Team Stress and Adverse Events during Neonatal Tracheal Intubations: A Report from NEAR4NEOS.

Objective: This study aimed to examine the association between team stress level and adverse tracheal intubation (TI)-associated events during neonatal intubations.

Study Design: TIs from 10 academic neonatal intensive care units were analyzed. Team stress level was rated immediately after TI using a 7-point Likert scale (1 = high stress).

Inadequate oral feeding as a barrier to discharge in moderately preterm infants.

Objectives: The objectives describe the frequency that inadequate oral feeding (IOF) is the reason why moderately preterm (MPT) infants remain hospitalized and its association with neonatal morbidities.

Study Design: Prospective study using the NICHD Neonatal Research Network MPT Registry. Multivariable logistic regression was used to describe associations between IOF and continued hospitalization at 36 weeks postmenstrual age (PMA).

Cracking the Nut on LCME Standard 8.7: Innovations to Ensure Comparability Across Geographically Distributed Campuses.

A large state university in the southeastern United States and state Area Health Education Centers (AHEC) collaborated to establish branch campuses to increase clinical capacity for medical student education. Prior to formally becoming branch campuses, two AHEC sites had established innovative curricular structures different than the central campus. These sites worked with the central campus as clinical training sites.

Cocaine-Induced Bronchospasm Mimicking Acute Asthma Exacerbation.

Cocaine can cause a myriad of changes in the lung, which can range from bronchoconstriction to destruction of the alveolar-capillary membrane and acute lung injury. Cocaine-induced bronchospasm is a diagnosis of exclusion that should be considered when the clinical presentation of acute hypoxic and hypercapneic respiratory failure cannot be explained by chronic obstructive pulmonary disease or asthma exacerbation, anaphylaxis to food or medications, exercise, or infection. Here, we present two patients with acute hypoxic and hypercapneic respiratory failure that was ultimately attributed to cocaine use shortly prior to symptom onset.

Improving fluid resuscitation in pediatric shock with LifeFlow: a retrospective case series and review of the literature.

Rapid delivery of an intravenous fluid bolus is commonly used in pediatric emergency care for the treatment of shock and hypotension. Early fluid delivery targeted at shock reversal results in improved patient outcomes, yet current methods of fluid resuscitation often limit the ability of providers to achieve fluid delivery goals. We report on the early clinical experience of a new technique for rapid fluid resuscitation.

Impact of Microbiological Organism Type on Surgically Managed Endocarditis.

Background: This study describes the impact of organism and valve type on surgically managed infective endocarditis (IE) from The Society of Thoracic Surgeons (STS) database. We developed a risk model for surgically managed endocarditis that includes the microbiological organism.

Methods: The STS database was queried for adult patients with surgically managed endocarditis from July 1, 2011, to June 30, 2016.

Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery After Surgery Society Recommendations.

Enhanced Recovery After Surgery (ERAS) evidence-based protocols for perioperative care can lead to improvements in clinical outcomes and cost savings. This article aims to present consensus recommendations for the optimal perioperative management of patients undergoing cardiac surgery. A review of meta-analyses, randomized clinical trials, large nonrandomized studies, and reviews was conducted for each protocol element.

Pain Management Pillars for the Clinical Nurse Specialist: Summary of National Association of Clinical Nurse Specialists Opioid Pain Management Task Force.

Purpose: This article describes the work of the National Association of Clinical Nurse Specialists (NACNS) Opioid/Pain Management Task Force and provides guidance for the clinical nurse specialist (CNS) in evidence-based pain management interventions and organizational program development.

Description: In September 2016, the NACNS commissioned a group of pain management experts to identify the resources that CNSs need to address appropriate opioid use and pain management in various practice settings. Challenges faced by CNSs related to opioids and pain management were identified through NACNS Conference forums and a pain management survey of NACNS members.

Premedication with neuromuscular blockade and sedation during neonatal intubation is associated with fewer adverse events.

Objective: To determine the impact of premedication for tracheal intubation (TI) on adverse TI associated events, severe oxygen desaturations, and first attempt success STUDY DESIGN: Retrospective cohort study in neonatal intensive care units (NICU) participating in the National Emergency Airway Registry for Neonates from 10/2014 to 6/2017. Premedication for TI was categorized as sedation with neuromuscular blockade, sedation only, or no medication.

Results: 2260 TIs were reported from 11 NICUs.

Effect of Sustained Inflations vs Intermittent Positive Pressure Ventilation on Bronchopulmonary Dysplasia or Death Among Extremely Preterm Infants: The SAIL Randomized Clinical Trial.

Importance: Preterm infants must establish regular respirations at delivery. Sustained inflations may establish lung volume faster than short inflations.

Objective: To determine whether a ventilation strategy including sustained inflations, compared with standard intermittent positive pressure ventilation, reduces bronchopulmonary dysplasia (BPD) or death at 36 weeks' postmenstrual age without harm in extremely preterm infants.

Duration of Operative Vaginal Delivery and Adverse Obstetric Outcomes.

Objective: This study aimed to evaluate whether the number of vacuum pop-offs, the number of forceps pulls, or the duration of operative vaginal delivery (OVD) is associated with adverse maternal and perinatal outcomes.

