Time course of C-reactive protein and inflammatory mediators after neonatal surgery.

Objective: To characterize the perioperative course of C-reactive protein (CRP) and inflammatory mediators in neonates ≤44 weeks' corrected gestational age.

Study Design: Prospective study of CRP and inflammatory mediators interleukin (IL)-1β, IL-6, IL-8, IL-10, and tumor necrosis factor-α in 55 neonates undergoing thoracic or abdominal surgery.

Results: In the absence of infection, CRP increased after surgery, peaking on post-operative day 2.

Hyperglycemia, insulin and slower growth velocity may increase the risk of retinopathy of prematurity.

Objective: Strategies to reduce Retinopathy of Prematurity (ROP) have focused primarily on respiratory management. Hyperglycemia (HG) and insulin use, risk factors for adult diabetic retinopathy, as well as growth rates may be modifiable variables useful to reduce ROP.

Study Design: This was a retrospective chart review of all infants born at <30 weeks gestation from 2003 to 2007 who survived to discharge in our neonatal intensive care unit (NICU).

Light-guided lumpectomy: device and case report.

We describe the development, design, fabrication, and testing of an optical wire to assist in the surgical removal of small lesions during breast-conserving surgery. We modify a standard localization wire by adding a 200-μm optical fiber alongside it; the resulting optical wire fit through an 18 gauge needle for insertion in the breast. The optical wire is anchored in the lesion by a radiologist under ultrasonic and mammographic guidance.

Statewide efforts to narrow the rural-urban gap in acute stroke care.

Background: Rural-urban gaps in stroke care remain challenging in part because of the lack of resources, personnel, and necessary infrastructure.

Purpose: The purpose of this study was to assess changes in the acute stroke diagnosis and treatment capacity among rural hospitals before and after implementation of a regionwide stroke initiative.

Methods: In 2004, the Montana Cardiovascular Health Program partnered with stroke stakeholders throughout the state and surveyed hospitals in Montana and northern Wyoming to assess the availability of technology, services, and personnel for acute stroke care.

Hemostasis after liver resection improves after single application of albumin and argon beam coagulation.

Background: Bleeding from the liver surface is common after hepatic resection. Animal studies have demonstrated superiority of argon beam coagulation (ABC) and 38% human serum albumin when applied together after partial liver resection when compared to ABC alone. There are no data addressing the combination of albumin and argon beam coagulation (ABCA) applied to the bleeding liver after resection in humans.

P.U.R.E. (purposeful, unambiguous, respectful, and effective) Conversations and electronic fetal monitoring: gaining consensus and collaboration.

A revised nomenclature regarding electronic fetal heart rate monitoring was accepted at a National Institute of Child Health and Human Development consensus conference in 2008. At the heart of patient safety are communication strategies that enhance teamwork and collaboration between health care professionals. Communications is a complex 2-way process that involves more than transfer of factual information.

Clinical benefits of tight glycaemic control: focus on the perioperative setting.

The benefits of tight glycaemic control (TGC) were first shown in cardiac surgical patients with diabetes. These concepts migrated to other surgical and medical specialties through intensive care units caring for a variety of patients with a variety of disease states Although some disagreement and controversy surrounds the use of TGC in the medical population, the benefits of this therapy ir the diabetes cardiac surgery population is unblemished. Perioperative hyperglycaemia has been shown to be associated with adverse surgical outcomes in several different patient populations TGC for 3 full postoperative days or more mitigates these risks Although this has been definitively proven in the diabetes coronary artery bypass graft (CABG) population, evidence for beneficia effects of TGC in other surgical populations remains elusive at this point in time.

Caring for the pregnant woman presenting at periviable gestation: acknowledging the ambiguity and uncertainty.

Counseling the periviable pregnant woman presenting at the edge of viability can often be confusing for the patient and frustrating for the clinician. Although neonatal survival rates have improved dramatically over the last few decades, severe morbidity is still common. This is further complicated by the fact that the information provided to the parents regarding the outcomes may not be up to date or completely accurate.

Monte Carlo Green's function formalism for the propagation of partially coherent light.

We present a Monte Carlo-derived Green's function for the propagation of partially spatially coherent fields. This Green's function, which is derived by sampling Huygens-Fresnel wavelets, can be used to propagate fields through an optical system and to compute first- and second-order field statistics directly. The concept is illustrated for a cylindrical f/1 imaging system.

Evaluation of a nurse practitioner-led care management model in reducing inpatient drug utilization and cost.

