Atrial fibrillation in cardiac resynchronization therapy patients: should we ablate the atrioventricular node?

Prevalence of persistent atrial fibrillation in patients undergoing cardiac resynchronization therapy remains high. Several factors, including suboptimal biventricular capture rates, compound the significant mortality and response rates in patients with atrial fibrillation and severe heart failure. Atrioventricular nodal ablation provides the best mean of rate control in this population.

Challenges in healthcare education: a correlational study of outcomes using two learning techniques.

Electronic learning has become an important tool in today's changing healthcare environment. Institutions confronted with limited resources, in the face of increased demands for education and a shortage of educators, have found electronically based education a significant resource. This study compares electronic-blended instruction technique with instructor-led delivery of the same content and examines the correlation of learning effectiveness to each delivery method.

Cardiovascular medication errors in children.

Objectives: We sought to describe pediatric cardiovascular medication errors and to determine patients and medications with more-frequently reported and/or more-harmful errors.

Methods: We analyzed cardiovascular medication error reports from 2003-2004 for patients <18 years of age, from the US Pharmacopeia MEDMARX database. Reports were stratified according to harm score (A, near miss; B-D, error, no harm; E-I, harmful error).

Sleep and kangaroo care: clinical practice in the newborn intensive care unit: where the baby sleeps..

This article provides a review of a change in practice within a Level III neonatal intensive care unit setting. The use of skin-to-skin holding as a means to secure parents' attachment to their infant, and support their child's rest and recovery in the neonatal intensive care unit, has been recognized historically and supported by research in this practice. The importance of sleep to the infant's developmental outcome was recognized and the use of skin-to-skin holding as a means of increasing stable infant sleep and rest was implemented.

Laparoscopic radical prostatectomy in a community hospital without robotic assistance.

Objectives: To develop a laparoscopic radical prostatectomy program in a community-based hospital without robotic assistance.

Methods: A total of 60 consecutive patients underwent laparoscopic radical prostatectomy by a single urologist in a community-based hospital without the use of the da Vinci robotic system. A general surgeon with advanced laparoscopic experience was initially used as the proctor.

The effect of etomidate on intracranial pressure and systemic blood pressure in pediatric patients with severe traumatic brain injury.

Objective: To evaluate the effects of single-dose etomidate in pediatric patients with intracranial hypertension after severe traumatic brain injury.

Methods: Patients admitted to the pediatric intensive care unit with severe traumatic brain injury were enrolled with the informed consent of their guardians. The experimental intervention was a single dose of etomidate 0.

Neonatal effects of breast cancer chemotherapy administered during pregnancy.

A human fetus is most susceptible to teratogenic agents during the first trimester of pregnancy. Cyclophosphamide and doxorubicin are pregnancy category D agents; however, potential benefits may warrant treatment with these agents during pregnancy under special circumstances. During her first trimester of pregnancy, a 37-year-old Caucasian woman was diagnosed with stage IIB infiltrating ductal carcinoma in situ (breast cancer) that was estrogen and progesterone receptor negative and human epidermal growth factor receptor-2 positive.

Blood glucose and heart failure in nondiabetic patients.

Objective: Nondiabetic patients were studied to determine whether increasing blood glucose is associated with subsequent incidence of heart failure.

Research Design And Methods: Baseline morning blood glucose determinations were evaluated with respect to subsequent heart failure using records from 20,810 nondiabetic patients. The onset of heart failure >1 year after initial glucose determinations was evaluated for patients who had 2-12 years of care.

Amifostine-induced fever: case report and review of the literature.

Amifostine, also known as WR-2721 (S-2-(3-aminopropylamino)-ethylphosphorothioic acid), is an organic thiophosphate cytoprotective agent used to reduce the frequency of severe xerostomia in patients with cancer undergoing postoperative radiation of the head and neck. A 56-year-old Caucasian man who received concomitant chemotherapy and radiation for head and neck cancer developed fever concurrent with the administration of amifostine. To our knowledge, this is the first case report that demonstrates the occurrence of fever with low-dose amifostine therapy without the manifestation of accompanying rash or hypotension.

A didactic and experiential approach to nursing education.

Postanesthesia care unit PACU nursing practice requires in-depth understanding of sedation, analgesia, and anesthetic agents and techniques; physiological and psychological responses to anesthesia; and the vulnerability of patients subjected to anesthesia. This article reviews a pilot program designed to broaden the knowledge base of PACU RNs. Twenty-three RNs completed a self-paced module on anesthetic agents before participating in an anesthesia and surgical observation phase.

A decade of interdisciplinary care.

