AngioVac Aspiration for Paradoxical Emboli Protection through a Fenestrated Fontan During Central Venous Thrombus Manipulation.

This case reports describes a 39-year-old female with a history of surgically repaired hypoplastic left heart syndrome who presented with a left peripherally inserted central catheter (PICC) with associated large volume subclavian and brachiocephalic vein thrombus. Due to the presence of a right-to-left shunt via a fenestrated Fontan, there was clinical concern for a paradoxical embolism during removal of the PICC. The AngioVac aspiration system was successfully utilized to aspirate thromboemboli from the level of the proximal Glenn shunt during manipulation and removal of the PICC.

Efficacy of endothelin blockade in adults with Fontan physiology.

Objective: Phosphodiesterase-5 inhibitors have shown to improve cardiac output and functional capacity in Fontan patients. We sought to test the efficacy and safety of endothelin blockade with bosentan in adult patients with Fontan physiology.

Design: Ten patients were enrolled and seven patients completed this single-center open-label clinical trial.

Cost-effectiveness of uterine-preserving procedures for the treatment of uterine fibroid symptoms in the USA.

Objective: To evaluate the cost-effectiveness of the following three treatments of uterine fibroids in a population of premenopausal women who wish to preserve their uteri: myomectomy, magnetic resonance-guided focused ultrasound (MRgFUS) and uterine artery embolization (UAE).

Materials & Methods: A decision analytic Markov model was constructed. Cost-effectiveness was calculated in terms of US$ per quality-adjusted life year (QALY) over 5 years.

Estimating the potential cost savings from the New York University Caregiver Intervention in Minnesota.

No therapies are known to substantially alter the course of dementia and associated treatment costs. However, enhanced support services for caregivers of people with dementia have been shown to improve caregivers' capabilities and well-being and delay patients' institutionalization. Using a model that simulated disease progression, place of residence, and direct costs of care, we estimated the potential savings to Minnesota from offering the New York University Caregiver Intervention, a program of enhanced support services for spouse and adult child caregivers of community-dwelling people with dementia, to all eligible people in the state from 2010 to 2025.

Inferior vena cava filter retrieval: effectiveness and complications of routine and advanced techniques.

Purpose: To investigate the success and safety of routine versus advanced inferior vena cava (IVC) filter retrieval techniques.

Materials And Methods: A retrospective review was performed of patients who underwent IVC filter placement and/or a retrieval attempt over a 10-year period. Retrieval technique(s), preretrieval computed tomography, preretrieval venography, and clinical/imaging follow-up for 30 days after retrieval were analyzed.

Novel integration of systems-based practice into internal medicine residency programs: the Interactive Cost-Awareness Resident Exercise (I-CARE).

Background: The Accreditation Council for Graduate Medical Education and American Board of Internal Medicine have identified cost-awareness as an important component to residency training. Cost-awareness is generally not emphasized in current, traditional residency curricula despite the recognized importance of this topic.

Description: Using a traditional Morning Report structure and actual charge data from our institution, the charges associated with trainee-directed workup of clinical cases are compared in a friendly competition among medical students, interns, residents, and faculty.

Evaluating implementation of a rapid response team: considering alternative outcome measures.

Objective: Determine the prolonged effect of rapid response team (RRT) implementation on failure to rescue (FTR).

Design: Longitudinal study of institutional performance with control charts and Bayesian change point (BCP) analysis.

Setting: Two academic hospitals in Midwest, USA.

Smoking status and health care costs in the perioperative period: a population-based study.

Importance: Cigarette smoking adds an estimated $100 billion in annual incremental direct health care costs nationwide. Cigarette smoking increases complication risk in surgical patients, but the potential effects of smoking status on perioperative health care costs are unclear.

Objective: To test the hypothesis that current and former smoking at the time of admission for inpatient surgery, compared with never smoking, are independently associated with higher incremental health care costs for the surgical episode and the first year after hospital discharge.

Applications of propensity score methods in observational comparative effectiveness and safety research: where have we come and where should we go?

Propensity score (PS) methods have proliferated in recent years in observational studies in general and in observational comparative effectiveness research (CER) in particular. PS methods are an important set of tools for estimating treatment effects in observational studies, enabling adjustment for measured confounders in an easy-to-understand and transparent way. This article demonstrates how PS methods have been used to address specific CER questions from 2001 through to 2012 by identifying six impactful studies from this period.

Cognitive predictors of cognitive change following bilateral subthalamic nucleus deep brain stimulation in Parkinson's disease.

The beneficial effects of deep brain stimulation (DBS) of the subthalamic nucleus (STN) for the motor symptoms in advanced Parkinson's disease (PD) are well established. Early in PD, mild cognitive impairment is present in a proportion of patients. Hence, it can also be present in PD patients considered for DBS.

ACR appropriateness criteria imaging for transcatheter aortic valve replacement.

Although aortic valve replacement is the definitive therapy for severe aortic stenosis, almost half of patients with severe aortic stenosis are unable to undergo conventional aortic valve replacement because of advanced age, comorbidities, or prohibitive surgical risk. Treatment options have been recently expanded with the introduction of catheter-based implantation of a bioprosthetic aortic valve, referred to as transcatheter aortic valve replacement. Because this procedure is characterized by lack of exposure of the operative field, image guidance plays a critical role in preprocedural planning.

