Implementing a Pediatric Surgical Safety Checklist in the OR and Beyond

An international study about implementation of the World Health Organization Surgical Safety Checklist showed that use of the checklist reduced complication and death rates in adult surgical patients. Clinicians at Children's Hospital Boston, Massachusetts, modified the Surgical Safety Checklist for pediatric populations. We pilot tested the Pediatric Surgical Safety Checklist and created a large checklist poster for each OR to allow the entire surgical team to view the checklist simultaneously and to promote shared responsibility for conducting the time out. Results of the pilot test showed improvements in teamwork, communication, and adherence to process measures. Parallel efforts were made in other areas of the hospital where invasive procedures are performed. Compliance with the checklist at our facility has been good, and team members have expressed satisfaction with the flow and content of the checklist.     

Universal leukocyte reduction: Is it appropriate medical practice or not?

This article discusses the evidence for the generally accepted uses of leukocyte-reduced blood and the controversy over leukocyte reduction and transfusion-related immunomodulation. A perspective is provided on the continued need for leukocyte reduction on the part of all patients in the United States.     

Looking Beyond Lifestyle: A Comprehensive Approach to the Treatment of Obesity in the Primary Care Setting

Obesity is a growing public health concern due to its increased health risks and comorbidities. Currently, the number of those affected is the highest ever seen in United States history. Obesity treatment in the primary care setting is generally focused on the very basic lifestyle modifications of diet and exercise; however, obesity is a complex chronic disease that is often multifactorial and requires modification to areas other than lifestyle behaviors alone. Primary care clinicians often see obesity as too difficult or time consuming to treat in the primary care setting, and due to factors including lack of comfort or familiarity in treatment, low patient adherence, and time constraints, providers often choose to avoid treatment altogether. This report challenges providers to look beyond lifestyle in the assessment and treatment of obesity, and recommendations are given for comprehensive management of obesity in the primary care setting.     

Insulation Lead Failure: Is it a Matter of Insulation Coating,Venous Approach,or Both?

Lead insulation material and implant route have a major impact on lead realiability and durability. We compare the incidence of lead insulation failure resulting from both the venous approach and insulation type. Two hundred ninty consecutive leads were followed for a mean period of 57 ± 30 months; leads with < 1 year follow-up were excluded. There were 116 Silicone Rubber insulated leads and 174 with polyurethane (151 Pellethane 80A and 23 Pellethane 55D) insulation; 279 leads were bipolar and 11 unipolar; 274 leads were implanted in the ventricle and 66 in the atrium. The venous route was the subclavian vein for 170 leads (58%) and the cephalic vein for 120 leads (42%). Insulation failure was diagnosed when a single sign of oversensing, undersensing, failure to capture, early pulse battery depletion, and lead impedance < 250 Ω was present. Measurement of lead impedance was performed intraopera-tively at implantation and during lead revision or pulse generator replacement. Lead failure caused by conductor coil fracture was not considered. There were 13 lead insulation failures, all among leads with polyurethane insulation (12 Pellethane 80A and 1 Pellethane 55D). Eleven failures (10%) occurred when the subclavian vein and 2 (3%) when the cephalic vein approach was used. The cumulative survival rate of polyurethane and silicone rubber insulated leads was 88.7% and 100%, respectively (P = 0.02); the cumulative survival rate of polyurethane insulated leads was 83.2% when the subclavian vein and 95.1% when the cephalic vein were used (P = 0.03). The mean time to polyurethane lead failure when the subclavian vein approach was used was 54 ± 17 months and when the cephalic route was 73 ± 4 months (P < 0.02). By multivariate analysis, the route of entry was found to be a significant variable related to polyurethane insulated lead failure (P < 0.05). At lead revision failure to capture was present in 7, over-sensing in 4, and undersensing in 2 instances; impedance was < 250 Ω in all cases. Pellethane 80A insulated leads are prone to insulation failure, but more when the subclavian vein is used, rather than the cephalic vein.