GPs, violence and work performance - 'just part of the job?'.

Background: This study explored the impact of work related violence on general practitioners' work performance.

Method: A postal survey of 1000 randomly selected GPs about work related violence. Those GPs reporting incidents of work related violence in the past 12 months were asked to write about its effect on them in response to an open question.

Anatomical and functional evaluation of pulmonary veins in children by magnetic resonance imaging.

Pulmonary vein pathologies often present a diagnostic challenge. Among the different imaging modalities used for the evaluation of pulmonary veins, magnetic resonance is the most comprehensive in assessing anatomy and pathophysiology at the same time. Bright blood cine sequences and contrast-enhanced magnetic resonance angiography outline the course and connections of the pulmonary veins.

Interatrial conduction measured during biventricular pacemaker implantation accurately predicts optimal paced atrioventricular intervals.

Background: Optimizing atrioventricular (AV) delay during biventricular (BiV) pacemaker implantation can require substantial resources. Hence, a simpler method is desirable. We hypothesized that interatrial conduction time (IACT), measured at the time of BiV device implant, could be a surrogate value for the optimal AV delay.

Mechanism-based MRI classification of traumatic brainstem injury and its relationship to outcome.

While computed tomography (CT) is the appropriate technique for the urgent detection of hematomas and contusions in the cerebral hemispheres, it is much less effective at documenting diffuse injury and posterior fossa lesions, and is therefore only partially predictive of outcome. More recently, magnetic resonance imaging (MRI) has been used, particularly to examine posterior fossa structures, but the relationship between brainstem injury and outcome is unclear and the types of brainstem injury are poorly understood. The aim of this study was to use acute MRI to examine the types of brainstem injury following severe traumatic brain injury (TBI) and their relationship to supratentorial injury.

Outcomes of pediatric patients bridged to heart transplantation from extracorporeal membrane oxygenation support.

Extracorporeal membrane oxygenation (ECMO) is used as a salvage therapy in children with irreversible myocardial failure who may be candidates for heart transplantation (HTx) (at the Hospital for Sick Children). We retrospectively assessed outcomes of children wait-listed for HTx from ECMO, and risk factors for patients (pts) bridged to HTx from January 1990 through December 2005. Of 205 patients supported with cardiac ECMO, 46 were wait-listed for HTx.

Surgical outcomes in the treatment of patients with tetralogy of Fallot and absent pulmonary valve.

Objective: Tetralogy of Fallot and absent pulmonary valve (TOF/APV) is associated with significant pulmonary artery dilatation and airway compression. Treatment of infants presenting with respiratory symptoms early in life is associated with high mortality (20-60%). We aim to report our results and identify factors associated with survival and prolonged ventilation.

Hyperventilation following head injury: effect on ischemic burden and cerebral oxidative metabolism.

Objective: To determine whether hyperventilation exacerbates cerebral ischemia and compromises oxygen metabolism (CMRO2) following closed head injury.

Design: A prospective interventional study.

Setting: A specialist neurocritical care unit.

Overexpression of integrin-linked kinase induces cardiac stem cell expansion.

Objective: Recent evidence suggests that the adult heart contains stem cells that are capable of self-renewal as well as multilineage differentiation. However, their inherent capacity for self-renewal is limiting to cell replacement applications. Integrin-linked kinase is a multifunctional protein kinase that activates Wnt target genes implicated in the symmetric replication of embryonic stem cells.

The impact of patch augmentation on left atrioventricular valve dynamics in patients with atrioventricular septal defects: early and midterm follow-up.

Objective: Left atrioventricular valve pericardial patch may prevent valve replacement. We assessed patch annular dynamics compared with conventional repair and normal annuli.

Methods: Transesophageal 3-dimensional echocardiography was acquired preoperatively and postoperatively in atrioventricular septal defects (n = 10, 5 patch, 5 conventional repair).

Integrin-linked kinase expression is elevated in human cardiac hypertrophy and induces hypertrophy in transgenic mice.

Background: Although numerous signaling pathways are known to be activated in experimental cardiac hypertrophy, the molecular basis of the hypertrophic response inherent in human heart diseases remains largely unknown. Integrin-linked kinase (ILK) is a multifunctional protein kinase that physically links beta-integrins with the actin cytoskeleton, suggesting a potential mechanoreceptor role.

Methods And Results: Here, we show a marked increase in ILK protein levels in hypertrophic ventricles of patients with congenital and acquired outflow tract obstruction.

Outcomes of variation in hospital nurse staffing in English hospitals: cross-sectional analysis of survey data and discharge records.

Context: Despite growing evidence in the US, little evidence has been available to evaluate whether internationally, hospitals in which nurses care for fewer patients have better outcomes in terms of patient survival and nurse retention.

Objectives: To examine the effects of hospital-wide nurse staffing levels (patient-to-nurse ratios) on patient mortality, failure to rescue (mortality risk for patients with complicated stays) and nurse job dissatisfaction, burnout and nurse-rated quality of care.

Design And Setting: Cross-sectional analysis combining nurse survey data with discharge abstracts.

Surgical repair of multiple muscular ventricular septal defects: the role of re-endocardialization strategy.

Objective: Surgical repair of multiple muscular ventricular septal defects (Swiss cheese septum) is associated with important morbidity and mortality. We sought to examine factors associated with permanent heart block, early mortality, and time-related survival. Additionally, we evaluated a new approach, transatrial re-endocardialization of interventricular septum, to mitigate risk.

Short and midterm results of aortic valve cusp extension in the treatment of children with congenital aortic valve disease.

Background: We evaluated our experience with aortic valve cusp extension techniques to identify predictors of successful intraoperative repair and subsequent durability.

