Artificial lungs: are we there yet?

New oxygenator technologies widened the application of extracorporeal life support significantly in the last decade. Currently the use is still limited within intensive care units. Compared to ventricular assist devices for heart failure, lung replacement technology is lagging behind, not allowing discharge on device.

Self-expanding transcatheter aortic valve replacement using alternative access sites in symptomatic patients with severe aortic stenosis deemed extreme risk of surgery.

Objectives: The CoreValve Extreme Risk US Pivotal Trial enrolled patients with symptomatic severe aortic stenosis deemed unsuitable for surgical aortic valve replacement. Implants were attempted using transfemoral access (n = 489) or an alternative access (n = 150). In present analysis, we sought to examine the safety and efficacy of CoreValve transcatheter aortic valve replacement using alternative access.

Transcatheter aortic-valve replacement with a self-expanding prosthesis.

Background: We compared transcatheter aortic-valve replacement (TAVR), using a self-expanding transcatheter aortic-valve bioprosthesis, with surgical aortic-valve replacement in patients with severe aortic stenosis and an increased risk of death during surgery.

Methods: We recruited patients with severe aortic stenosis who were at increased surgical risk as determined by the heart team at each study center. Risk assessment included the Society of Thoracic Surgeons Predictor Risk of Mortality estimate and consideration of other key risk factors.

Cost of isolation: daily cost of isolation determined and cost avoidance demonstrated from the overuse of personal protective equipment in an acute care facility.

We determined the prevalence and associated cost of isolation precautions. Current census and historic microbiology cultures were assessed for isolation appropriateness following national guidelines. Based on patient assessment and culture data, isolation was discontinued resulting in 4,087 days of isolation and over $141,000 dollars avoided from excess supplies and time.

Comparison of neonatal skin sensor temperatures with axillary temperature: does skin sensor placement really matter?

Purpose: Appropriate thermoregulation affects both morbidity and mortality in the neonatal setting. Nurses rely on information from temperature sensors and radiant warmers or incubators to appropriately maintain a neonate's body temperature. Skin temperature sensors must be repositioned to prevent skin irritation and breakdown.

The relationship of bedside nurses' emotional intelligence with quality of care.

Emotional intelligence, a predictor of productivity and success, may impact behaviors responsible for quality of care. This study examined if emotional intelligence of units' bedside nurses is related to the quality of care delivered to the patients. In this study, emotional intelligence was found to be correlated to the number of Clostridium difficile infections, MRSA infections, patient falls with injury, and pressure ulcer screenings (P < .

Developing an early sepsis alert program.

Severe sepsis and septic shock are major health care problems affecting millions of people around the world each year. To aid in early identification and treatment of patients with sepsis, one Midwestern health care system has developed and implemented a computer-assisted sepsis alert system. Despite some limitations, the program has been moderately successful in identifying patients whose condition is declining, and it is having an overall positive effect on patient care.

What is new in the field of genetics.

There is exciting research occurring the field of genetics and this article provides a summary of a few of the areas under active study, including chromosomal microarray, net-generation sequencing, and concepts of epigenetics. It is clear we do not have all the answers yet, but it is exciting to see what the future holds for our ability to diagnose and understand the causes of genetic disease. However, this is still not likely to be the end of the story, in that as we continue to study the human genome, we will continue to discover genetic influences on human health and disease.

Thrombocytopenia-absent radius syndrome.

Thrombocytopenia-absent radius (TAR) syndrome is a relatively uncommon condition characterized by absent radii with the presence of thumbs and congenital or early-onset thrombocytopenia that tends to resolve in childhood. The precise cause of this condition is unknown, although recently a microdeletion of chromosome 1q21.1 has been found in all investigated individuals.

Reduced time for urinary alkalinization before high-dose methotrexate with preadmission oral bicarbonate.

Purpose: Hydration and urinary alkalinization are essential for reducing renal dysfunction with high dose methotrexate (HDMTX). This report presents an analysis of institutional methods used to achieve adequate urinary alkalinization and output for patients receiving single agent HDMTX. Renal and metabolic parameters of tolerance were examined.

