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1. Proyección y copia: enciende el interruptor de proyección en la parte superior del juguete, inserta la diapositiva giratoria y ajusta el controlador a continuación para enfocar. Elige el patrón que te gusta y empieza a copiarlo.
2. Tablero de dibujo sin polvo: la superficie de la placa de porcelana se puede utilizar repetidamente, y la escritura a mano se puede borrar con solo un poco de agua. La escritura y el dibujo son claros y suaves, respetuosos con el medio ambiente y seguros.
3. Bolígrafos de acuarela: te equipamos con bolígrafos de acuarela de diferentes colores. Deja que los niños disfruten pintando y copiando.
4. Extraíble: las patas sólidas de la mesa son gruesas. No te preocupes por que los niños se caigan cuando la mesa no está firme al jugar, seguro y estable.
5. Esquinas suaves: evita golpes accidentales y lesiones durante el juego. El corte fino no tiene rebabas y no daña las manos.
6. Función de música: simplemente enciende el interruptor detrás del cuello de la jirafa para encender la música. Puedes escuchar mientras dibujas.
El color real puede ser ligeramente diferente al de la imagen debido a los diferentes monitores y efectos de luz.
Puede haber una diferencia de 1 a 3 cm debido a la medición manual.
Tamaño: como se muestra en la imagen.
Batería: 3 pilas AA (no incluidas).
Color/estilo: como se muestra en la imagen.
Edad recomendada: a partir de 3 años.
Material: plástico ABS, componentes electrónicos.
Aplicación: niños, dibujo.
(Batería no incluida)
Elección 1: 6 diapositivas para mesa de pintura de proyección desmontable.
Elección 2: 1 escritorio de dibujo para niños, 3 diapositivas.
Elección 3: 1 escritorio de dibujo para niños, 3 diapositivas, 1 cargador.
Elección 4: 1 escritorio de dibujo para niños, 6 toboganes.
Elección 5: 1 escritorio de dibujo para niños, 6 diapositivas, 1 cargador.
Elección 6: 1 escritorio de dibujo para niños, 9 toboganes.
Elección 7: 1 escritorio de dibujo para niños, 9 diapositivas, 1 cargador.
November 2021 Br J Cardiol 2021;28:155–62 doi: 10.5837/bjc.2021.051
Rea Ganatra, Robert Smith
Mitral regurgitation is a common valvular heart disorder increasing with age. Many patients are ineligible for mitral valve surgery due to their age and other comorbidities. Left untreated, patients develop severe disease with a poor prognosis. The development of lower risk percutaneous mitral valve interventions has helped meet the needs of this previously untreated patient group. This review explores the recent and more established developments that have expanded the armamentarium for transcatheter mitral valve intervention.
November 2021 Br J Cardiol 2021;28:134–38 doi: 10.5837/bjc.2021.048
Patrick Tran, Leeann Marshall, Ian Patchett, Handi Salim, Shamil Yusuf, Sandeep Panikker, Michael Kuehl, Faizel Osman, Prithwish Banerjee, Harpal Randeva, Tarvinder Dhanjal
Implantable cardiac defibrillators (ICDs) can prevent sudden cardiac death, but the risk of recurrent ventricular arrhythmia (VA) and ICD shocks persist. Strategies to minimise such risks include medication optimisation, device programming and ventricular tachycardia (VT) ablation. Whether the choice of these interventions at follow-up are influenced by factors such as the type of arrhythmia or ICD therapy remains unclear. To investigate this, we evaluated ICD follow-up strategies in a real-world population with primary and secondary prevention ICDs.
REFINE-VT (Real-world Evaluation of Follow-up strategies after Implantable cardiac-defibrillator therapies in patients with Ventricular Tachycardia) is an observational study of 514 ICD recipients recruited between 2018 and 2019. We found that 77 patients (15%) suffered significant VA and/or ICD therapies, of whom 26% experienced a second event; 31% received no intervention. We observed an inconsistent approach to the choice of strategies across different types of arrhythmias and ICD therapies. Odds of intervening were significantly higher if ICD shock was detected compared with anti-tachycardia pacing (odds ratio [OR] 8.4, 95% confidence interval [CI] 1.7 to 39.6, p=0.007). Even in patients with two events, the rate of escalation of anti-arrhythmics or referral for VT ablation were as low as patients with single events.