Methods: Twenty-two children (ages 5-18 years) underwent aortic cusp extension with autologous pericardium between 1999 and 2005. Sixteen children had previous surgical or percutaneous intervention.

Imaging of cerebral blood flow and metabolism.

Purpose Of Review: To review the techniques for imaging cerebral blood flow and metabolism following injury to the brain.

Recent Findings: Xenon enhanced computerized tomography (Xenon CT), CT perfusion and single photon emission CT provide measurements of cerebral perfusion, while positron emission tomography (PET), and magnetic resonance imaging and spectroscopy (MRI and MRS) are able to assess both perfusion and cerebral metabolism. Xenon CT and CT perfusion are readily available and have proved useful in a variety of causes of brain injury.

Immunocytochemical analysis of rat vagus nerve by antibodies against glycogen phosphorylase isozymes.

Glycogen is an endogenous store of glucose equivalents for energy metabolism in many tissues. The brain contains a significant amount of glycogen the role of which as an energy reserve is currently under debate. Apparently little is known concerning a possible role of glycogen in peripheral nerves.

Recreating an artificial biological pacemaker: insights from a theoretical model.

Background: Normal cardiac rhythm is critically dependent on the sinoatrial (SA) node, the natural biological pacemaker. Although recent studies have focused on the development of "artificial" biological pacemakers using gene transfer, less is known about the functional consequences of such interventions.

Objective: The purpose of this study was to investigate the electrophysiological consequences of two approaches used to create a biological pacemaker: overexpression of the hyperpolarization-activated cyclic nucleotide gated channel (HCN "pacemaker" channels) and suppression of the inward-rectifier potassium current, I(K1).

VDD lead-lead interaction and atrial oversensing: an acute animal study.

Limited data exist on the utilization of a transvenous A-sense; V-pace/sense (VDD)pacing system with a chronically retained nonfunctioning endocardial V-sense/pace (VVI)pacing lead. In an acute canine model, no atrial oversensing was observed with lead-lead interaction between the VDD lead and the pseudo-retained VVI lead. Undersensing occurred <10% of all beats observed.

First successful lower-extremity transplantation: technique and functional result.

Composite tissue transplantation has emerged as a viable alternative to prosthetics and complex reconstructive surgery. Thus far it is reserved for cases which cannot be effectively reconstructed and where it offers some benefits over prostheses. It has been used in the upper extremity with encouraging results and, most recently, in the face.

Focal pharmacological modulation of atrioventricular nodal conduction via implantable catheter: a novel therapy for atrial fibrillation?

Background: Pharmacological ventricular rate control is an acceptable atrial fibrillation (AF) therapy limited by systemic toxicity. We postulate that focal catheter-based drug delivery into the atrioventricular nodal (AVN) region may effectively control ventricular rate during AF without systemic toxicity. This study evaluated the effects of focally administered acetylcholine on AVN conduction and refractoriness during sinus rhythm and AF.

Contemporary management of right atrial isomerism: effect of evolving therapeutic strategies.

Objectives: Infants with right atrial isomerism have poor outcomes because of a complex combination of cardiac anomalies. Aggressive management of total anomalous pulmonary venous drainage might have a positive effect on the prognosis.

Methods: Outcomes of all children with right atrial isomerism from 1994 to the present were reviewed.

Imaging of cerebral blood flow and metabolism in brain injury in the ICU.

The heterogeneity of the initial insult and subsequent pathophysiology has made both the study of human head injury and design of randomised controlled trials exceptionally difficult. The combination of multimodality bedside monitoring and functional brain imaging positron emission tomography (PET) and magnetic resonance (MR), incorporated within a Neurosciences Critical Care Unit, provides the resource required to study critically ill patients after brain injury from initial ictus through recovery from coma and rehabilitation to final outcome. Methods to define cerebral ischemia in the context of altered cerebral oxidative metabolism have been developed, traditional therapies for intracranial hypertension re-evaluated and bedside monitors cross-validated.

Glucose metabolism in traumatic brain injury: a combined microdialysis and [18F]-2-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) study.

Following traumatic brain injury, as a consequence of ionic disturbances and neurochemical cascades, glucose metabolism is affected. [18F]-2-Fluoro-2-deoxy-D-glucose (FDG) Positron Emission Tomography (FDG-PET) provides a measure of global and regional cerebral metabolic rate of glucose (rCMRglc), but only during the time of the scan. Microdialysis monitors energy metabolites over extended time periods, but only in a small focal volume of the brain.

Effects of moderate hyperventilation on cerebrovascular pressure-reactivity after head injury.

In volunteers, hyperventilation improves autoregulation. However, in head-injured patients, hyperventilation-induced deterioration and improvement of autoregulation have been reported. We have re-examined this question using an index of pressure reactivity.

Impact on outcomes after listing and transplantation, of a strategy to accept ABO blood group-incompatible donor hearts for neonates and infants.

Background: Recent data suggest that ABO blood group-incompatible donor hearts are immunologically well tolerated in infants undergoing transplantation.

Methods: Competing-risks methodology was used to assess outcomes after listing and the impact of a strategy to accept heart grafts from any blood group donor for infants less than 18 months of age.

Results: From 1992 to 2002, there were 91 listing episodes in 84 patients (including 20 fetuses; 50% were male and 63% had congenital heart disease).

Characterizing speech and language pathology outcomes in stroke rehabilitation.

Unlabelled: Hatfield B, Millet D, Coles J, Gassaway J, Conroy B, Smout RJ. Characterizing speech and language pathology outcomes in stroke rehabilitation.

Objectives: To describe a subset of speech-language pathology (SLP) patients in the Post-Stroke Rehabilitation Outcomes Project and to examine outcomes for patients with low admission FIM levels of auditory comprehension and verbal expression.