Serum Biomarkers of Inflammation, Fibrosis, and Cardiac Function in Facilitating Diagnosis, Prognosis, and Treatment of Anti-SSA/Ro-Associated Cardiac Neonatal Lupus.

Background: Cardiac manifestations of neonatal lupus (cardiac NL) include congenital heart block and cardiomyopathy. Several candidate biomarkers were evaluated in cases at risk for cardiac NL on the basis of potential roles in inflammation, fibrosis, and cardiac dysfunction: C-reactive protein (CRP); NT-pro-B-type natriuretic peptide (NT-proBNP); troponin I; matrix metalloproteinase (MMP)-2; urokinase plasminogen activator (uPA); urokinase plasminogen activator receptor (uPAR); plasminogen; and vitamin D.

Objectives: Identification of maternal and fetal biomarkers associated with development and morbidity of cardiac NL should provide clues to pathogenesis with translational implications for management.

Clinical efficacy of epicardial application of drug-releasing hydrogels to prevent postoperative atrial fibrillation.

Objective: Postoperative atrial fibrillation is the most frequent complication arising after cardiac surgery, occurring in 40% of cases. The treatment of postoperative atrial fibrillation with epicardial amiodarone/corticosteroid hydrogel delivery can increase efficacy and reduce side effects. To further evaluate whether amiodarone hydrogel is superior to corticosteroid hydrogel or placebo, we performed a randomized prospective study in 150 patients with coronary artery bypass grafting to compare the effectiveness with different epicardial drug approaches in the postoperative period.

Head injuries in hospital-admitted adolescents and adults with skateboard-related trauma.

Objective: To provide new information on properties of skateboarders who were hospital admitted with head injuries with details of the injuries including region of head impact.

Methods: Hospital records of patients aged 15 and older with a skateboard injury admitted to one Level II Trauma Centre during a 10-year period were reviewed. Data on demographic, exposure, severity, diagnostic and clinical factors for patients with head injury (HI) and without HI (N-HI) were compared analytically.

ICD-9-CM and ICD-10-CM mapping of the AAST Emergency General Surgery disease severity grading systems: Conceptual approach, limitations, and recommendations for the future.

The American Association for the Surgery of Trauma (AAST) recently established a grading system for uniform reporting of anatomic severity of several emergency general surgery (EGS) diseases. There are five grades of severity for each disease, ranging from I (lowest severity) to V (highest severity). However, the grading process requires manual chart review.

Application of a uniform anatomic grading system to measure disease severity in eight emergency general surgical illnesses.

Background: Emergent general surgical diseases encompass a broad spectrum of anatomy and pathophysiology, creating challenges for outcomes assessment, research, and surgical training. The goal of this study was to measure anatomic disease severity for eight emergent general surgical diseases using the uniform grading system of the American Association for the Surgery of Trauma (AAST).

Methods: The Committee on Patient Assessment and Outcomes of AAST applied the previously developed uniform grading system to eight emergent general surgical diseases using a consensus of experts.

Eliminating catheter-associated urinary tract infections in the intensive care unit: is it an attainable goal?

Background: Purpose of this study is to determine strategies to decrease catheter-associated urinary tract infection (CAUTI) in intensive care unit (ICU) patients.

Methods: ICU patients with an indwelling urinary catheter (UC) in one tertiary hospital were monitored for CAUTI. Interventions were implemented sequentially with quarterly data collection.

Impact of an electronic medication administration record on medication administration efficiency and errors.

The study aims were to evaluate the impact of electronic medication administration record implementation on medication administration efficiency and occurrence of medication errors as well as to identify the predictors of medication administration efficiency in an acute care setting. A prospective, observational study utilizing time-and-motion technique was conducted before and after electronic medication administration record implementation in November 2011. A total of 156 cases of medication administration activities (78 pre- and 78 post-electronic medication administration record) involving 38 nurses were observed at the point of care.

Effectiveness of biatrial epicardial application of amiodarone-releasing adhesive hydrogel to prevent postoperative atrial fibrillation.

Objective: Postoperative atrial fibrillation (POAF) is the most frequent complication arising after cardiac surgery, occurring in 30% of cases. Amiodarone is the most effective drug for prophylaxis and treatment. However, because of significant extracardiac side effects, only high-risk patients are eligible for prophylactic amiodarone therapy.

Ambulatory cardiac monitoring for discharged emergency department patients with possible cardiac arrhythmias.

Introduction: Many emergency department (ED) patients have symptoms that may be attributed to arrhythmias, necessitating outpatient ambulatory cardiac monitoring. Consensus is lacking on the optimal duration of monitoring. We describe the use of a novel device applied at ED discharge that provides continuous prolonged cardiac monitoring.

Evaluation of a new silicone adhesive tape among clinicians caring for patients with fragile or at-risk skin.

