MRSA nasal screening predictive values assessment in patients with osteomyelitis.

Objective And Design: The purpose of this study was to evaluate the diagnostic value of methicillin-resistant (MRSA) nasal screening utilizing polymerase chain reaction (PCR) assays in patients with osteomyelitis.

Setting: A multisite, retrospective adult chart review from March 2021 to June 2022 was conducted, with no interventions performed. Patients treated with anti-MRSA therapy for osteomyelitis, MRSA nares PCR collected within 48 hours of antibiotic initiation, and related cultures were evaluated.

Degradation of lymphatic anatomy and function in early venous insufficiency.

Objective: We used near-infrared fluorescence lymphatic imaging in a pilot study to assess the lymphatics in preulcerative (C2-C4) venous insufficiency and determine whether involvement and/or degradation of lymphatic anatomy or function could play a role in the progression of chronic venous insufficiency. We also explored the role of lymphatics in early peripheral arterial disease.

Methods: After informed consent and intradermal injections of indocyanine green for rapid lymphatic uptake, near-infrared fluorescence lymphatic imaging was used to assess the lymphatic anatomic structure and quantify the lymphatic propulsion rates in subjects with early venous insufficiency.

The Development and Treatment of Lymphatic Dysfunction in Cancer Patients and Survivors.

Breast-cancer-acquired lymphedema is routinely diagnosed from the appearance of irreversible swelling that occurs as a result of lymphatic dysfunction. Yet in head and neck cancer survivors, lymphatic dysfunction may not always result in clinically overt swelling, but instead contribute to debilitating functional outcomes. In this review, we describe how cancer metastasis, lymph node dissection, and radiation therapy alter lymphatic function, as visualized by near-infrared fluorescence lymphatic imaging.

The ventilatory effect of high velocity nasal insufflation compared to non-invasive positive-pressure ventilation in the treatment of hypercapneic respiratory failure: A subgroup analysis.

Purpose: Oxygen delivery by high flow nasal cannula (HFNC) is effective in providing respiratory support. HFNC has utility in clearing the extra-thoracic dead space, making it potentially beneficial in the treatment of hypercapnic respiratory failure. This study compares high velocity nasal insufflation (HVNI), a form of HFNC, to non-invasive positive pressure ventilation (NIPPV) in their abilities to provide ventilatory support for patients with hypercapnic respiratory failure.

Assessing lymphatic route of CSF outflow and peripheral lymphatic contractile activity during head-down tilt using near-infrared fluorescence imaging.

Evidence overwhelmingly suggests that the lymphatics play a critical role in the clearance of cerebrospinal fluid (CSF) from the cranial space. Impairment of CSF outflow into the lymphatics is associated with a number of pathological conditions including spaceflight-associated neuro-ocular syndrome (SANS), a problem that limits long-duration spaceflight. We used near-infrared fluorescence lymphatic imaging (NIRFLI) to dynamically visualize the deep lymphatic drainage pathways shared by CSF outflow and disrupted during head-down tilt (HDT), a method used to mimic the cephalad fluid shift that occurs in microgravity.

Evaluation of a heparin monitoring protocol for extracorporeal membrane oxygenation and review of the literature.

Background: Bleeding complications are common with extracorporeal membrane oxygenation (ECMO). We investigated whether a heparin monitoring protocol using activated partial thromboplastin time (aPTT) and thromboelastography (TEG) affected clinical outcomes.

Methods: This retrospective chart review stratified cohorts by study interval: pre-protocol (January 2016-March 2017) or post-protocol (March 2017-December 2017).

Natural History of Isolated Skull Fractures in Children.

Head injury is the most common cause of neurologic disability and mortality in children. We had hypothesized that in children with isolated skull fractures (SFs) and a normal neurological examination on presentation, the risk of neurosurgical intervention is very low. We retrospectively reviewed the medical records of all children aged six to sixteen years presenting to our Level 1 trauma center with traumatic brain injuries between January 1, 2006 and December 31, 2014.

