Evaluating the Impact of Eat, Sleep, Console in Neonatal Abstinence Syndrome Treatment for Infants Exposed to Substance Use .

Objective: An increase in maternal use of licit or illicit substances, alcohol, and tobacco has resulted in an increased incidence of neonatal abstinence syndrome (NAS). In recent years, NAS management has shifted to initiating an Eat, Sleep, Console (ESC) approach prior to pharmacologic treatment. The objective of this study was to evaluate the impact of ESC in combination with pharmacologic treatment in the management of NAS for infants exposed to substance use .

Determining the Educational Value of an Emergency Medicine Rotation for Non-Emergency Medicine Residents.

Background Residents from diverse specialties perform clinical rotations in the emergency department (ED). There is little research about the value of the ED rotation for them. Objectives We sought to determine the learning objectives of non-EM residents (NEMRs) in the ED, the effectiveness of the rotation, and the highest-yield components of their experience.

Sodium-Glucose Cotransporter-2 (SGLT-2) Inhibitors Use among Heart Failure Patients and the Role of Pharmacists in Early Initiation of Therapy.

Heart failure (HF) is a growing major public health and economic concern in the United States and worldwide. Heart failure mortality rates can be as high as 75% despite advances in therapies. HF is expected to be the fastest growing among all cardiovascular diseases, with HF-associated direct medical costs projected to nearly double over the next 10 years.

Examination of clinical and laboratory measures of static and dynamic balance in breast cancer survivors.

Balance in breast cancer survivors is understudied. Increased understanding of how postural control is affected when the body is stationary, moving, or engaged in a concurrent cognitive task, can aid clinicians who work with this population in identifying how altered postural control may indicate a potential functional decline. Therefore, the purpose of this study was to compare performance on several assessments of static and dynamic balance, with and without a concurrent cognitive task, in women with and without a history of breast cancer.

Behavioral Deficits at 18-22 Months of Age Are Associated with Early Cerebellar Injury and Cognitive and Language Performance in Children Born Extremely Preterm.

Objective: To investigate associations in toddlers born extremely preterm (<28 weeks) between neonatal neuroimaging and 18- to 22-month developmental and behavioral outcomes.

Study Design: Cohort analysis from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network Surfactant Positive Airway Pressure and Pulse Oximetry Trial Neuroimaging and Neurodevelopmental Outcomes Study of infants born extremely preterm. Subjects underwent cranial ultrasonography and near-term magnetic resonance imaging (MRI).

Decreasing Wait Times and Increasing Patient Satisfaction: A Lean Six Sigma Approach.

Background: Patient satisfaction scores in the vascular interventional radiology department were low, especially related to wait times in registration and for tests/treatments, with low scores for intentions to recommend.

Purpose: The purpose of our quality improvement project was to decrease wait times and improve patient satisfaction using Lean Six Sigma's define, measure, analyze, improve, and control (DMAIC) framework with a pre-/postintervention design.

Results: There was a statistically significant decrease in wait times (P < .

Effectiveness of targeted enhanced terminal room disinfection on hospital-wide acquisition and infection with multidrug-resistant organisms and Clostridium difficile: a secondary analysis of a multicentre cluster randomised controlled trial with crossover design (BETR Disinfection).

Background: The hospital environment is a source of pathogen transmission. The effect of enhanced disinfection strategies on the hospital-wide incidence of infection has not been investigated in a multicentre, randomised controlled trial. We aimed to assess the effectiveness of four disinfection strategies on hospital-wide incidence of multidrug-resistant organisms and Clostridium difficile in the Benefits of Enhanced Terminal Room (BETR) Disinfection study.

Markers of Successful Extubation in Extremely Preterm Infants, and Morbidity After Failed Extubation.

Objectives: To identify variables associated with successful elective extubation, and to determine neonatal morbidities associated with extubation failure in extremely preterm neonates.

Study Design: This study was a secondary analysis of the National Institute of Child Health and Human Development Neonatal Research Network's Surfactant, Positive Pressure, and Oxygenation Randomized Trial that included extremely preterm infants born at 24 to 27 weeks' gestation. Patients were randomized either to a permissive ventilatory strategy (continuous positive airway pressure group) or intubation followed by early surfactant (surfactant group).

Building Community Through a #pulmcc Twitter Chat to Advocate for Pulmonary, Critical Care, and Sleep.

Background: Social media sites such as Twitter can significantly enhance education and advocacy efforts. In 2013, the American College of Chest Physicians (CHEST) launched a Twitter chat series using the hashtag #pulmcc to educate and advocate for topics related to pulmonary, critical care, and sleep medicine.

Methods: To assess the reach of these chats, we analyzed the metrics using Symplur analytics, and compared data from each chat, as well as participant data.

Patterns of Oxygenation, Mortality, and Growth Status in the Surfactant Positive Pressure and Oxygen Trial Cohort.

Objective: To characterize actual achieved patterns of oxygenation in infants born appropriate vs small for gestational age (SGA) randomized to a lower (85-89%) vs higher (91%-95%) oxygen saturation target in the Surfactant Positive Pressure and Oxygen Trial. To determine the association between achieved oxygen saturation levels and survival in infants born appropriate vs SGA enrolled in the Surfactant Positive Pressure and Oxygen Trial.