Policy statement on folic acid and neural tube defects.

It now recognized that the use of folate fortification and/or supplementation before initiation of pregnancy can impact the risk of the fetus developing a neural tube defect. This document serves to update the policy statement issued by the American College of Medical Genetics and published in 2005.

Pediatric craniocervical junction injuries.

Objective: The purpose of this article is to review pediatric craniocervical junction injuries in the context of embryology, developmental anatomy, and biomechanics.

Conclusion: The craniocervical junction is functionally and developmentally distinct from the rest of the spine, and mechanistic models often fail to explain these injuries. Various developmental features and complex anatomy likely contribute to injury in this region in children.

Vascular procedures in nonagenarians and centenarians are safe.

Background: An increasing number of elderly patients present for elective and emergent vascular procedures. The purpose of this study was to analyze the 30-day and long-term outcome of patients in their 10th decade of life undergoing vascular procedures.

Methods: We reviewed the outcomes of all patients in the 10th decade of life included in our registry.

Pigmentary anomalies and hearing loss.

A number of syndromes that include hearing loss in the phenotype also have pigmentary anomalies as a component manifestation. One of the most common of these is Waardenburg syndrome, which includes hypopigmentation and sensorineural hearing loss in the phenotype. There are four types of Waardenburg syndrome, distinguishable from each other by clinical findings.

Condition concern: an innovative response system for enhancing hospitalized patient care and safety.

Patient safety is rapidly becoming everyone's responsibility. Bedside clinicians, physicians, and ancillary and administrative staff are well aware of their roles in patient safety, but patients and their families are becoming increasingly knowledgeable about potential safety issues related to hospitalization. This article describes how a Midwestern regional health care system enhances safety for its hospitalized patients through a program called "Condition Concern," designed to provide patients and their families/friends with a quick, convenient method for reporting unattended care concerns.

How can hospitals be better prepared? A case study of an exercise design program and its effect on a real-life event.

Hospitals continue to strive to meet exercise requirements of The Joint Commission and simultaneously identify organization-specific components of a successful exercise design program. The authors suggest that using a department-level focus during this process improves education, exercise design and outcome, and contributed to the success of a real life disaster response.

Adverse drug reactions resulting in hyperthermia in the intensive care unit.

Hyperthermia is frequently seen in the intensive care setting and is associated with significant morbidity and mortality. It is often initially misdiagnosed as fever associated with infection. Atypical presentations of classic syndromes are common.

Anticholinergic medications for managing noisy respirations in adult hospice patients.

Purpose: Anticholinergic medications for reducing noisy respirations in adult hospice patients are evaluated.

Summary: Anticholinergic medications used to reduce noisy respirations from retained secretions in terminal patients include atropine, glycopyrrolate, scopolamine, and scopolamine derivatives. Pharmaceutical anticholinergic treatment of retained secretions in hospice patients was evaluated in six studies, three of which compared the efficacy of glycopyrrolate to scopolamine in actively dying patients.

Increased risk of metabolic syndrome, diabetes mellitus, and cardiovascular disease in men receiving androgen deprivation therapy for prostate cancer.

Prostate cancer is the leading cancer diagnosis and second leading cause of cancer-related mortality for men in the United States. Due to the increased prevalence of prostate cancer in men older than 50 years, men at risk for prostate cancer represent the same population of men who are at greatest risk for metabolic syndrome, diabetes mellitus, and coronary artery disease (CAD). In addition to risk factors for CAD that are applicable to the general population, men with prostate cancer can be at increased risk for CAD due to long-term androgen deprivation therapy (ADT) administered as treatment for prostate cancer.

Docetaxel-associated epiphora.

Docetaxel is a semisynthetic taxane indicated for the treatment of advanced breast, prostate, and non-small cell lung cancers; it is also used for the treatment of various other solid tumors. The standard intermittent dosage of docetaxel is 60-100 mg/m2 every 3 weeks. At this dose and schedule, myelosuppression is common and neutropenia is usually the dose-limiting toxicity.