Mobilization strategies for the collection of peripheral blood progenitor cells: Results from a pilot study of delayed addition G-CSF following chemotherapy and review of the literature.

Objective: Given the potential to limit cost, we conducted a pilot study evaluating delayed, low-dose granulocyte colony-stimulating factor (G-CSF) following chemotherapy for the procurement of peripheral blood progenitor cells (PBPCs) for autologous transplantation and reviewed the relevant literature.

Patients And Methods: Twenty-eight patients with various malignancies received cyclophosphamide 4 gm/m(2) and paclitaxel 170 mg/m2 followed by G-CSF 300 microg/d or 480 microg/d starting day +5 until two to four daily large volume leukapheresis yielded > or =5.0 x 10(6) CD34+ cells.

Rural-urban partnering in continuing education.

Background: One urban center provided an Advanced Cardiac Life Support (ACLS) course to a rural hospital using a minimum of on-site instructors.

Method: Interactive television (ITV) conferencing was used to educate health care providers in a hospital more than 100 miles away.

Results: Nurses and physicians from a small rural hospital in northern Nevada were able to "attend" a full-scale ACLS course without having to leave their hospital, resulting in minimal cost to the agency.

The Very Important Partner program: integrating family and friends into the health care experience.

The hospital experience, especially in critical care units, can be perceived by patients and their family as unwelcoming, intimidating, and anxiety producing. Patients desire the presence of loved ones and family members and may commonly express feelings of helplessness and not feeling valued or important. The Very Important Partner (VIP) program integrates family and friends into the health care experience in order to create an environment that provides opportunities for patients and their loved ones to truly experience healing of the mind, body, and spirit.

Positive outcome after looped peripherally inserted central catheter malposition. A case study.

Tip malposition of peripherally inserted central catheters (PICCs) is a frequently encountered problem. Invasive and noninvasive techniques for resolution of malpositions described in the literature are reviewed. A positive outcome using non-invasive techniques after a looped malposition in the axillary vein is discussed.

Experience with intubated patients does not affect the accidental extubation rate in pediatric intensive care units and intensive care nurseries.

Accidental extubation is a potentially serious event for pediatric or neonatal patients with respiratory failure, especially in clinical settings in which personnel capable of performing reintubation may not be readily available. Thus the rate of accidental extubation in small intensive care units that operate without 24-hour in-house physician availability may be an important quality assurance indicator. The objective of this study were to determine the accidental extubation rate at a single small pediatric intensive care unit (PICU) and compare it with published reports.

Cytomegalovirus as a cause of pancytopenia.

Human cytomegalovirus, HCMV, infects most of the population by adulthood; The primary infection is often accompanied by transient neutropenia and thrombocytopenia, and is followed by a period asymtomatic viral latency. In the setting of bone marrow transplantation, however, the immunosuppressed state of the recipient enables HCMV to re-activate or to infect the individual and cause serious sequelae. These range from hepatitis and gastrointestinal disease to interstitial pneumonia and hematologic abnormalities, which are more common in the allograft.

Enteral tube feeding in a patient with traumatic brain injury.

Tube feeding is frequently needed for patients with severe traumatic brain injury. When the patient is on the rehabilitation unit, bolus type feeding by gastrostomy tube is more easily accomplished than continuous type feeding by jejunostomy tube (J-tube). In the case presented here, the patient received less calories via J-tube feeds while he was on the rehabilitation unit than when he was in the intensive care unit or the neurosurgical unit.

Artificial neural networks for cancer research: outcome prediction.

The use of artificial neural networks in biological and medical research has increased tremendously in the last few years. Artificial neural networks are being used in cancer research for image processing, the analysis of laboratory data for breast cancer diagnosis, the discovery of chemotherapeutic agents, and for cancer outcome prediction. A neural network generalizes from the input data to patterns inherent in the data, and its uses these patterns to make predictions or to classify.

Increasing the power of surrogate endpoint biomarkers: the aggregation of predictive factors.

A variable that predicts an outcome with sufficient accuracy is called a predictive factor. Predictive factors can be divided into three types based on the outcomes to be predicted and on the accuracy with which they can be predicted. These three types include risk factors, where the main outcome of interest is incidence and the predictive accuracy is less than 100%; diagnostic factors, where the main outcome of interest is also incidence but the predictive accuracy is almost 100%; and prognostic factors, where the main outcome of interest is death and the predictive accuracy is variable.

Enhancing recovery via neuro-rehab rounds.

The neurologically injured patient experiences physiological and psychological disruptions regardless of the type of severity of injury. Through increased knowledge, nurses planning care can minimize loss of functional ability, anticipate complications and enhance recovery. Neuro-rehab rounds were developed to increase the involvement of support therapies for the patient in the neurotrauma intensive care unit (ICU) of a particular hospital.

Analysis of trauma intubations.

The timing of trauma patient intubation is dependent on clinical presentation and clinician judgment. We sought to correlate the timing of intubation with the presenting of physiologic parameters and clinical outcome to identify potential quality assurance audit filters. Patients (n = 82) were grouped by timing of intubation: PREHOSPITAL, paramedic intubation; IMMEDIATE, within 10 minutes of arrival; DELAYED, beyond 10 minutes but within 2 hours of arrival; and NONURGENT, beyond 2 hours or at the time of surgery.

Quantitative quality assurance in a community hospital pediatric intensive care unit.

Unbiased, objective evaluations of quality of care are preferred over subjective evaluations. We observed 681 admissions to a pediatric intensive care unit of a community hospital from 1989 through 1990 for outcomes and physiologic profiles of the patients on the admission day using the Pediatric Risk of Mortality score to assess severity of illness. Mortality adjusted for severity of illness was compared with that predicted from a pediatric intensive care unit of a tertiary medical center: 32.

Intra-arterial urokinase as the initial therapy for acutely ischemic lower limbs.

Acute ischemia of the lower limb remains a significant risk to both life and limb. Mortality rates of approximately 10-30% and amputation rates of the same magnitude in the survivors are repeatedly reported despite advances in medical and surgical techniques. Our experience, which utilized percutaneous intra-arterial thrombolysis as the initial treatment in 72 instances (63 patients), has resulted in a markedly lower mortality rate of 1.

Posttraumatic acute cholecystitis on the rehabilitation service.

Posttraumatic acute cholecystitis is a serious complication which can occur in multitrauma patients. Predisposing factors may include fasting, hypotension, transfusions, sepsis, and narcotics. Common signs and symptoms include right upper-quadrant pain or tenderness, nausea and vomiting, and fever.

Bilateral analysis of the knee and ankle during gait: an examination of the relationship between lateral dominance and symmetry.

This study examined the relationship between lower extremity dominance and kinematic symmetry during gait. Fourteen healthy volunteers without any observable gait deviations participated in the study. The subjects (8 male, 6 female) ranged in age from 19 to 56 years.

Should we X-ray Halloween candy? Revisited.

The well-intentioned program of X-raying Halloween candy is costly. The annual expense to the 3 local hospitals in the Reno/Sparks area was $1625.62.

Technique and results of "higher-dose" infusion.

We experimented with thrombolytic technique in an attempt to maximize therapeutic outcome, selecting urokinase because of its proven safety and efficacy in clinical investigation. An initially "high-dose" regimen, starting at 4,000 U/min and decreasing to 1,000 U/min after restoration of antegrade blood flow, generally establishes lysis within 3-4 h--even after acute embolic or thrombolytic occlusion. It can also be used effectively and safely as a therapeutic trial.