Cardiovascular Journal of Africa: Vol 24 No 1 (February 2013) - page 106

CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013 104 AFRICA
Methods: Echocardiograms of newborns with critical congenital
heart disease with resolutions of 640 × 448 and frame rates of 30 fps
were encoded into two layers for scalability with resolutions of 640
× 448 and 320 × 224. Four sets of bit-rate were tested; no compres-
sion, 2 Mbps, 1 Mbps and 0.5 Mbps. Images were coded by VPN
system and randomly transmitted to decoders in three device/network
conditions; PC/local network, PC/wide area network (WAN) and
tablet/WAN. Fifteen blinded board-certified paediatric cardiologists
subjectively assessed images and scored between 0, i.e. unsuitable
for diagnosis and 1.0, i.e. compatible with normal studies. Subjective
assessments were compared with objective quality metrics peak
signal-to-noise ratio (PSNR).
Results: In PC/WAN condition, SVC images with resolutions of
640 × 448 required bandwidths of more than 1 Mbps to get aver-
age scores of 0.5 or more. At bandwidths less than 1 Mbps, scores
for images with resolutions of 320 × 224 were significantly higher
than values for 640 × 448 images (0.47 vs 0.27). Images in tablet/
WAN condition at 1 Mbps scored 0.42. Subjective assessments were
significantly correlated with PSNR. An application (Vidyo Inc) using
SVC showed successful transmission of images with 950 × 540 and
30 fps at 768 kbps on mobile devices in a pilot LTE environment,
allowing interaction between participating medical staff.
Conclusion: The real-time mobile system using SVC may be useful
for neonatal tele-cardiology in the unreliable wireless network.
539: SAVE A CHILD’S HEART: SPECIFIC ETHICAL QUES-
TIONS IN A CHARITY PROGRAMME
Akiva Tamir1,2, Sion Houri1,3, Alona Raucher Sternfeld1,2, Ilan Cohen 1,3,
Livia Kapusta1,2, Sagi Assa 1,2, Lior Sasson1,4
1Save a Child’s Heart, Israel
2Paediatric Cardiology Unit, Edith Wolfson Medical Centre, Israel
3Paediatric Intensive Care Unit, Edith Wolfson Medical Centre, Israel
4Cardiothoracic Surgery Department, Edith Wolfson Medical Centre,
Israel
Save a Child’s Heart is a charity programme that has treated over 2
900 paediatric cardiac patients from 43 underdeveloped countries
during the past 17 years. Throughout the years, many ethical ques-
tions have arisen. The purpose of this presentation is to bring up
these questions, describe our approach to solving them and open the
subject for further discussion.
A relative paucity of available openings for treatment due to
both money restraints and bed limitations imposes ethical problems
that are not faced by most programmes. Patients’ acceptance to the
programme induces a conflict between the referring and accepting
systems due to the medical severity of cases, chances of success
and, sometimes, due to secondary benefits. The feasibility of further
medical follow up needs to be considered before acceptance to a
charity programme, especially if there is a potential need for a pros-
thetic valve or pacemaker and the possible continuation of expensive
medications. A very important issue is whether patients should be
admitted for palliative treatment, considering the availability of
future surgeries and catheterisation as a part of the planned repair of
the specific patient. As a paediatric charity, what is our commitment
to adults who were treated by us as children?
Air travel is a risk for cyanotic children. Is there a benefit in a
medical escort on the fight and if one is not available should we avoid
transferring cyanotic children for treatment? In charity programmes
where the parent and physician have a language and cultural barrier,
the meaning of consent forms is questionable. There is a relative
absence of parental supervision and when parents have no choice,
quality control may be jeopardised. So far we have dealt with all
these questions in accordance with our personal and cultural morals
and attitude. These dilemmas are open for different approaches and
merit further discussion.
585: HOSPITAL VARIATION IN POST-OPERATIVE INFEC-
TION AND ASSOCIATED OUTCOMES FOLLOWING
CONGENITAL HEART SURGERY
Sara Pasquali1, Xia He2, Marshall Jacobs3, Matthew Hall4 , J. William
Gaynor5, Samir Shah6, Eric Peterson7, Kevin Hill7, Jennifer Li 7,
Jeffrey Jacobs8
1CS Mott Children’s Hospital, University of Michigan Medical
School, Ann Arbor, MI, USA
2Duke Clinical Research Institute, Durham, NC, USA
3Cleveland Clinic, Cleveland, OH, USA
4Child Health Corporation of American, Shawnee Mission, KS, USA
5The Children’s Hospital of Philadelphia, University of Pennsylvania
School of Medicine, Philadelphia, PA, USA
6Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,
USA
7Duke University Medical Center, Duke University School of
Medicine, Duke Clinical Research Institute, Durham, NC, USA
8All Children’s Hospital, St Petersburg FL, USA
Background: While previous studies have demonstrated the associa-
tion of post-operative infection with morbidity and mortality follow-
ing congenital heart surgery, variation across hospitals has not been
well described. This study evaluated hospital infection rates across a
large multi-centre cohort, and association with other hospital-level
outcome measures.
Methods: The Society of Thoracic Surgeons Congenital Heart
Surgery database was linked to resource utilisation data from
the Pediatric Health Information Systems Database for hospitals
participating in both databases (2006–2010). Hospital infection rates
(sepsis, wound infection, mediastinitis, endocarditis, pneumonia)
adjusted for patient risk factors, case mix and delayed sternal closure
were calculated using Bayesian methodology. Association with
hospital mortality rate, post-operative length of stay (LOS), and total
costs were evaluated.
Results: The cohort included 32 856 patients (28 centres). Across
hospitals, the adjusted infection rate varied from 0.9 to 9.8% (median
4.1%). The most common types of infection were sepsis (51%) and
wound infection (35%). On a patient level, infection was associated
with increased mortality (OR 2.8, 95% CI: 2.2–3.6, p < 0.001),
prolonged LOS (25.5 vs 11.2 days, p < 0.001) and increased hospital
costs ($115 800 vs $63 300, p < 0.001). Similar results were observed
when hospitals at the extremes of infection rates were excluded.
Hospitals were divided into tertiles according to adjusted infection
rate. Hospitals with the highest infection rates (vs lowest) had longer
average LOS (13.2 vs 12.0 days, p < 0.001) and hospital costs ($70
900 vs $58 200, p < 0.001), but no significant difference in mortality
(OR 0.9, 95% CI: 0.7–1.1, p = 0.2).
Conclusions: Post-operative infection following congenital heart
surgery contributes to prolonged LOS and increased costs on a hospi-
tal level. Initiatives aimed at reducing post-operative infection may
reduce variation and improve outcomes across centres.
702: TRACKING CARDIOVASCULAR MORBIDITY: UTIL-
ITY OF A HAND-HELD DEVICE TO MONITOR CARDIO-
VASCULAR COMPLICATIONS
Derek Human1, Sanjiv Gandhi1,2, Andrew Campbell1,2, Martin
Hosking1, James Potts1
1British Columbia Children’s Hospital, Canada
2University of British Columbia, Canada
Background: In this era of declining cardiovascular mortality,
other measures of quality assurance (QA) become important. We
have previously described the utility of a hand-held device to track
complication rates (chosen from a pre-defined pick list including all
body systems) related to cardiac procedures [cardiac catheterisation,
closed-heart surgery or open-heart surgery (OHS)].
Objective: To record the complication rate for OHS and document
variation related to changes in clinical practice.
Methods: Five cardiologists used Palm OS-based software (Smart-