This is the first contemporary study evaluating how strategies that reduce the risk of recurrent ICD events are executed in a real-world population. Significant inconsistencies in the choice of interventions exist, supporting the need for a multi-disciplinary approach to provide evidence-based care to this population.
November 2021 Br J Cardiol 2021;28:144–7 doi: 10.5837/bjc.2021.049
Jamie Sin Ying Ho, George Collins, Vikram Rohra, Laura Korb, Bhathika Perera
We performed a single-centre study to assess the risk of cardiovascular disease (CVD) in psychiatry outpatients with intellectual disability (ID) using the QRISK-3 score.
There were 143 patients known to the ID psychiatry clinic enrolled. Of these, 28 (19.6%) had elevated CVD risk – defined as 10-year risk of heart attack or stroke of ≥10%. Of these, 57.1% were not prescribed statin therapy, which – after lifestyle measures – is recommended by National Institute for Health and Care Excellence (NICE) guidelines. The mean QRISK-3 score was 6.31% (95% confidence interval [CI] 4.84 to 7.78), with a relative risk of 3.50 (95%CI 2.34 to 4.67) compared with matched controls.
The high CVD risk identified in this study supports routine CVD risk assessment and management in adult outpatients with ID. Appropriate lifestyle measures and statin therapy could help reduce the excess CVD-related morbidity and mortality in ID patients.
November 2021 Br J Cardiol 2021;28:148–52 doi: 10.5837/bjc.2021.050
Kay Dowling, Amanda Colling, Harriet Walters, Badrinathan Chandrasekaran, Helen Rimington
Transthoracic echocardiography presents a risk of COVID-19 transmission between an echocardiographer and the patient. Reducing the scanning time is likely to mitigate this risk for them both. British Society of Echocardiography (BSE) level 1 echocardiography offers a potential framework for focused scanning in an outpatient setting. There were 116 outpatients scheduled for a level 1 scan supplemented with additional pre-defined views, if required. Unexpectedly, a fifth of the scans were performed as an unintended full scan for a variety of reasons. Our results showed that focused scans were performed more quickly than full scans and below the NHS Test and Trace exposure cut-off of 15 minutes. However, if more than three sets of additional measurements were required then a full scan could be performed more quickly. Seniority of the echocardiographer and scan time had an inverse relationship. By examining the patients’ clinical records we were confident that all of the scans, whether focused or full, had answered the requestor’s clinical question. Although the COVID-19 vaccination programme should reduce the necessity of minimising exposure time during a scan there could still be a role for level 1 scanning during the COVID-19 recovery programme to tackle the vast lists of patients waiting for an echocardiogram.
October 2021 Br J Cardiol 2021;28:139–43 doi: 10.5837/bjc.2021.042
Angela Hall, Andrew Robert John Mitchell, Lisa Ashmore, Carol Holland
Quality of life (QoL) is an essential consideration when managing the wellbeing of patients and assists in interpretation of symptoms, functional status and perceptions. Atrial fibrillation (AF) and diabetes demand significant healthcare resources. Existing data demonstrate a negative impact on QoL as individual conditions, but there is less evidence relating to the impact of these disease groups in combination. This study therefore explores QoL in patients with AF and diabetes.
This cross-sectional, observational study required participants to complete the short form (SF)-36 survey via an online platform and was offered to people affected by AF alone and people with AF and diabetes in combination. The SF-36 provides a prevalidated tool with eight domains relating to physical and psychological health.
A total of 306 surveys were completed (231 AF group, 75 AF and diabetes group). The mean and standard deviation (SD) were calculated for each QoL domain, after re-coding in accordance with SF-36 guidance. Multi-variate analysis of variance (MANOVA) demonstrated an overall significant difference between the groups when considered jointly across all domains. There were significant differences between AF and AF with diabetes QoL responses in physical functioning, energy fatigue, emotional wellbeing, social functioning and pain. In these domains, the mean was highest in the AF group. There were no significant differences in the role physical, role emotional and general health domains.
In conclusion, this study demonstrates that diabetes and AF has a more detrimental effect on QoL than AF alone, in the majority of domains. Further research into the general AF population and where chronic conditions co-exist is important to comprehend the true impact this disease combination has on QoL.
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