"Microbleeding" from intracranial aneurysms: Local hemosiderin deposition identified during microsurgical treatment of unruptured intracranial aneurysms.

Background: During elective surgery for unruptured aneurysms, we have identified a group of patients with hemosiderin staining of the pial surface immediately adjacent to the aneurysm dome suggesting a remote and unrecognized history of microbleeding from the aneurysm. These cases form the basis for this report.

Methods: Medical records of 421 unruptured cerebral aneurysm patients treated surgically between January 2003 and September 2010 were retrospectively reviewed.

Peripheral i.v. stabilization and the rate of complications in children: an exploratory study.

Peripheral intravascular catheter insertion is the most common invasive procedure performed on the hospitalized child with a significant potential for complications. This study compared complication rates between a standard aseptic taping technique and a commercially-available adhesive anchoring device in 80 hospitalized children ages 2-17 years. Eighteen (18) participants (22.

Normal anatomic variants of the acetabular labrum.

Within the past two decades, magnetic resonance imaging (MRI) has evolved into an integral part of noninvasive diagnostic testing for evaluation of musculoskeletal disorders. With the advancements in imaging and coil technology, assessment of small and spatially complex structures, such as the acetabular labrum, became possible. Labral tears are being diagnosed with increasing frequency with MRI.

Identification of potential barriers to nurse-sensitive outcome demonstration.

Objective: The objective of this study was to determine differences in chief nursing officer, Magnet(®) program director, nurse leader, and direct care RN perspectives of potential barriers to demonstration of nurse-sensitive outcomes.

Background: The Magnet Recognition Program(®) and other designations are focusing on patient outcomes. No evidence is available addressing barriers to demonstration of nursing outcomes at multiple levels of practice.

Awakening after cardiac arrest and post resuscitation hypothermia: are we pulling the plug too early?

Background: Time to awakening after out-of-hospital cardiac arrest (OHCA) and post-resuscitation therapeutic hypothermia (TH) varies widely. We examined the time interval from when comatose OHCA patients were rewarmed to 37°C to when they showed definitive signs of neurological recovery and tried to identify potential predictors of awakening.

Methods: With IRB approval, a retrospective case study was performed in OHCA patients who were comatose upon presentation to a community hospital during 2006-2010.

A cognitive-behavioral treatment for depression in rural American Indian middle school students.

Rural American Indian (AI) middle school students with depressive symptoms who participated in a culturally modified version of the Adolescent Coping with Depression (CWD-A) course (n = 8) reported significant improvement in depressive symptoms at post-intervention and at 3-month follow-up. There was also a nonsignificant but clinically relevant decrease in participants' anxiety symptoms. Students reported satisfaction with the intervention, and it was potentially more cost-effective and less stigmatizing than the individualized treatment-as-usual interventions to which it was compared.

Development and implementation of a pediatric palliative care program.

Palliative care, long-used in the adult setting, is new to the pediatric setting. Research indicates that palliative care reduces length of stay and use of aggressive end-of-life interventions, improves quality of life, and provides hope. It balances provision of coordinated care with building of family memories and preparation for the child's death with celebration of the child's life.

Implementing the 2005 American Heart Association guidelines, including use of the impedance threshold device, improves hospital discharge rate after in-hospital cardiac arrest.

Objective: To determine the impact of the 2005 American Heart Association cardiopulmonary resuscitation (CPR) guidelines, including use of an impedance threshold device (ITD), on survival after in-hospital cardiac arrest.

Methods: Two community hospitals that tracked outcomes after in-hospital cardiac arrest pooled and compared their hospital discharge rate before and after implementing the 2005 American Heart Association CPR guidelines (including ITD) in standardized protocols. In CPR we used the proper ventilation rate, allowed full chest-wall recoil, conducted continuous CPR following intubation, and used an ITD.

A regional system for delivery of primary percutaneous coronary intervention in ST-elevation myocardial infarction: STEMI-St. Cloud.

Background: Strategies of emergency care in the treatment of ST-segment elevation myocardial infarction (STEMI) have evolved rapidly over the past two decades to include primary percutaneous coronary intervention (PPCI) when possible. Most U.S.

Using research to determine support for a policy on family presence during resuscitation.

National guidelines and professional organizations have recommended allowing family presence during resuscitation and bedside invasive procedures. Studies found that only 5% of critical care units have written policies. Periodic requests by family members prompted the creation of a task force, including nurses, physicians, and respiratory therapists, to develop this controversial policy.

Clinical inquiries. What's the most practical way to rule out adrenal insufficiency?

A morning serum cortisol level >13 mcg/dL reliably rules out adrenal insufficiency, and the test is easy and safe to perform. Because of low specificity, patients with a level of < or =13 mcg/dL need further evaluation with the cosyntropin stimulation test (CST). The 250 mcg CST requires intravenous (IV) or intramuscular (IM) administration of cosyntropin and multiple blood draws; a normal response reliably rules out primary adrenal insufficiency and moderately decreases the likelihood of secondary adrenal insufficiency.

Graduated compression stocking and intermittent pneumatic compression device length selection.

Purpose: The purpose of this project was to incorporate current evidence into length selection for graduated compression stockings (GCS) and intermittent pneumatic compression (IPC) devices in order to evaluate and modify current practice.

Rationale: Staff nurses relate concerns regarding the fit and complications related to poorly fitting thigh length GCS and IPC devices. Current evidence supports using knee length over thigh length.

Clinical inquiries. Who should receive vertebroplasty?

Percutaneous vertebroplasty has been used to treat aggressive vertebral hem-angiomas, osteoporotic vertebral compression fractures, and vertebral lesions from metastatic disease or myeloma. Consider it for patients with severe acute or chronic pain related to one of these lesions who have failed a reasonable course of medical therapy (strength of recommendation [SOR]: B, based on structured reviews of observational studies). Contraindications include an uncorrectable coagulation disorder, infection in the area, spinal cord compression, destruction of the posterior wall of the vertebral body, and severe degrees of vertebral body collapse (SOR: B, based on structured reviews of observational studies).

The relationship of residency performance to match status and US versus international graduate status.

Background And Objectives: This study compared the performance of family practice residents selected through the National Resident Matching Program (NRMP) with those selected outside the NRMP and that of US medical graduates (USMGs) versus international medical graduates (IMGs).

Methods: Surveys were mailed to all 470 US family practice residencies asking Match status and USMG versus IMG status of graduates accepted into their programs from 1994-1996.

Results: Of 3,222 residents, 2,815 (87.