available and that improve patient outcomes, including quality of life.

Chronic Disease↗
PubMedDate not supplied

Salmon caviar-induced anaphylactic shock.

Foods, particularly shellfish and nuts, are commonly implicated as causes of anaphylaxis. Salmon caviar, to our knowledge, is an exceedingly rare cause of anaphylactic shock. This study describes a patient who experienced anaphylactic shock on her initial ingestion of caviar. Skin testing and inhibition assays using the enzyme-linked immunosorbent assay were performed. On the percutaneous test, the patient had a 7 x 9 mm/15 x 55 mm wheal/ erythema reaction to caviar liquid. Caviar liquid caused 68, 73, and 73% inhibition of immunoglobulin E (IgE) binding at concentrations of 0.01, 0.1, and 1.0 mg/mL in an enzyme-linked immunosorbent assay, respectively. There was no evidence for IgE antibodies that could be demonstrated to bind to the caviar eggs. Despite using both metoprolol and lisinopril, the patient responded promptly to subcutaneous epinephrine. This report indicates that an IgE-mediated response occurred after caviar ingestion. Although she experienced anaphylactic shock, the patient recovered quickly after epinephrine administration despite routine use of a 3-adrenergic blocker and angiotensin-converting enzyme inhibitor.

Anaphylaxis↗