Staff solutions for noise reduction in the workplace.

Setting: A comprehensive noise-reduction project was initiated in response to low patient-satisfaction scores on an inpatient neuroscience unit at St Luke's Hospital and Health Network. The effects of noise on the health of patients and staff provided additional rationale for the project.

Methods: The performance-improvement model of Plan, Do, Check, Act, along with a literature review, was used to identify the negative effects of noise on patients and staff.

Vasculitis presenting with myocardial infarction, stroke, and aortitis in a middle-aged man.

Background: Vasculitis may cause inflammation in any single or group of blood vessels. Traditionally, giant cell arteritis involves the extracranial branches of the carotid, and Takayasu arteritis affects the aorta and its major branches. These diseases are quite rare, but have the potential to be fatal.

The nature of emergency department interruptions and their impact on patient satisfaction.

Objective: To explore the nature of interruptions that occur during clinical practice in the emergency department (ED). We determined the frequency, duration and type of interruptions that occurred. We then determined the impact on patient satisfaction of those interruptions occurring at the bedside.

Dedicated Shift Wrap-up Time Does Not Improve Resident Sign-out Volume or Efficiency.

Objectives: Sign-out (SO) is a challenge to the emergency physician. Some training programs have instituted overlapping 9-hour shifts. The residents see patients for eight hours, and have one hour of wrap-up time.

Emergency traumatologists as partners in trauma care: the future is now.

Background: Decreasing manpower available to care for trauma patients both in and out of the ICU has led to a number of proposed solutions, including increasing involvement of emergency medicine-trained physicians in the care of these patients. We performed a descriptive comparative study in an effort to define the role of fellowship-trained emergency medicine physicians as full-time traumatologists.

Study Design: We performed a retrospective review of concurrent and prospectively collected data comparing process of care and outcomes for the resuscitative phase of trauma patients cared for by full-time fellowship-trained trauma surgeons (TS), a fellowship-trained emergency medicine physician (ET), and a first-year fellowship-trained trauma surgeon (TS1).

Adrenal gland injury secondary to blunt traumatic mechanisms: a marker of overall injury severity.

Introduction: Adrenal gland injuries (AGI) are seen increasingly frequently owing to advances in modern imaging techniques. This study describes a series of patients with blunt AGI, with the emphasis on AGI as a marker of injury severity, CT-radiographic classification of AGI and associated injury patterns.

Material And Methods: A retrospective review of blunt trauma patients with AGI was performed.

The molecular basis of cancer and the development of targeted therapy.

The sequencing of the human genome and the ability to rapidly identify genes and proteins, both normal and mutant, that are involved in tumorigenesis and malignant phenotypes, have changed the ability to understand malignant cells. Understanding and applying this information to the diagnosis and treatment of cancer are facilitated best with a multidisciplinary team. The cancer surgeon plays a pivotal role in this team.

Cervical length screening in patients who have undergone loop electrosurgical excision procedure.

Objective: To determine whether cervical length measurements in patients who have undergone a loop electrosurgical excision procedure (LEEP) is a predictor of spontaneous preterm delivery (PTD) at < 35 weeks.

Study Design: A retrospective chart review of 97 pregnant patients with a history of prior LEEP undergoing cervical length screening by transvaginal ultrasound (TVUS) was done. Of these, 87 were included in the study.

Melanoma vaccines.

Over the last century, vaccine studies have demonstrated that the human immune system, with appropriate help, can limit or prevent infection against otherwise lethal pathogens. Encouraged by these results, success in animal models and numerous well-documented reports of immune-mediated melanoma regression in humans, investigators developed melanoma vaccines. However, despite considerable laboratory evidence for vaccine-induced immune responses, clinical responses remain poor.

Evolving role of endoscopic retrograde cholangiopancreatography in management of extrahepatic hepatic ductal injuries due to blunt trauma: diagnostic and treatment algorithms.

Extrahepatic hepatic ductal injuries (EHDIs) due to blunt abdominal trauma are rare. Given the rarity of these injuries and the insidious onset of symptoms, EHDI are commonly missed during the initial trauma evaluation, making their diagnosis difficult and frequently delayed. Diagnostic modalities useful in the setting of EHDI include computed tomography (CT), abdominal ultrasonography (AUS), nuclear imaging (HIDA scan), and cholangiography.