Study Design: Median oxygen saturation and intermittent hypoxemia events (<80%, 20 seconds-5  minutes) were documented in 1054 infants of 24-27 weeks of gestation while receiving supplemental oxygen during the first 3 days of life.

Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile (the Benefits of Enhanced Terminal Room Disinfection study): a cluster-randomised, multicentre, crossover study.

Background: Patients admitted to hospital can acquire multidrug-resistant organisms and Clostridium difficile from inadequately disinfected environmental surfaces. We determined the effect of three enhanced strategies for terminal room disinfection (disinfection of a room between occupying patients) on acquisition and infection due to meticillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, C difficile, and multidrug-resistant Acinetobacter.

Methods: We did a pragmatic, cluster-randomised, crossover trial at nine hospitals in the southeastern USA.

Ramucirumab With Eribulin Versus Eribulin in Locally Recurrent or Metastatic Breast Cancer Previously Treated With Anthracycline and Taxane Therapy: A Multicenter, Randomized, Phase II Study.

Background: Use of antiangiogenic agents in treatment of metastatic breast cancer (MBC) remains controversial. We evaluated the efficacy and safety of ramucirumab and eribulin versus eribulin alone as third- to fifth-line therapy in women with advanced breast cancer.

Patients And Methods: In this randomized (1:1), open-label, phase II study, US women aged 18 years or older with 2 to 4 previous chemotherapy regimens for locally recurrent or MBC, previous anthracycline and taxane treatment, and Eastern Cooperative Oncology Group performance status of 0 or 1 received ramucirumab with eribulin or eribulin alone in 21-day cycles (eribulin 1.

Cardiorenal syndrome: understanding the connections between cardiac and renal disease.

Renal and cardiac diseases are nearly ubiquitous in hospitalized patients and common causes of morbidity in outpatients. Although the connection between the heart and kidneys is relatively well known in the medical community, a more formal classification for the clinical interplay of the two systems has been developed only recently. Cardiorenal syndrome was described by Italian nephrologist Claudio Ronco in 2008.

Vitamin K deficiency bleeding: a case study.

Vitamin K deficiency bleeding (VKDB), formerly known as hemorrhagic disease of the newborn (HDN), is a bleeding disorder in neonates that is caused by inadequate serum levels of vitamin K. Vitamin K is a nutrient essential for adequate function of the coagulation cascade. Certain internal and external factors place newborn infants at higher risk for VKDB.

Phase 2 study of pemetrexed plus carboplatin, or pemetrexed plus cisplatin with concurrent radiation therapy followed by pemetrexed consolidation in patients with favorable-prognosis inoperable stage IIIA/B non-small-cell lung cancer.

Introduction: There is no consensus chemotherapy regimen with concurrent radiotherapy (RT) for inoperable stage IIIA/B non-small-cell lung cancer. This trial evaluated pemetrexed with carboplatin (PCb) or cisplatin (PC) with concurrent RT followed by consolidation pemetrexed.

Methods: In this open-label, noncomparative phase II trial, patients with inoperable stage IIIA/B non-small-cell lung cancer (initially all histologies, later restricted to nonsquamous) were randomized (1:1) to PCb or PC with concurrent RT (64-68 Gy over days 1-45).

Managing officer morale in 2012.

The stresses inherent in a hospital environment which impact on security may result in officers who do not see or feel positive results from the hard work they provide and, in experiencing low morale, can affect the performance of their peers, according to the author. In this article he describes what the healthcare security director can do to maintain high morale and, in doing so, retain the key members of his or her team.

Giant hypopharyngeal atypical lipomatous tumor.

The so-called "giant fibrovascular polyps" of the esophagus and hypopharynx typically present as sausage-like pedunculated structures that protrude into the lumen and cause obstructive symptoms. Most are cured by local resection but they may recur. Microscopically, they display an admixture of fibrovascular and adipose tissue that is coated by unremarkable squamous mucosa.

Outcomes following elective percutaneous coronary intervention without on-site surgical backup in a community hospital.

Despite guidelines to the contrary, limited numbers of elective percutaneous coronary intervention (PCI) procedures without on-site surgical backup are being performed, particularly in Europe and Canada. In the United States, many hospitals are considering establishing on-site surgical programs, in part to facilitate PCI. At a hospital with only off-site surgical backup, 562 elective PCI procedures were performed on 489 consecutive patients.

Alamance Regional Medical Center improves patient safety with CPOE.

While it is widely written that advanced clinical information systems can help healthcare organizations reduce adverse medical events and increase patient safety, Alamance Regional Medical Center (ARMC) has proven that it truly does. ARMC chose Eclipsys' Sunrise Clinical Manager for its ability to provide knowledge-based clinical decision support and its alert capabilities at the time of order entry. Since its organization-wide rollout in summer 2000, ARMC has been using the computerized physician order entry (CPOE) system with widespread success and has transformed the care delivery process.