The aim of this research was to evaluate the economic impact of a collaborative nurse practitioner (NP) care management model on the use of pharmaceutical resources, with a focus on antibiotics, among general medicine inpatients. Although studies have shown the effectiveness of care management by NPs, especially as reflected on length of stay and hospital cost, little is known about their impact on drug cost. The researchers utilized pharmaceutical claims data of 1,200 subjects who participated in the Multidisciplinary, Physician, and Nurse Practitioner Study from 2000 to 2004 to assess the effect of the NP-led care management model on drug utilization outcomes.

Counseling pregnant women who may deliver extremely premature infants: medical care guidelines, family choices, and neonatal outcomes.

Objectives: The justification of neonatal intensive care for extremely premature infants is contentious and of considerable importance. The goal of this report is to describe our experience implementing consensus medical staff guidelines used for counseling pregnant women threatening extremely premature birth between 22 and 26 weeks' postmenstrual age and to give an account of family preferences and the immediate outcome of their infants.

Methods: Retrospective chart review was performed for all women threatening premature birth between 22 and 26 weeks postmenstrual age who presented to our high-risk obstetric service between June 2003 and December 2006.

The emperor's tailors: the failure of the medical weight loss paradigm and its causal role in the obesity of America.

During the past century, the medical profession has developed a paradigm for the treatment of obesity, which prescribes specific exercise and dietary goals under the umbrella of 'lifestyle change'. It has three components, all of which evolved from origins that had nothing to do with weight control. First, it is individually prescriptive, that is weight loss is considered the responsibility of the individual as contrasted to a societal or group responsibility.

Accuracy of different temperature devices in the postpartum population.

Objectives: To determine if different temperature monitoring devices routinely used in postpartum mothers and newborns provide similar temperatures and to compare the rectal and axillary routes for temperature monitoring in newborns.

Design: A method comparison design with randomization of the temperature device sequence was used to evaluate the level of agreement between the 3 different types of thermometers used.

Setting: A Level 3 (high risk) postpartum unit with 6,200 deliveries per year in a 450-bed, not-for-profit hospital in the Pacific Northwest.

Comparison of finger and forehead oximetry sensors in postanesthesia care patients.

We compared loss of pulse oximetry signal (dropout rates) for both finger and forehead sensors in postanesthesia patients. Pulse oximetry is a widely practiced method for measuring oxygen saturation. Several studies in various patient populations have demonstrated that low flow states, patient movement, and hypothermia may result in poor signal quality with the use of finger oximetry sensors.

Efficiency of Core Biopsy for BI-RADS-5 Breast Lesions.

Stereotactic biopsy has proven more cost effective for biopsy of lesions associated with moderately suspicious mammograms. Data regarding selection of stereotactic biopsy (CORE) instead of excisional biopsy (EB) as the first diagnostic procedure in patients with nonpalpable breast lesions and highest suspicion breast imaging-reporting and data system (BI-RADS)-5 mammograms are sparse. Records from a regional health system radiology database were screened for mammograms associated with image-guided biopsy.

Laparoscopic repair of inferior vena caval injury using a chitosan-based hemostatic dressing.

Background: Vena caval injury is a rare but serious complication of laparoscopic surgery, and often requires conversion to an open procedure. The current study investigated whether a vena caval injury could be repaired with a chitosan dressing laparoscopically.

Methods: Six domestic swine were studied.

Chitosan hemostatic dressing for renal parenchymal wound sealing in a porcine model: implications for laparoscopic partial nephrectomy technique.

Background And Objectives: This study was to evaluate the feasibility of using a novel chitosan hemostatic dressing to control hemorrhage and urinary leakage by sealing off the parenchymal wound following LPN.

Methods: Nine heparinized domestic swine underwent bilateral laparoscopic partial nephrectomies involving either a polar or wedge resection. Estimated blood loss (EBL), hemostatic score, operative time, and adhesion score of the chitosan dressing were documented during LPN.

A comparison of different assessment techniques for measuring foot and ankle volume in healthy adults.

Background: Foot and ankle volume may be an important measurement for conditions such as lower-extremity trauma or pathologic abnormalities. Water volumetry, often used for this measure, is accurate but not always convenient. We used figure-of-eight tape measurement, prism approximation, foot size measurement (Brannock device), and optoelectric measurement (Perometer) with the standard of water volumetry to compare foot and ankle volumes.

Improving outpatient warfarin use for hospitalized patients with atrial fibrillation.

Unlabelled: Atrial fibrillation affects an estimated 5 million Americans and accounts for approximately 15% of all strokes. Few studies have successfully addressed patient screening, assessment, and introduction of appropriate antithrombotic therapy in patients with atrial fibrillation.

Objective: To assess whether an intervention improved planned antithrombotic prescribing at the time of discharge in hospitalized patients.