A decade of organizing, implementing, and evaluating interdisciplinary care teams at St Luke's Regional Medical Center has reinforced the value of developing and maintaining clinical and nonclinical competencies. The value of consensus in task delegation cannot be overemphasized. Unit directors have expanded their scope of responsibility and must remain vigilant to avoid fragmentation of care in an interdisciplinary team delivery system.

Efficacy and safety of aerosolized tobramycin in cystic fibrosis.

Aerosolized tobramycin has been extensively used in cystic fibrosis (CF) patients in order to directly deliver the antibiotic to the endobronchial site of infection, and decrease toxicity by limiting systemic absorption. Aerosolized tobramycin doses ranging from 80 mg twice or three times daily to 600 mg three times daily have been used in various clinical trials. At an 80-mg dose, preservation of pulmonary function with little or no improvement over the baseline was reported.

Imaging-Guided Core Needle Biopsy of the Breast: Study of Psychological Outcomes.

The objective of this study was to evaluate and document pain and psychological distress related to imaging-guided core needle biopsy (CNB) of the breast. This prospective study of 52 consecutive patients undergoing CNB of the breast assessed anxiety, pain, acute stress disorder, and activities of daily living both preprocedure and at 24 hours, 5 days, and 30 days postprocedure. Survey instruments included the State-Trait Anxiety Inventory (STAI), a visual analog pain scale, the SF-36 Physical Functioning Scale, and DSM IV criteria for acute stress disorder.

Variation in fundic dimensions with respect to short gastric vessel division in laparoscopic fundoplication.

Background: This study analyzes the geometry involved in laparoscopic fundoplication with respect to short gastric vessel division for the creation of a tension-free Nissen fundoplication.

Methods: For fundoplication, the gastric fundus must be long enough to traverse the fixed distance between the right edge of the plication and the highest lateral fixation of the fundus (distance alpha) and to encircle the esophagus (esophageal circumference). We compared these two dimensions to the length of fundus available for fundoplication both before and, when needed, after division of the short gastric vessels.

Acute hepatitis and bleeding possibly induced by zidovudine and ritonavir in an infant with HIV infection.

Acute hepatitis led to abnormal coagulopathy, bleeding, and death in a nonhemophiliac infant infected with the human immunodeficiency virus, possibly due to zidovudine or ritonavir or both. Acute hepatitis during ritonavir treatment and episodes of spontaneous bleeding have been reported in patients with hemophilia. Zidovudine is associated with elevated liver enzymes, elevated bilirubin, and hepatomegaly leading to abnormal coagulopathy, bleeding, and death in adults.

Historical development of latex allergy.

Latex allergy has become an increasing problem for both patients and health care providers. This article presents an overview of the historical background of latex and how it was developed. This information is helpful in understanding our current reliance on and problems associated with latex use.

Small bowel obstruction secondary to stapled laparoscopically assisted vaginal hysterectomy.

Background: This study analyzes the complication of small bowel obstruction following stapled division of the adnexa during laparoscopically assisted vaginal hysterectomy (LAVH).

Methods: We reviewed the records of three patients with small bowel obstruction following stapled LAVH. We then tested the proposed mechanisms of obstruction by firing endoscopic staplers across silicon tubing to simulate division of the adnexal structures.

A nurse's story. The journey of a staff nurse.

This article describes the professional growth of a nurse who journeyed from being a staff nurse to becoming a coordinator of a national program. The critical turning points that fostered this nurse's development are detailed. The guidance and support of the nursing and hospital administration as well as the mentorship of fellow professionals were key in this developmental process.

Proactive nursing: the evolution of a task force to help women with postpartum depression.

In response to several women who presented with postpartum depression in 1 year, a group of nurses developed a task force made up of hospital nurses, obstetricians, psychiatrists, pediatricians, family practitioners, lactation specialists, home care nurses, and mental health counselors. The purposes of this task force were to educate health care professionals about postpartum depression, to help identify women who might be affected, and to develop interventions for adjusting to parenthood. This article details the evolution of that task force, and how it has assisted not only the women but also the health care providers involved.

ANA standards for nursing data sets in information systems.

The American Nurses Association has established the Nursing Information and Data Set Evaluation Center. The purpose of this Center is to develop and disseminate standards pertaining to information systems that support the documentation of nursing practice, and to evaluate voluntarily submitted information systems against these standards. The need for an evaluation center arises out of a long history of calls for standards pertaining to nursing data and information systems.

Short-term outcome of laparoscopic paraesophageal hernia repair. A case series of 58 consecutive patients.

Background: The purpose of this study is to determine the morbidity, mortality, and short-term outcomes associated with laparoscopic paraesophageal hernia repair (LPHR).

Methods: A series of 58 consecutive LPHRs performed by the author were reviewed with an average 1-year follow-up. Morbidity and mortality rates were compared with historical series of open repairs.