PCO2 and room air saturation values in premature infants at risk for bronchopulmonary dysplasia.

Objective: To determine the capillary partial pressure of carbon dioxide (PCO(2)) and room air transcutaneous hemoglobin saturation (RA SAT) at 36 weeks' postmenstrual age (PMA) in infants born with weight between 501 and 1250 g.

Study Design: Multicenter, prospective investigation with primary data collection within 72 h of 36 weeks PMA or discharge, whichever first. PCO(2) and RA SAT determinations were done at rest on infants not requiring mechanical ventilation or nasal continuous positive airway pressure (NCPAP).

Use of concentrated human albumin with argon-beam coagulation in laparoscopic partial nephrectomy.

Purpose: Laparoscopic partial nephrectomy (LPN) remains a technically challenging procedure mainly because of the lack of reliable methods of hemostasis. We evaluated the feasibility of using concentrated human albumin with argon-beam coagulation to control hemorrhaging and urinary leakage during LPN.

Materials And Methods: Six domestic swine underwent heparinization, then lower-pole LPN after renal-hilar vascular control had been obtained.

Use of a chitosan-based hemostatic dressing in laparoscopic partial nephrectomy.

Objectives: An external chitosan-based hemostatic bandage has been used to control aggressive bleeding from traumatic injuries. This study was to evaluate the feasibility of using an internal chitosan dressing based on the external platform to control hemorrhage and urinary leakage by sealing off the parenchymal wound following Laparoscopic partial nephrectomy (LPN) in a porcine model.

Methods: Nine heparinized domestic swine underwent bilateral laparoscopic partial nephrectomies involving either a polar (N = 13) or wedge resection (N = 5) followed by treatment with the chitosan dressing.

Disruptive behavior in obstetrics: a hidden threat to patient safety.

Objective: This study was to determine the frequency of disruptive behavior on labor and delivery units, its effect on work performance, and its contribution to adverse outcomes.

Study Design: One hundred questionnaires were sent to nurse managers of labor and delivery units in selected hospitals in Washington, Oregon, and California regarding the occurrence of disruptive behavior and the consequences of this behavior with respect to patient safety.

Results: Fifty-six percent of questionnaires were returned.

Achieving tight glycemic control in the operating room: lessons learned from 12 years in the trenches of a paradigm shift in anesthetic care.

Intensive insulin therapy to control perioperative hyperglycemia has become the new standard of care for cardiac surgery patients. Although there are several published protocols for achieving tight glycemic control in the postoperative period, there are no such published protocols or even suggested methods for intraoperative control. At Providence St.

PURE conversations: enhancing communication and teamwork.

Communications failures have been identified as a significant cause of adverse outcomes in obstetrics. Following the lead of some high reliability organizations, healthcare has introduced structured communication such as SBAR as a way to make sure communications between professionals are direct, complete and effective. The authors have observed, however, that structured communication in healthcare often requires a cultural change in the way that professionals relate to each other; PURE conversations (Purposeful/prepared/productive, Unambiguous, Respectful and Effective) can facilitate this cultural shift.

Implementation and case-study results of potentially better practices for collaboration between obstetrics and neonatology to achieve improved perinatal outcomes.

Objective: The objective of this study was to make improvements in communication and collaboration between neonatal and obstetric specialties. Five NICUs from the Vermont Oxford Network's Evidence-Based Quality Improvement Collaborative in Neonatal and Perinatal Medicine tested potentially better practices that overlap obstetric and NICU care.

Methods: One area of practice improvement was the management of the pregnancy at the margin of viability.

Successful implementation of the National Institutes of Health Stroke Scale on a stroke/neurovascular unit.

The National Institutes of Health Stroke Scale (NIHSS) is accepted as the definitive clinical examination to assess stroke severity. This project examined barriers to implementation and NIHSS use by registered nurses on a stroke/neurovascular Unit. Staff members were surveyed to determine nurse-perceived barriers to the routine use of the NIHSS.

Different outcomes in urethral reconstruction using elastin and collagen patches and conduits in rabbits.

Objectives: To study the feasibility of urethral reconstruction with two urethroplasty techniques using an elastin and collagen heterograft in rabbits.

Materials And Methods: Fifty-two male rabbits were studied. Two types of injury, (1) a 1.

Clinical effects of hyperglycemia in the cardiac surgery population: the Portland Diabetic Project.

Objective: To determine the outcome effects of hyperglycemia, and its pharmacologic reduction with continuous intravenous insulin infusions (CII) in the cardiac surgery patient population.

Methods: The Portland Diabetic Project is a prospective, non-randomized, observational study of 5,510 consecutive diabetic cardiac surgery patients treated between January 1987 and November 2005.

Results: This study was the first to reveal that hyperglycemia in the first 3 postoperative days is independently predictive of mortality (P<0.

Ethics consultation in Portland. Providence Health's Oregon Region has created an ethics consult service.

In response to the need for a more structured approach toward the enhancement of and preparation for case consultation, the Portland Service Area (PSA) of the Providence Health System Oregon Region implemented a "special team" system. These teams--an extension of the ethics committees already in place--underwent training in areas such as an overview of ethics, patient decision making, professionalism, organizational ethics, and palliative and end-of-life care. Moving ethics consultation away from the purview of ethics committees generally, and into the realm of these trained special teams, has improved PSA's ability to respond to ethics needs in the region.

Intracardiac extension of lung cancer demonstrated on PET scanning.

