Multicenter Analysis of the Relationship Between Operative Team Familiarity and Safety and Efficiency Outcomes in Cardiac Surgery.

Background: Safety in cardiac surgical procedures is predicated on effective team dynamics. This study associated operative team familiarity (ie, the extent of clinical collaboration among surgical team members) with procedural efficiency and Society of Thoracic Surgeons (STS) adjudicated patient outcomes.

Methods: Institutional STS adult cardiac surgery registry and electronic health record data from 2014 to 2021 were evaluated across 3 quaternary hospitals.

Impact of repeated intranasal gentamicin irrigation on auditory brainstem evoked potentials in rats.

Gentamicin is a bactericidal aminoglycoside antibiotic that broadly targets Gram-negative microbes. Both human and animal studies have shown that administration of gentamicin is ototoxic by several routes of administration and results in sensorineural hearing loss due to damaged hair cell at the base of the cochlea. However, gentamicin is also administered intranasally to treat sinusitis in humans, but no animal studies have examined ototoxicity of gentamicin administered via this route.

In-person prospective audit and feedback on an oncology ward: development of an immunocompromised antimicrobial stewardship program.

Objective: To describe clinical syndromes, opportunities for antimicrobial optimization, and acceptance of recommendations made by an immunocompromised antimicrobial stewardship program performing in-person prospective audit and feedback (IPPAF) on inpatient oncology services.

Design: Retrospective cohort study.

Setting: Three inpatient oncology services including patients with solid tumor malignancies in an academic cancer center.

Third generation versus fourth generation percutaneous hallux valgus correction: A radiographic analysis of outcomes.

Percutaneous hallux valgus correction is gaining popularity with foot and ankle surgeons. Various studies have found that the percutaneous approach has increased patient satisfaction and outcomes. The technique of the procedure has some variability with the geometry of the distal osteotomy being the most scrutinized.

Safety and efficacy of aminophylline in the prevention of bradyarrhythmia during coronary atherectomy.

Coronary calcified lesions are commonly encountered and coronary atherectomy is commonly used for lesion modification during percutaneous coronary interventions (PCI). The release of adenosine during atherectomy can result in bradyarrhythmias and aminophylline is commonly used to prevent this reaction. We identified 138 patients to evaluate the safety and efficacy of intravenous (IV) aminophylline administration prior to coronary atherectomy.

Catastrophic Femoral Component Failure of a Unicompartmental Knee Arthroplasty.

We report a case of previously undescribed medial unicompartmental knee arthroplasty failure due to femoral component implant fracture. The patient experienced sudden pain and locking while ambulating 8 years postoperatively. Radiographs revealed catastrophic femoral component failure with a transverse break through the metal.

Analysis of aborted bariatric surgeries and potential opportunities.

Background: Aborted bariatric surgeries are an undesirable experience for patients as they are subjected to potential physical harm and emotional distress. A thorough investigation of aborted bariatric surgeries has not been previously reported. This information may allow the discovery of opportunities to mitigate the risk of aborting some bariatric operations.

Rapid Acute Coronary Syndrome Evaluation Over One Hour With High-Sensitivity Cardiac Troponin I: A United States-Based Stepped-Wedge, Randomized Trial.

Study Objective: The real-world effectiveness and safety of a 0/1-hour accelerated protocol using high-sensitivity cardiac troponin (hs-cTn) to exclude myocardial infarction (MI) compared to routine care in the United States is uncertain. The objective was to compare a 0/1-hour accelerated protocol for evaluation of MI to a 0/3-hour standard care protocol.

Methods: The RACE-IT trial was a stepped-wedge, randomized trial across 9 emergency departments (EDs) that enrolled 32,609 patients evaluated for possible MI from July 2020 through April 2021.

Hospital Acquired Venous Thromboembolism: A Preventability Assessment.

The American Heart Association has a call to action to reduce hospital acquired venous thromboembolism (HA-VTE) by 20% by the year 2030. There is increasing recognition that quality improvement initiatives for VTE reduction should focus on reducing potentially preventable HA-VTE. The objective of our study was to determine what proportion of HA-VTE events are potentially preventable.