Study Design: This is a secondary analysis of a multicenter observational cohort of women who underwent an attempted OVD. Women were stratified by the duration of OVD and the number of pop-offs (vacuum) or pulls (forceps) attempted.

What Is the Impact of NICU-Dedicated Lactation Consultants? An Evidence-Based Practice Brief.

Background: Benefits of exclusive human milk diets for preterm and low birth-weight infants are well established. Despite known benefits, supporting mothers in the provision of mother's own milk for high-risk infants is challenging. Lactation support in the neonatal intensive care unit (NICU) is highly variable.

Antibacterial Envelope to Prevent Cardiac Implantable Device Infection.

Background: Infections after placement of cardiac implantable electronic devices (CIEDs) are associated with substantial morbidity and mortality. There is limited evidence on prophylactic strategies, other than the use of preoperative antibiotics, to prevent such infections.

Methods: We conducted a randomized, controlled clinical trial to assess the safety and efficacy of an absorbable, antibiotic-eluting envelope in reducing the incidence of infection associated with CIED implantations.

Group B Streptococcus (GBS) Colonization and Disease among Pregnant Women: A Historical Cohort Study.

Background: Maternal GBS colonization is associated with early-onset neonatal sepsis and extensive efforts are directed to preventing this complication. Less is known about maternal risks of GBS colonization. We seek to provide a modern estimate of the incidence and impact of maternal GBS colonization and invasive GBS disease.

Incidence, impact and indicators of difficult intubations in the neonatal intensive care unit: a report from the National Emergency Airway Registry for Neonates.

Objective: To determine the incidence, indicators and clinical impact of difficult tracheal intubations in the neonatal intensive care unit (NICU).

Design: Retrospective review of prospectively collected data on intubations performed in the NICU from the National Emergency Airway Registry for Neonates.

Setting: Ten academic NICUs.

One-year results from the first US-based enhanced recovery after cardiac surgery (ERAS Cardiac) program.

Objective: Our enhanced recovery after cardiac surgery (ERAS Cardiac) program is an evidence-based interdisciplinary process, which has not previously been systematically applied to cardiac surgery in the United States.

Methods: The Knowledge-to-Action Framework synthesized evidence-based enhanced recovery interventions and implementation of a designated ERAS Cardiac program. Standardized processes included (1) preoperative patient education, (2) carbohydrate loading 2 hours before general anesthesia, (3) multimodal opioid-sparing analgesia, (4) goal-directed perioperative insulin infusion, and (5) a rigorous bowel regimen.

The association between progesterone receptor expression and survival in women with adult granulosa cell tumors.

Background: Granulosa cell tumors (GCT) variably express estrogen receptors (ER) and progesterone receptors (PR). The goal of this study is to evaluate the relationship between ER and PR expression patterns and clinical outcomes in women with GCT.

Methods: A multicenter, retrospective analysis was performed of all cases of GCT diagnosed between 1989 and 2012.

Nurses' Knowledge and Treatment Beliefs: Use of Complementary and Alternative Medicine for Pain Management.

To examine the relationship between nurses' knowledge, attitudes, and beliefs about medicines, in general, and complementary and alternative medicine (CAM) and identify the predictors of referrals for pain management. This descriptive, correlational study utilized an online survey to collect data from direct care nurses at a large medical center in southeastern United States. The online survey consisted of the Complementary and Alternative Medicines and Beliefs Inventory (CAMBI), the Beliefs about Medicine Questionnaire, and four open-ended questions.

Does the Use of Locking Screws Decrease the Rate of Hardware Removal in Ankle Fractures?

While biomechanical characteristics of locking screw fixation versus traditional plating has been studied extensively in orthopaedic literature, clinical outcome studies are lacking. The goal of this study was to evaluate the efficacy and complications rate of locking versus traditional nonlocking screws in complex ankle fractures employing distal fibula internal fixation with 1/3 semitubular small fragment plates. A retrospective review was performed between January 2010 and June 2013 of all patients in whom internal fixation of the fibula in an ankle fracture (open or closed) was performed using only 1/3 semitubular small fragment fibular plates.

Cavitary lung disease following transbronchial biopsy using cryoadhesion in a patient with diffuse parenchymal lung disease.

Transbronchial lung biopsy using cryoadhesion is a diagnostic technique gaining in popularity. Several studies have been performed on its diagnostic yield and safety profile. However, definitive conclusions are limited due to the heterogeneity of results.

Improving Aseptic Technique During the Treatment of Pediatric Septic Shock: A Comparison of 2 Rapid Fluid Delivery Methods.

Rapid fluid resuscitation is used to treat pediatric septic shock. However, achieving fluid delivery goals while maintaining aseptic technique can be challenging. Two methods of fluid resuscitation-the commonly used push-pull technique (PPT) and a new fluid infusion technique using the LifeFlow device (410 Medical, Inc; Durham, NC)-were compared in a simulated patient model.

Neonatal Intubation Practice and Outcomes: An International Registry Study.

Background And Objectives: Neonatal tracheal intubation is a critical but potentially dangerous procedure. We sought to characterize intubation practice and outcomes in the NICU and delivery room (DR) settings and to identify potentially modifiable factors to improve neonatal intubation safety.

Methods: We developed the National Emergency Airway Registry for Neonates and collected standardized data for patients, providers, practices, and outcomes of neonatal intubation.