Objective: To evaluate performance of a new silicone tape among clinicians caring for patients with fragile skin.

Design: An international, multisite, 2-week-use evaluation.

Participants And Settings: Caregivers (n = 217) from acute care hospitals in the United States, United Kingdom, and France who regularly use tapes on patients with fragile skin.

Complications in facelift surgery: avoidance and management.

Rhytidectomy remains a challenging surgical procedure for even the most experienced aesthetic plastic surgeons. The challenges are compounded by complications that are inherent to this procedure and place added pressure on the doctor-patient relationship. Expectations for both parties are high and the margin for error nil.

Multi-institutional comparison of whole slide digital imaging and optical microscopy for interpretation of hematoxylin-eosin-stained breast tissue sections.

Context: Whole slide imaging (WSI) is now used for educational purposes, for consultation, and for archiving and quantitation of immunostains. However, it is not routinely used for the primary diagnosis of hematoxylin-eosin-stained tissue sections.

Objective: To compare WSI using the Aperio digital pathology system (Aperio Technologies, Inc, Vista, California) with optical microscopy (OM) for the interpretation of hematoxylin-eosin-stained tissue sections of breast lesions.

A novel patch for heart rhythm monitoring: is the Holter monitor obsolete?

A number of substantial improvements to the 60-year-old concept of the Holter monitor have recently been developed. One promising advance is the Zio(®) Patch (iRhythm Technologies, Inc., CA, USA), a small 2 × 5-inch patch, which can continuously record up to 14 days of a single ECG channel of cardiac rhythm without the need for removal during exercise, sleeping or bathing.

Effectiveness of biatrial pacing in reducing early postoperative atrial fibrillation after the maze procedure.

Objectives: Interatrial conduction abnormalities have an important role in the initiation of recurrent atrial fibrillation (AF) after the maze procedure. Biatrial pacing or single atrial pacing alters the site and timing of atrial depolarization and may improve restoration of sinus rhythm after the maze procedure. To further evaluate whether biatrial pacing is superior to single atrial or no pacing, we performed a randomized prospective study on 240 patients with a full maze procedure to compare the effectiveness with different pacing approaches in the postoperative period.

Changing nursing practice: letting go of the nursing history on admission.

In this project, 2 performance improvement (PI) methodologies were used to evaluate the process of nursing admission and history collection. Nurses have a responsibility to methodically assess bedside care, ensuring that practice changes do not merely add on to an often inefficient workload but add value. This article illustrates the use of PI to modify the initial nursing inpatient admission assessment process.

Comprehensive surgical approach to treat atrial fibrillation in patients with variant pulmonary venous anatomy.

Objectives: Catheter radiofrequency ablation procedures yield fairly successful results for the treatment of atrial fibrillation; however, patients with anatomic variant pulmonary veins (PV) are generally thought not to benefit from catheter ablation technique, with recurrence rates observed as high as 78%. We report a comprehensive surgical approach to treat this subset of patients with a modified full maze procedure.

Methods: From January 2002 to December 2009, 72 patients undergoing cardiac surgery who had drug-refractory and/or recurrent AF after catheter ablation were identified.

Epidemiological and clinical features of an older high-risk population of skateboarders.

Background: Skateboard injuries have been described in the media and scientific journals as a problem prevalent among children and adolescents. Skateboarding popularity has continued to grow since the 1970s with ridership increasing to include all age groups. Recently, surgeons at one trauma centre at an urban hospital noted an increase in the number of older skateboarders with life-threatening injuries.

Port fixation during gastric banding: 4-year outcome using a synthetic mesh.

Background: Laparoscopic adjustable gastric banding surgery is one of the most popular procedures for patients with morbid obesity. Although it is one of the least invasive surgical treatments for obesity, the most common reasons for reoperation are complications arising from the subcutaneous reservoir (port) used to adjust the band. Mesh fixation of the port, in which the port is sutured to a piece of mesh and then placed without anchoring sutures onto the fascia is a method of securing the port.

Recognizing asthma mimics and asthma complications.

Asthma is a chronic inflammatory disorder of the airways characterized by airflow obstruction, bronchial hyperreactivity, and underlying inflammation. Two common reasons asthmatics fail standard therapy are incorrect diagnosis and failure to recognize underlying contributing factors. A correct diagnosis of asthma is of great importance to military practitioners since misdiagnosis or uncontrolled asthma affects an individual's operational readiness or determines whether one can receive a medical waiver to enlist in military service.

Preventing intensive care unit delirium: a patient-centered approach to reducing sleep disruption.

Delirium in the intensive care unit is a disorder with multifactorial causes and is associated with poor outcomes. Sleep-wake disturbance is a common experience for patients with delirium. Care processes that disrupt sleep can lead to sleep deprivation, contributing to delirium.