Current Expectations and Opinions on Single-port Robotic Surgery: A Survey Among European Experts by the SPARC Collaborative Group.

Unlabelled: Single-port (SP) robotic surgery is a relatively new technology that is expected to become available on the European market within a year. We investigated the current expectations of robotic surgery experts and opinion leaders practicing in Europe. A 17-item online questionnaire was sent to 120 participants identified as "experts" on the basis of their general contributions to the field of robotic surgery.

Antithrombotic Management for Transcatheter Aortic Valve Implantation.

Background: There have been significant changes in the optimal antithrombotic regimen post transcatheter aortic valve implantation (TAVI) after the results of major clinical trials in the past few years. Given the clinical importance of the optimal antithrombotic therapy post TAVI, we performed a narrative description of the major clinical trials behind the scientific evidence supporting these changes, as well the current guideline recommendations and knowledge gaps.

Methods: We performed a narrative description of the major clinical trials behind the scientific evidence supporting these changes.

Scoring big: Aligning inpatient clinical pharmacy services through implementation of an electronic scoring system.

Purpose: Data are limited on utilizing a comprehensive scoring system in the electronic health record to help prioritize, align, and standardize clinical pharmacy services across multiple hospitals and practice models within a health system. The purpose of this article is to describe the development and implementation of an electronic scoring system to help inpatient pharmacists prioritize patient care activities and standardize clinical services across a diverse health system.

Summary: Inpatient pharmacists from all specialty areas across the health system partnered with health information technology pharmacists to develop a scoring system directly integrated into the electronic health record that would help triage patient care, identify opportunities for pharmacist intervention, and prioritize clinical pharmacy services.

Evaluating the Impact of Operative Team Familiarity on Cardiac Surgery Outcomes: A Retrospective Cohort Study of Medicare Beneficiaries.

Objective: To associate surgeon-anesthesiologist team familiarity (TF) with cardiac surgery outcomes.

Background: TF, a measure of repeated team member collaborations, has been associated with improved operative efficiency; however, examination of its relationship to clinical outcomes has been limited.

Methods: This retrospective cohort study included Medicare beneficiaries undergoing coronary artery bypass grafting (CABG), surgical aortic valve replacement (SAVR), or both (CABG+SAVR) between January 1, 2017, and September 30, 2018.

Credentialed and Privileged Clinical Nurse Specialists.

Purpose/objectives: The purpose of this article is to illustrate, using exemplars, the practice of clinical nurse specialists (CNSs) in Michigan who are credentialed and privileged as providers by hospital/healthcare agencies to practice in acute inpatient and ambulatory settings.

Description: The CNS provides expert specialty direct patient care to improve patient outcomes. They hold a graduate degree as a CNS, are professionally certified as a CNS in a specialty practice population, and are licensed or otherwise recognized to practice as an advanced practice nurse by the state nursing practice regulatory agency.

Evidence-based opioid prescribing guidelines after lung resection: a prospective, multicenter analysis.

Background: Opioid prescribing guidelines have significantly decreased overprescribing and post-discharge use after cardiac surgery; however, limited recommendations exist for general thoracic surgery patients, a similarly high-risk population. We examined opioid prescribing and patient-reported use to develop evidence-based, opioid prescribing guidelines after lung cancer resection.

Methods: This prospective, statewide, quality improvement study was conducted between January 2020 to March 2021 and included patients undergoing surgical resection of a primary lung cancer across 11 institutions.

Tension Pneumopericardium Causing Cardiogenic Shock due to Blunt Injury to the Chest.

Pneumopericardium is an exceptionally uncommon phenomenon in the setting of blunt polytrauma. It is imperative for trauma providers to identify tension pneumopericardium despite its rarity. A 22-year-old male motorcyclist presented to the hospital after colliding with a car going approximately 50 mph.

Identification of Seniors at Risk Score to Determine Geriatric Evaluations on Trauma Patients With Hip Fractures.

Background: Trauma centers are confronted with rising numbers of geriatric trauma patients at high risk for adverse outcomes. Geriatric screening is advocated but not standardized within trauma centers.

Objective: This study aims to describe the impact of Identification of Seniors at Risk (ISAR) screening on patient outcomes and geriatric evaluations.