Saint Vincent Health System, commonly known as simply St. Vincent's, is medical facility located in Erie, Pennsylvania. It is one of the largest employers in the Erie region. The complex features several large buildings, including a heart attack heart care unit..
BACKGROUND:For patients with atrial fibrillation, the use of oral anticoagulant therapy to prevent stroke is limited by the risk of bleeding. Left atrial appendage closure is considered for patients who are unsuitable candidates for long-term anticoagulation, but its role in patients who are eligible for anticoagulants has not been established. METHODS:In this ongoing, prospective, international, randomized trial involving patients with atrial fibrillation who were suitable candidates for anticoagulation, we randomly assigned patients in a 1:1 ratio to receive either device-based left atrial appendage closure (device group) or non-vitamin K antagonist oral anticoagulant (NOAC) therapy (anticoagulation group). The primary efficacy end point - a composite of death from cardiovascular causes, stroke, or systemic embolism - was tested for noninferiority (noninferiority margin, 4.8 percentage points) after 3 years of follow-up. The primary safety end point, non-procedure-related bleeding, was tested for superiority. RESULTS:Of the 3000 patients who underwent randomization, 1499 were assigned to the device group and 1501 to the anticoagulation group. The mean (±SD) age of the patients was 71.7±7.5 years, 31.9% of the patients were women, and the mean CHA2DS2-VASc score was 3.5±1.3. At 3 years, a primary efficacy end-point event had occurred in 81 patients (Kaplan-Meier estimate, 5.7%) in the device group and in 65 patients (Kaplan-Meier estimate, 4.8%) in the anticoagulation group (difference, 0.9 percentage points; 95% confidence interval [CI], -0.8 to 2.6; P<0.001 for noninferiority). Non-procedure-related bleeding occurred in 154 patients (Kaplan-Meier estimate, 10.9%) in the device group and in 260 patients (Kaplan-Meier estimate, 19.0%) in the anticoagulation group (hazard ratio, 0.55; 95% CI, 0.45 to 0.67; P<0.001 for superiority). CONCLUSIONS:Among patients with atrial fibrillation who were candidates for anticoagulation, device-based left atrial appendage closure was noninferior to NOAC therapy with respect to a composite of death from cardiovascular causes, stroke, or systemic embolism and was superior to NOAC therapy for non-procedure-related bleeding at 3 years. (Funded by Boston Scientific; CHAMPION-AF ClinicalTrials.gov number, NCT04394546.).
Objective: This retrospective chart review examine the relationship between blood loss in postpartum hemorrhage and the change in PHQ-9 scores in women receiving prenatal care at Ascension Joshua Max Simon Primary Care Center Women’s Health Clinic and delivered at Ascension St. Vincent Women’s Hospital-Indianapolis. Methods: This was a retrospective chart review of women with a postpartum hemorrhage from January 1, 2023 through December 31st, 2023. We assessed variables including mode of delivery, gestational age, first live birth, age of the patient at delivery, hemorrhage medications/devices utilized, and range of time between PHQ9 surveys. Previable and IUFDs were excluded from the study. Results: We identified 700 patients who received prenatal care, postpartum care, and delivered at Ascension St. Vincent Women’s Hospital-Indianapolis. Of these 700 patients, 71 patients had a postpartum hemorrhage (10.1%). Of these 71 patients, 25 patients had a PHQ 9 recorded at their NOB and their postpartum appointment (35.2%). Overall, the majority of patients at their NOB appointment and 6 week postpartum appointment did not have any depression (72%, 80%). A multiple linear regression model was unable to be performed assessing mode of delivery, gestational age at delivery, parity, patient age at delivery and the presence of hemorrhage medications due to sample size. Conclusion: When assessing the relationship between the amount of blood loss in PPH and worsening PHQ-9 scores there was no statistically significant association even when excluding one outlier (t=0.67, p=0.51). Only 35.2% of patients who had a postpartum hemorrhage had a PHQ 9 recorded at their NOB and postpartum appointment.