Two-dimensional carrier distribution in top-gate polymer field-effect transistors: correlation between width of density of localized states and Urbach energy.

A general semiconductor-independent two-dimensional character of the carrier distribution in top-gate polymer field-effect transistors is revealed by analysing temperature-dependent transfer characteristics and the sub-bandgap absorption tails of the polymer semiconductors. A correlation between the extracted width of the density of states and the Urbach energy is presented, corroborating the 2D accumulation layer and demonstrating an intricate connection between optical measurements concerning disorder and charge transport in transistors.

Brain trauma, PET scans and forensic complexity.

Positron Emission Tomography (PET) is a medical imaging technique that can be used to show brain function. Courts have admitted PET scan evidence in cases involving brain damage, injury, toxic exposure, or illness ("brain trauma") and to support claims of diminished cognitive abilities and impulse control. Despite the limited data on the relationships between PET, brain trauma and behavior, many courts admit PET scan evidence without much critical analysis.

Specialist inpatient treatment for severe motor conversion disorder: a retrospective comparative study.

Background: Gold standard protocols have yet to be established for the treatment of motor conversion disorder (MCD). There is limited evidence to support inpatient, multidisciplinary intervention in chronic, severe cases.

Aims: To evaluate the characteristics and outcomes of MCD patients admitted to a specialist neuropsychiatric inpatient unit.

Quality of discharge practices and patient understanding at an academic medical center.

Importance: With growing national focus on reducing readmissions, there is a need to comprehensively assess the quality of transitional care, including discharge practices, patient perspectives, and patient understanding.

Objective: To conduct a multifaceted evaluation of transitional care from a patient-centered perspective.

Design: Prospective observational cohort study, May 2009 through April 2010.

Examining day centre provision for older people in the UK using the Equality Act 2010: findings of a scoping review.

This article reports the findings from a literature review of day care services undertaken during March-June 2012 and repeated in May 2013. The databases searched included AgeInfo, Embase, Medline, PsycINFO, Social Care Online, Web of Science and the publication platform Ingenta Connect as well as specialist older people's sites. It discusses these findings in the context of services for older people in the UK, defined as those aged 65 years and over.

Attitudes and intentions of current anaesthetic trainees.

We report the results of a survey of Irish anaesthetic specialist trainees to establish their future training intentions, their interest in seeking a Consultant position in Ireland and identification of factors that may reduce the attractiveness of future employment in the HSE. 149 responses were received (71% of trainees). 137 (92%) are likely to complete further training abroad, but only 24 (16.

Using Brain Imaging for Lie Detection: Where Science, Law and Research Policy Collide.

Progress in the use of functional magnetic resonance imaging (fMRI) of the brain to evaluate deception and differentiate lying from truth-telling has created anticipation of a breakthrough in the search for technology-based methods of lie detection. In the last few years, litigants have attempted to introduce fMRI lie detection evidence in courts. This article weighs in on the interdisciplinary debate about the admissibility of such evidence, identifying the missing pieces of the scientific puzzle that need to be completed if fMRI-based lie detection is to meet the standards of either legal reliability or general acceptance.

Risk factors for excessive anticoagulation among hospitalized adults receiving warfarin therapy using a pharmacist-managed dosing protocol.

Study Objective: To identify specific risk factors for excessive anticoagulation, defined as an international normalized ratio (INR) higher than 5, in hospitalized adults receiving warfarin therapy using a pharmacist-managed dosing protocol.

Design: Retrospective nested case-control study.

Setting: Large academic tertiary care medical center.

Impact of a palliative care consult service.

Established hospital palliative care consult services (PCCS) have been associated with reduced costs and length of stay, decreased symptom burden, and increased satisfaction with care. Using a retrospective case-control design, we analyzed administrative data of patients seen by PCCS while hospitalized at the Rochester, Minnesota Mayo Clinic hospitals from 2003 to 2008. The PCCS patients were matched to 3:1.

Comprehensive quality of discharge summaries at an academic medical center.

Background: Discharge summaries are essential for safe transitions from hospital to home.

Objective: To conduct a comprehensive quality assessment of discharge summaries.

Design: Prospective cohort study.

Population-based comparison of laparoscopic and open pyeloplasty in paediatric pelvi-ureteric junction obstruction.

Objective: To describe the extent of use and in-hospital outcomes of open and laparoscopic pyeloplasty for paediatric pelvi-ureteric junction (PUJ) obstruction in the USA.

Patients And Methods: Using the 2004-2008 Nationwide Inpatient Sample, we identified 4590 paediatric patients (≤18 years old) who underwent open or laparoscopic pyeloplasty for PUJ obstruction at 195 hospitals. Multivariable regression models were used to test the associations between hospital and patient covariates (age, gender, race, primary health insurance), type of admission (emergent vs elective), and hospital characteristics (teaching vs non-teaching status; rural vs urban location) with complications, length of stay (LOS), and total hospitalization costs.