Fetal cardiocentesis: a review of indications, risks, applications and technique.

Objectives: To review the indications, applications and technique of fetal cardiocentesis.

Methods: Review of published case reports and case series of fetal cardiocentesis utilizing the PubMed search engine of the National Library of Medicine.

Results: Case reports and case series demonstrate that fetal cardiocentesis may be an alternative method by which to facilitate prenatal diagnosis, intravascular therapy, multifetal and selective fetal reduction and in utero therapy of congenital heart disease.

Use of human and porcine dermal-derived bioprostheses in complex abdominal wall reconstructions: a literature review and case report.

The goal of abdominal wall reconstruction is to restore and maintain abdominal domain. A PubMed(R) review of the literature (including "old" MEDLINE through February 2007) suggests that bioprosthetic materials are increasingly used to facilitate complex abdominal wall reconstruction. Reported results (eight case reports/series involving 137 patients) are encouraging.

Cervical lacerations: some surprising facts.

Objective: Our aim was to calculate the incidence of cervical lacerations after vaginal delivery and to study its associated risk factors.

Study Design: A retrospective chart review of all patients with a cervical laceration after vaginal delivery during a 5 year period was performed. Their risk factors were studied.

The effect of preoperative clopidogrel on bleeding after coronary artery bypass surgery.

Introduction: Clopidogrel treatment is associated with a reduction in thrombotic complications in coronary stent placement, improved outcome after acute coronary syndromes, and decreased mortality in patients with coronary artery disease. The purpose of this study was to analyze the effect of preoperative clopidogrel exposure on bleeding complications, blood transfusions requirements, and reoperations in patients undergoing coronary artery bypass grafting (CABG).

Patients And Methods: This study included 320 patients from a single institution that underwent an isolated CABG who were discharged between July 2003 and June 2004.

Celiac artery compression syndrome: successful utilization of robotic-assisted laparoscopic approach.

Median arcuate ligament (MAL) syndrome, also known as the celiac axis compression syndrome (CACS) is rare, and a topic of ongoing academic controversy. CACS is a diagnosis of exclusion, characterized by the clinical triad of postprandial abdominal pain, weight loss, and vomiting. The classic management of CACS involves the surgical division of the MAL fibers.

Emergent fetal intracardiac transfusion for thrombocytopenia and acute hypovolemia due to cordocentesis-associated hemorrhage in parvovirus-induced hydrops.

Objectives: To demonstrate the utility of fetal intracardiac transfusion to correct acute fetal hypovolemia and thrombocytopenia in fetal Parvovirus infection.

Methods: Intracardiac transfusion in a 19-week gestation was indicated due to cordocentesis-associated hemorrhage.

Results: Intracardiac transfusion resulted in correction of acute bradycardia, anemia and thrombocytopenia and persistent umbilical cord hemorrhage following attempted intravascular transfusion.

Lower extremity arterial thrombosis following sonographically guided thrombin injection of a femoral pseudoaneurysm.

Sonographically guided percutaneous thrombin injection is a minimally invasive and highly successful treatment of arterial pseudoaneurysms. Despite a very low complication rate, several severe arterial thrombotic events have been reported following thrombin injection of pseudoaneurysms. Native arterial thrombosis, though recognized as a severe complication of thrombin injection, has not been well described in the literature.

Bilateral renal vein thrombosis secondary to membraneous glomerulonephritis: successful treatment with thrombolytic therapy.

Renal vein thrombosis (RVT) is a rare phenomenon. Bilateral RVT is even less common. RVT has been reported as idiopathic or in association with puerperium, hypercoagulable states, membraneous glomerulonephritis (MGn), renal transplantation, malignancy, and renal vein instrumentation or trauma.

Use of non-invasive esophageal echo-Doppler system in the ICU: a practical experience.

In a recent issue of the Journal of Trauma, Kim et al. described their experience with the esophageal Doppler monitor (EDM) in major burn patients. Other authors have reported the historical development of the EDM, reviewed the technical and scientific aspects of this modality, and compared the EDM with the pulmonary arterial catheter (PAC).