Advancing global antibiotic research, development and access.

The pipeline of new antibiotics is insufficient to keep pace with the growing global burden of drug-resistant infections. Substantial economic challenges discourage private investment in antibiotic research and development (R&D), with a decline in the number of companies and researchers working in the field. Compounding these issues, many countries (from low income to high income) face a growing crisis of antibiotic shortages and inequitable access to existing and emerging treatments.

Focused transoesophageal TOE (fTOE): A new accreditation pathway.

The concept of a focused ultrasound study to identify sources of haemodynamic instability has revolutionized patient care. Point-of-care ultrasound (POCUS) using transthoracic scanning protocols, such as FUSIC Heart, has empowered non-cardiologists to rapidly identify and treat the major causes of haemodynamic instability. There are, however, circumstances when a transoesphageal, rather than transthoracic approach, may be preferrable.

Definition of hourly urine output influences reported incidence and staging of acute kidney injury.

Background: Acute kidney injury (AKI) is commonly defined using the KDIGO system, which includes criteria based on reduced urine output (UO). There is no consensus on whether UO should be measured using consecutive hourly readings or mean output. This makes KDIGO UO definition and staging of AKI vulnerable to inconsistency which has implications both for research and clinical practice.

Focus cardiac ultrasound core curriculum and core syllabus of the European Association of Cardiovascular Imaging.

There is a growing trend of using ultrasound examination of the heart as a first-line diagnostic tool for initial patient evaluation in acute settings. Focus cardiac ultrasound (FoCUS) is a standardized but restricted cardiac ultrasound examination that may be undertaken by a range of medical professionals with diverse backgrounds. The intention of this core curriculum and syllabus is to define a unifying framework for educational and training processes/programmes that should result in competence in FoCUS for various medical professionals dealing with diagnostics and treatment of cardiovascular emergencies.

Tricuspid Annular Plane Systolic Excursion: Comparing Transthoracic to Transesophageal Echocardiography.

Objective: Tricuspid annular plane systolic excursion (TAPSE) represents movement of the lateral annulus of the tricuspid valve toward the apex and denotes right ventricular contractility in the long axis. In transesophageal echocardiography with the probe in the mid-esophagus, TAPSE occurs at a significant angle to the M-mode scan line. The authors describe a novel method to assess TAPSE in 2 dimensions (2D) and compare this with an established method.

Advanced care nurse practitioners can safely provide sole resident cover for level three patients: impact on outcomes, cost and work patterns in a cardiac surgery programme.

Objectives: There are significant pressures on resident medical rotas on intensive care. We have evaluated the safety and feasibility of nurse practitioners (NPs) delivering first-line care on an intensive care unit with all doctors becoming non-resident. Previously, resident doctors on a 1:8 full-shift rota supported by NPs delivered first-line care to patients after cardiac surgery.

Unusual case of two synchronous intracavitary primary cardiac tumors.

We report a patient who had two histologic and distinct synchronous intracardiac tumors, with one located in each atrium. The second tumor was missed on intraoperative transesophageal echocardiography, but was discovered when the right atrium was opened using a bi-atrial trans-septal approach. We discuss the merits of this approach and the role of additional imaging for cardiac tumors.

Can lean body mass be used to reduce the dose of heparin and protamine for obese patients undergoing cardiopulmonary bypass?

Increasing numbers of obese patients are presenting for cardiac surgery. The convention for heparin dose dictates that a bolus of 300 IU heparin per kilogram of total body weight (TBW) is administered before CPB. During CPB, the activated clotting time (ACT) is maintained for longer than 480 seconds.