Effect of pneumatic compression therapy on lymph movement in lymphedema-affected extremities, as assessed by near-infrared fluorescence lymphatic imaging.

Previous studies have shown cost effectiveness and quality-of-life benefit of pneumatic compression therapy (PCT) for lymphedema. Insurers, such as the Centers for Medicare/Medicaid (CMS), however, desire visual proof that PCT moves lymph. Near-infrared fluorescence lymphatic imaging (NIRFLI) was used to visualize lymphatic anatomy and function in four subjects with primary and cancer treatment-related lymphedema (LE) of the lower extremities before, during, and after pneumatic compression therapy (PCT).

Lymphatic delivery of etanercept via nanotopography improves response to collagen-induced arthritis.

Background: Evidence suggests lymphatic function mediates local rheumatoid arthritis (RA) flares. Yet biologics that target the immune system are dosed systemically via the subcutaneous (SC) administration route, thereby inefficiently reaching local lymphatic compartments. Nanotopography has previously been shown to disrupt tight cellular junctions, potentially enhancing local lymphatic delivery and potentially improving overall therapeutic efficacy.

Lymphatic transport in patients with chronic venous insufficiency and venous leg ulcers following sequential pneumatic compression.

Background: Recent advancements in near-infrared fluorescence lymphatic imaging (NIRFLI) technology provide opportunities for non-invasive, real-time assessment of lymphatic contribution in the etiology and treatment of ulcers. The objective of this study was to assess lymphatics in subjects with venous leg ulcers using NIRFLI and to assess lymphatic impact of a single session of sequential pneumatic compression (SPC).

Methods: Following intradermal microdoses of indocyanine green (ICG) as a lymphatic contrast agent, NIRFLI was used in a pilot study to image the lymphatics of 12 subjects with active venous leg ulcers (Clinical, Etiologic, Anatomic, and Pathophysiologic [CEAP] C6).

Monitoring Enoxaparin with Antifactor Xa Levels in Obese Patients.

Study Objectives: To characterize antifactor Xa peak levels (as therapeutic, subtherapeutic, and supratherapeutic) in morbidly obese patients receiving treatment doses of enoxaparin, using a therapeutic range of 0.5-1.1 units/ml, and to assess the occurrence of bleeding complications in these patients.

Significant publications on infectious diseases pharmacotherapy in 2013.

Purpose: The most important articles on infectious diseases (ID) pharmacotherapy published in the peer-reviewed literature in 2013, as nominated and selected by panels of pharmacists and others with ID expertise, are summarized.

Summary: Members of the Houston Infectious Diseases Network were asked to nominate articles published last year in prominent biomedical journals that had a major impact in the field of ID pharmacotherapy. A list of 27 nominated articles on ID-related topics in general and 26 articles specifically focused on human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) was compiled.

Antibiogram compliance in University HealthSystem Consortium participating hospitals with Clinical and Laboratory Standards Institute guidelines.

Purpose: The degree of compliance with antibiogram guidance among University HealthSystem Consortium (UHC) hospitals was analyzed.

Methods: The UHC Pharmacy Council Pharmacy Practice Advancement Committee conducted a survey to evaluate hospital policies regarding the generation, reporting, and utilization of antibiograms among UHC hospitals. The survey was distributed via a UHC online survey tool to pharmacy directors at 237 UHC hospitals.

Leadership in challenging times: it starts with passion.

Leadership is paramount during these challenging times of healthcare reform, workforce shortages, economic conditions, and aging population. Leadership success comes from a combination of the following: passion, vision, quality outcomes, strong knowledge of the industry, the ability to critically think, perspective, adaptability, and ongoing learning.

Medication safety: just a label away.

In perioperative settings, medications are removed from manufacturers' identifying containers; therefore, scrub personnel should label medications placed on the sterile field. Compliance with medication labeling practices with the use of both blank and preprinted labels was tested in the OR at a Houston, Texas, hospital. Scrub personnel were more likely to label medications and medication-delivery devices when preprinted medication labels were provided.