How to Start an Enhanced Recovery After Surgery Cardiac Program.

In this review the authors introduce a practical approach to guide the initiation of an enhanced recovery after surgery (ERAS) cardiac surgery program. The first step in implementation is organizing a dedicated multidisciplinary ERAS cardiac team composed of representatives from nursing, surgery, anesthesiology, and other relevant allied health groups. Identifying a program coordinator or navigator who will have responsibilities for developing and implementing educational initiatives, troubleshooting, monitoring progress and setbacks, and data collection is also vital for success.

Survey of Anticoagulation Practices with the Impella Percutaneous Ventricular Assist Device at High-Volume Centers.

Objectives: To characterize anticoagulation practices with the Impella percutaneous ventricular assist device (pVAD).

Background: Managing anticoagulation in patients being supported by the Impella pVAD is made challenging by several unique features of the device. These include the release of a dextrose-based purge solution containing unfractionated heparin (UFH), the need to concurrently administer systemic anticoagulation with intravenous UFH, and the lack of an alternative strategy in patients with contraindications to UFH.

One-year results from the first US-based enhanced recovery after cardiac surgery (ERAS Cardiac) program.

Objective: Our enhanced recovery after cardiac surgery (ERAS Cardiac) program is an evidence-based interdisciplinary process, which has not previously been systematically applied to cardiac surgery in the United States.

Methods: The Knowledge-to-Action Framework synthesized evidence-based enhanced recovery interventions and implementation of a designated ERAS Cardiac program. Standardized processes included (1) preoperative patient education, (2) carbohydrate loading 2 hours before general anesthesia, (3) multimodal opioid-sparing analgesia, (4) goal-directed perioperative insulin infusion, and (5) a rigorous bowel regimen.

Medication Management of Patients Undergoing Transcatheter Aortic Valve Replacement.

Aortic stenosis (AS) is the most common form of valvular heart disease. A detailed diagnostic workup is necessary to promptly stage and classify disease severity to determine optimal management. Medical therapy and valvuloplasty are options that fail to delay or reverse disease progression.

Pharmacologic Considerations in the Management of Patients Receiving Left Ventricular Percutaneous Mechanical Circulatory Support.

Percutaneous mechanical circulatory support (MCS) devices, including the intraaortic balloon pump, Impella, and TandemHeart, are often used for hemodynamic support in the setting of refractory cardiogenic shock. The thrombotic and bleeding complications associated with these devices is well recognized, and the Impella and TandemHeart devices have unique anticoagulation considerations that may influence patient outcomes. Both devices typically require use of a heparinized purge solution in combination with intravenous unfractionated heparin, thereby providing multiple sources of heparin exposure.

Management of anticoagulant and antiplatelet therapy in patients undergoing interventional pulmonary procedures.

There has been great progress in antithrombotic therapy over the past several years. Its use has increased with the advent of novel anticoagulants, as these medications do not require frequent blood tests for monitoring. Antithrombotic therapy is aimed at reducing the risk of thromboembolic events in patients with atrial fibrillation, coronary artery disease, deep vein thrombosis, valvular heart disease and pulmonary embolism.

Key articles and guidelines in the management of patients undergoing cardiac surgery.

Significant numbers of patients undergo cardiac surgery worldwide each year. A large evidence base exists regarding the optimal pre-, intra-, and postoperative mediation management for patients undergoing coronary artery bypass grafting (CABG) surgery, valve replacements or repairs, and mechanical circulatory support (MCS). Prevention and treatment of perioperative arrhythmias, perioperative antimicrobial prophylaxis, prevention of thrombosis, and bleeding through proper management of perioperative antiplatelet and anticoagulant therapies, and the use of pharmacotherapy to optimize both short- and long-term patient outcomes after cardiac surgery are the focus of this first compilation of guidelines and key articles in this patient population to be published in the Journal of Pharmacy Practice.

HIV-related training programs for health care professionals: findings from a collaborative assessment.

Seeking to avoid duplication of effort, evaluators from twelve separate HIV-related training programs worked together to share information, assessment tools, measurement instruments, and preliminary findings across programs. Each training program focused on preparing health care professionals to meet the growing demands of the AIDS epidemic and specifically address psychosocial issues of care. The collaborative effort of program evaluators included an examination of experiences across programs and yielded recommendations for needs assessments, process evaluation procedures, and outcome measures.

Comparing obligatory to nonobligatory runners.

This study compares "obligatory" runners (runners who continue to run despite clear physical injury or contraindications) to nonobligatory runners. Both groups scored within the normal range on most psychological test indices. The two groups had more similarities than differences.

Controlled clinical trial of cannabidiol in Huntington's disease.

Based on encouraging preliminary findings, cannabidiol (CBD), a major nonpsychotropic constituent of Cannabis, was evaluated for symptomatic efficacy and safety in 15 neuroleptic-free patients with Huntington's Disease (HD). The effects of oral CBD (10 mg/kg/day for 6 weeks) and placebo (sesame oil for 6 weeks) were ascertained weekly under a double-blind, randomized cross-over design. A comparison of the effects of CBD and placebo on chorea severity and other therapeutic outcome variables, and on a Cannabis side effect inventory, clinical lab tests and other safety outcome variables, indicated no significant (p greater than 0.

Effects of subject variables on attitude change and knowledge acquisition in an AIDS education program.

The need for improved knowledge and attitudes about HIV infection and HIV-infected clients has been documented, as has the effectiveness of AIDS education programs in affecting change in these characteristics of health care workers. Analyzing a sample of 336 health care providers, the current study assessed the impact of subject variables on knowledge and attitude change for health care providers after educational programs of 4 to 8 hours. Results indicated that several subject characteristics were significantly related to pretest levels of attitudes and knowledge.

Processing of emotional cues in patients with dementia of the Alzheimer's type.

Previous research on patients with dementia of the Alzheimer's type (DAT) has focused primarily on intellectual and memory deficits. The present study investigated another aspect of cognitive functioning, that of processing of emotional cues. Subjects included 30 DAT patients and 13 normal controls who were asked to identify emotional expressions in pictured faces and in tone of tape recorded sentences.

Parameters that bias the measurement of airborne concentration within a respirator.

This paper describes the theoretical basis upon which a test system has been set up to evaluate the sampling error associated with in-facepiece sampling on half-mask respirators. The in-facepiece sampling technique evaluated in this study is the one currently used in the U.S.

Workplace protection factor measurements on powered air-purifying respirators at a secondary lead smelter--test protocol.

A study was conducted at a secondary smelter to evaluate the workplace performance of the 3M Model W-344 and Racal Model AH3 powered air-purifying respirators ( PAPR ) equipped with helmets and high efficiency filters. The research protocol developed for obtaining leakage measurements in the field provides for proper respirator fitting, use, wear, maintenance and worker supervision, all of which are problems commonly associated with data acquisition when field testing respirators. The protocol proved to be very workable, even though it required extensive worker and equipment monitoring.