Implementing potentially better practices for improving family-centered care in neonatal intensive care units: successes and challenges.

Objective: Multidisciplinary teams from 11 medical center neonatal intensive care units collaborated in a quality improvement project with a focus on family-centered care.

Methods: Through a process of self-analysis, literature review, benchmarking site visits, and expert consultation, 10 potentially better practice (PBP) areas were defined. Improvement activities in 4 of the 10 areas are given as examples of successes and challenges that individual centers encountered.

Intra-operative ultrasound guidance of vena caval umbrella placement in a super obese patient.

Morbidly obese patients are often denied the benefits of sophisticated diagnostic studies and interventions because of the maximum weight limits of available equipment. Two examples in our hospital include a limit of 227 kg (500 lb) on our CT and angiographic tables. We present a patient who was considered to be high risk for recurrent pulmonary emboli and who could not undergo preoperative vena caval umbrella placement, because his weight exceeded the limit of our angiographic table.

Case report: solitary pelvic osteochondroma presenting with L3 nerve root compression.

Osteochondroma is the most common benign bone tumor, comprising 40% of benign bone tumors. Typically they are found in adolescents growing on long bones such as the femur or radius and are clinically obvious. Very rarely, osteochondromas grow in the pelvis where they can reach a large size and present in more subtle ways.

Immune responses of prematurely born infants to hepatitis B vaccination: results through three years of age.

Background: Hepatitis B vaccine is effective in infants. Preterm infants also respond but information on long term immunogenicity is limited.

Purpose Of Study: To compare response of premature and full term infants to hepatitis B vaccine.

High-altitude medicine.

This article discusses prevention, recognition, and treatment of altitude illnesses, especially acute mountain sickness, high-altitude pulmonary edema, and high-altitude cerebral edema. Physicians advising travelers and trekkers who will be visiting high-altitude areas will find an organized approach to giving pretravel advice. Physicians practicing in or visiting high-altitude areas will find guidelines for diagnosis and treatment.

What determines survival and morbidity at very early gestation? Alaska's experience.

The charts of all infants (N = 46) 22-25 weeks gestation admitted to the Newborn Intensive Care Unit at Providence Alaska Medical Center from 1991-1994 were reviewed to determine factors associated with mortality and severe morbidity. Survival rates at 22 & 23 weeks gestation was poor (25% and 14% respectively). Survival rates of 24 and 25 week gestation infants were similar (53% and 62% respectively).