ABSTRAK Kasus perundungan/bullying di Sekolah Dasar Katolik (SDK) Santo Yusup, Trapodo, Sidoarjo masih terjadi hingga saat ini, berdasarkan hasil wawancara dalam 3 bulan terakhir tercatat terdapat beberapa laporan ditemukan kasus bullying verbal seperti ejekan, menggoda teman, menyampaikan komentar buruk. Selain itu, didapati agrevitas sosial seperti pengucilan antarsiswa, tidak mengajak teman bermain atau berkelompok. Serta tindakan agrevitas fisik seperti memukul, mencubit dan menarik rambut. Hal ini terjadi karena beberapa siswa kurang memahami bentuk dari tindakan bullying maupun kekerasan, guru belum pernah mendapat pelatihan terkait perlindungan anak dan pihak sekolah belum memiliki struktur formal dan diagram alir (Satuan Operasional Prosedur) dalam pelaporan mengenai adanya tindak perundungan maupun kekerasan yang terjadi di sekolah. Sedangkan orang tua juga belum mendapatkan pemahaman pentingnya pengawasan perilaku anak di luar sekolah. Kegiatan pelatihan ini bertujuan untuk memperluas wawasan dan meningkatkan pemahaman peserta, khususnya komunitas sekolah serta orang tua dalam pencegahan kekerasan melalui pemberdayaan serta inisiasi pembentukan Satgas Anti-Bullying dan Kekerasan Seksual. Kegiatan dilaksanakan selama tiga hari di SDK Santo Yusup Tropodo dengan sasaran siswa, guru, dan orang tua. Total peserta terdiri atas ±400 siswa serta 75 guru dan orang tua. Pendekatan yang diterapkan dalam kegiatan ini ialah participatory learning and action (PLA), yang dilaksanakan melalui serangkaian tahapan seperti sosialisasi, pelatihan, penerapan teknologi, pendampingan serta upaya menjaga keberlanjutan program, dengan media berupa video edukatif, buku saku, poster, serta instrumen evaluasi pre-test dan post-test. Hasil pre-test dan post-test menunjukkan peningkatan rata-rata skor dari 82,27% menjadi 94,13% (kenaikan 11,86%). Peserta menunjukkan peningkatan pemahaman, keaktifan, serta komitmen untuk membentuk Satgas sekolah. Peningkatan ini menunjukkan keefektivitasan pelatihan partisipatif dalam memberdayakan komunitas sekolah sebagai langkah awal mitigasi bullying dan kekerasan di lingkungan pendidikan dasar. Kegiatan ini membuktikan bahwa pelatihan pemberdayaan pemula dapat menjadi strategi berkelanjutan dalam menciptakan lingkungan belajar yang aman dan ramah anak. Kata Kunci: Pelatihan, Pemberdayaan Sekolah, Komunitas Sekolah, Bullying, Kekerasan Seksual, Satgas. ABSTRACT Bullying still occurs at Santo Yusup Catholic Elementary School (SDK), Trapodo, Sidoarjo. In the past three months, interviews revealed cases of verbal bullying, such as taunting, teasing, and negative comments. Social aggression, including ostracism and exclusion from play or groups, was noted alongside physical aggression, such as hitting, pinching, and hair-pulling. Some students do not recognize forms of bullying and violence, teachers lack child protection training, and the school does not have Standard Operating Procedures for reporting bullying. Parents have not been informed about monitoring children’s behavior outside school. This training aimed to enhance the knowledge and involvement of the school community and parents in preventing violence by empowering them and initiating an Anti-Bullying and Sexual Violence Task Force. The activity lasted three days at SDK Santo Yusup Tropodo and involved approximately 400 students, 75 teachers and parents. The Participatory Learning and Action (PLA) method was used, involving socialization, training, technology application, mentoring, evaluation, and program sustainability. Media included educational videos, pocketbooks, posters, and pre or post-evaluation tools. Pre-test and post-test results showed an average score increase from 82.27% to 94.13% (an 11.86% rise). Participants demonstrated improved understanding, engagement, and commitment to forming a school Task Force. This increase indicates the effectiveness of participatory training in empowering the school community to help prevent bullying and violence at the basic education level. The activity shows that introductory empowerment training can be a sustainable way to create a safe, child-friendly learning environment. Keywords: Training. School Empowerment, School Community, Bullying, Sexual Violence, Task Force.
Background Despite the well-established role of CRT in heart failure, major limitations of CRT are an occasional incidence of unsuccessful coronary sinus (CS) lead placement, one third non-responders in conventional CRT patients and higher complications risk in CRT upgrade procedures. The WiSE® Wireless Stimulation Endocardial) CRT System is designed to overcome these limitations. Prior non-randomised studies with the WiSE® CRT System have shown high implant success rates and improvement in LV remodeling and heart failure symptoms. Objectives Pivotal study to assess the safety and effectiveness of the WiSE® CRT System in an international, randomized, two-arm, double blinded, prospective study (randomized part only). Method 99 Patients with indication for CRT and previously failed CRT implant, considered as high-risk upgrade to conventional CRT, or non-responders to conventional CRT underwent device implantation and were then randomised into treatment (47 pts, System ON) and control (52 pts System OFF) groups for 6 months. Primary efficacy endpoints were change in LVESV, LVEDV, LVEF and QRS over 6 months in blinded Echo and ECG core lab analysis. Results Mean ΔLVESV (%) -14.6 (-19.6, -9.6); mean ΔLVEDV (%) -8.1 (-11.9, -4.3) and mean ΔQRS (ms) -41.9 (-50.1, -33.7) in the treatment group were significantly lower/shorter than mean ΔLVESV (%) -5.2 (-10.7, 0.2); mean ΔLVEDV (%) -3.0 (-7.0, 1.0) and mean ΔQRS (ms) -1.7 (-7.1,3.8) in the control group, p=0.005; p=0.027 and p=0.001, 95% CI. Mean ΔLVEF (%) 5.4 (3.2, 7.7) in the treatment group increased significantly compared to control group ΔLVEF (%) 2.4 (0.2, 4.5), p=0.048. 8 of 99 pts were attempted from WiSE CRT implant. Conclusion This randomized sub-study of the pivotal SOLVE-CRT trial demonstrates that leadless, ultrasound-based endocardial pacing for heart failure is feasible and efficacious showing evidence of left ventricular remodelling and electrical response after 6 months.Figure 1WISE® CRT System Figure 2Efficacy entire randomised population