Intracardiac tumors are unusual and can originate within the heart or spread from other sites. This is a report of a patient who presented with a TIA, and during the subsequent stroke workup, a right hilar nonsmall cell lung carcinoma was discovered. The tumor had extended into the left atrium through a pulmonary vein.

Medical staff guidelines for periviability pregnancy counseling and medical treatment of extremely premature infants.

Objectives: The goal of this report is to describe the collaborative formation of rational, practical, medical staff guidelines for the counseling and subsequent care of extremely early-gestation pregnancies and premature infants between 22 and 26 weeks. The purposes of the guidelines were to improve knowledge regarding neonatal outcomes, to provide consistency in periviability counseling, and to promote informed, supportive, responsible choices.

Methods: To formulate the guidelines, a 5-step process was conducted; it began with a series of multidisciplinary meetings among maternal-fetal medicine specialists (MFMs), obstetricians, neonatologists, neonatal nurse practitioners, and nurses from both the labor and delivery unit and the NICU at Providence St Vincent Medical Center (Portland, OR).

Design, testing, and clinical studies of a handheld polarized light camera.

Polarized light imaging has been used to detect the borders of skin cancer and facilitate assessment of cancer boundaries. A design for an inexpensive handheld polarized camera is presented and clinical images acquired with this prototype are shown. The camera is built with two universal serial bus (USB) color video cameras, a polarizing beamsplitter cube, and a 4x objective lens.

Adjunctive granulocyte colony-stimulating factor therapy for diabetic foot infections.

Objective: To evaluate the role of granulocyte colony-stimulating factor (G-CSF) as adjunctive therapy for the treatment of diabetic foot infections in non-neutropenic patients.

Data Sources: Clinical literature was accessed through MEDLINE (1965-April 2004). Key search terms included G-CSF, infection, and diabetes.

Laser-assisted vascular end to end anastomosis of elastin heterograft to carotid artery with an albumin stent: a preliminary in vivo study.

Background And Objectives: Laser-assisted end to end vascular anastomosis of an elastin heterograft to native artery may prevent problems associated with currently available vascular synthetic grafts and conventional suture anastomosis.

Study Design/materials And Methods: A total of 21 anastomoses in the carotid arteries of 7 domestic swine were performed with an 800 nm laser and an albumin stent plus solder. There were 5 artery to artery and 16 elastin heterograft to native artery anastomoses.

Concentrated albumin as a biological glue for hemorrhage control on hepatic resection with argon beam coagulation.

Topically applied concentrated albumin with argon beam coagulation (ABCA) has been shown to be more effective at achieving hemostasis than using argon beam coagulation alone (ABC) in a liver injury model. This study investigated the host response to the concentrated albumin after argon beam coagulation. Complete hemostasis was achieved using ABCA (N = 10) or ABC (N = 10) on a nonanatomic liver resection in a heparinized porcine model.

Laser-assisted end-to-end vascular anastomosis of elastin heterograft to carotid artery with an albumin stent in vivo.

Background Data: Laser-assisted end-to-end vascular anastomosis of an elastin heterograft to native artery may avoid the problems associated with currently available vascular synthetic grafts and conventional suture anastomosis.

Methods: A total of 21 anastomoses in the carotid arteries of seven domestic pigs were performed with an 800-nm laser and an albumin stent plus solder. There were five artery to artery and 16 elastin heterograft to native artery anastomoses.

Long-term effects of polymer-based, slow-release, sirolimus-eluting stents in a porcine coronary model.

Background: Stent-based delivery of sirolimus (SRL) has shown reduction in neointimal hyperplasia and restenosis. The purpose of this study was to evaluate the chronic vascular response and the expression of cell cycle regulators after SRL-eluting stent implantation in a porcine coronary model.

Methods: Forty-nine pigs underwent placement of 109 oversized stents (control, n=54, SRL (140 microg/cm(2)), n=55) in the coronary arteries with histologic analysis and Western blot (PCNA, p27(kip1), CD45, MCP-1, IL-2, IL-6, TNF-beta) at 3, 30, 90 or 180 days.

Optimal dye concentration and irradiance for laser-assisted vascular anastomosis.

Objective: This investigation was done in order to find optimal indocyanine green (ICG) concentration and energy irradiance in laser vascular welding.

Background Data: Many studies have shown that laser tissue welding with albumin solder/ICG may be an effective technique in surgical reconstruction. However, there are few reports regarding optimal laser settings and concentrations of ICG within the albumin solder in laser-assisted vascular anastomosis.

Filtration fraction and its implications for radionuclide renography using diethylenetriaminepentaacetic acid and mercaptoacetyltriglycine.

Purpose: Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were determined in 92 patients to calculate filtration fraction (GFR/EFPR) and evaluate its change in renal diseases. This information was used as the rationale for a renogram protocol using DTPA (to estimate GFR) and MAG3 (to produce images and curves).

Methods: Individual kidney GFR and ERPF were determined by gamma camera techniques using Tc-99m DTPA and I-131 OIH.

Biocompatibility of a xenogenic elastin-based biomaterial in a murine implantation model: the role of aluminum chloride pretreatment.

We have investigated the long-term effect of aluminum chloride (AlCl(3)) treatment on the calcification and inflammatory reaction of a porcine elastin-derived biomaterial (PEB) in a novel subdermal adult mouse model. Untreated PEB disks and PEB treated with AlCl(3) were implanted subdermally in BALB/c mice for 30, 60, and 180 days. The calcification of the elastin disks was examined with histological analysis and atomic absorption analysis of calcium content.