Facilitators and Barriers to Implementation of Safe Infant Sleep Recommendations in the Hospital Setting

ObjectiveTo identify facilitators and barriers to the implementation of safe sleep recommendations from the American Academy of Pediatrics from the perspective of hospital staff as part of a needs assessment that was used to design a successful quality improvement intervention to change clinical practice.DesignQualitative design.SettingMultiple sites of three hospitals in the northeastern and southern United States.ParticipantsWe used purposeful sampling to identify 46 participants who cared for infants on inpatient hospital units (nurses and other staff members).MethodsA qualitative researcher used grounded theory to moderate the focus groups. We constructed the initial interview guide and then changed it as needed to capture more information about new ideas as they arose. Researchers from diverse backgrounds participated in the analysis and used the constant comparative method to select important concepts and to develop codes and subsequent themes. We continued to collect data until saturation was reached.ResultsWe identified themes and subthemes, and the taxonomy fit into the Grol and Wensing framework for change in clinical practice. The six primary themes included The Innovation Itself, The Individual Health Care Professional, The Patient, The Social Context, The Organizational Context, and The Economic and Political Context.ConclusionParticipants described facilitators and barriers to the implementation of the American Academy of Pediatrics recommendations for safe infant sleep. Identification of these themes informed our quality improvement intervention to promote safe infant sleep. Findings can be used by others when faced with the need for similar change.     

Operative Duration and Short-Term Postoperative Complications after Unicompartmental Knee Arthroplasty

BackgroundProlonged operative duration is an independent risk factor for postoperative complications in many orthopedic procedures ranging from shoulder arthroscopy to total hip and knee arthroplasties. It has not been well studied in unicompartmental knee arthroplasty (UKA). The purpose of this study is to assess the effect of operative duration on complications after UKA.MethodsUsing the American College of Surgeons National Surgical Quality Improvement Program registry, we identified all primary unilateral UKAs from 2005 to 18. Patients were divided into three cohorts based on the operative duration: < 90 minutes, between 90 and 120 minutes, and >120 minutes. Baseline patient and operative demographics (age, gender, etc.) and thirty-day complications were compared using bivariate analysis. Multivariate analysis was used to assess the independent effect of operative duration on postoperative outcomes after adjusting for differences in baseline characteristics.ResultsWe identified 11,806 patients who underwent primary UKA from 2005 to 18. There was no difference in the “any complication” rate between cohorts. However, operative duration >120 minutes was associated with a significantly higher likelihood of reoperation (odds ratio [OR] 2.02, 95% confidence interval [CI]: 1.15-3.57, P = .015), non–home discharge (OR: 2.14, CI: 1.65-2.77, P < .001), surgical site infection (OR: 1.76, CI: 1.03-3.01, P = .038), and blood transfusions (OR: 3.23, CI: 1.44-7.22, P = .004) when compared with operative duration <90 minutes. There was no difference in mortality rates.ConclusionIncreased operative duration greater than 2 hours in primary UKA is associated with an increased risk of non–home discharge, surgical site infection, reoperation, and blood transfusion.     

“双一流”建设背景下学科服务品牌建设研究

“双一流”建设背景下学科服务是图书馆工作面临的新挑战。本文以广西中医药大学图书馆为例,从内涵、背景、措施和意义等角度,对创建学科服务品牌进行分析,提出在保障人力资源、加强思想教育的基础上,成立品牌管理团队,做好学科服务品牌建设顶层设计,做好做优知识服务工作,创新知识服务新模式,推进学科服务的发展。     

Idiopathic myelofibrosis: dental treatment considerations

Idiopathic myelofibrosis is a myeloproliferative disorder of unknown origin. The bone marrow becomes fibrotic with an associated decrease in hematopoiesis resulting in anemia, bleeding problems, splenomegaly, and other secondary abnormalities. Although idiopathic myelofibrosis is usually diagnosed in middle age, there have been a few reports of the disorder in the pediatric population. This case report documents dental treatment considerations in a 6-year-old female with idiopathic myelofibrosis, severe anemia, and abnormal blood coagulation studies. The patient was successfully treated in a hospital after medical consultation, transfusion of packed red blood cells, and administration of prophylactic antibiotics. Local hemostatic measures following multiple extractions of carious teeth controlled bleeding. No postoperative sequelae occurred.     

Focal MRI findings in early SSPE

Many investigators have identified localized cortical involvement in subacute sclerosing panencephalitis (SSPE) by clinical and electrophysiologic criteria. Some investigators have reported such abnormalities in the posterior cerebrum early in the course of the disease, but without radiologic correlation. Recently, magnetic resonance imaging has been used to follow the progression of SSPE. The largest reported study of SSPE utilizing magnetic resonance imaging indicated that focal abnormalities were distinctly rare and actually mitigated against the diagnosis of SSPE. We report an SSPE patient with focal cerebral dysfunction and magnetic resonance imaging evidence of distinctly focal inflammatory disease early in the course of the illness.     

Prognostic factors for relapse after complete response in patients with metastatic germ cell tumors

Among 216 patients with metastatic germ cell tumors who achieved a complete response (CR) to cisplatin-based chemotherapy (CT), 38 have experienced a relapse. Prognostic factors for time to relapse from time of response were considered using the Cox proportional hazards model. Compared with patients who responded to CT and did not require surgery and patients whose surgery showed only either necrotic debris or mature teratoma, those who required surgery for residual tumor after CT were at much higher risk for relapse, although their residual tumor was totally resected. Of the 19 patients who required this surgery, eight have experienced a relapse. Other prognostic factors for relapse included lactate dehydrogenase (LDH) and human chorionic gonadatropin (hCG) at the time of initial CT. Although those who require surgery for residual tumor after CT receive additional CT, there is still a high risk of relapse.     

Use of synthetic oligonucleotides in the characterization of antithrombin III Northwick Park (393 CGT----TGT) and antithrombin III Glasgow (393 CGT----CAT)

Antithrombin III (ATIII) Northwick Park is caused by a single amino acid substitution, Arg 393---Cys and antithrombin III Glasgow is caused by Arg 393----His. Examination of the genetic code and the sequence of normal antithrombin III revealed that these amino acid substitutions could arise from the substitution of either two nucleotides or a single nucleotide at codon 393 of the antithrombin III gene. In two families, detection of the ATIII variants by genetic linkage analysis was not possible owing to lack of informative RFLP markers. Consequently, we synthesized two 22-base-long oligonucleotides specific for the single- base substitutions in the region of codon 393 and demonstrated by oligonucleotide hybridization that the molecular defect of ATIII Northwick Park is caused by the CGT----TGT mutation at codon 393 and that ATIII Glasgow is caused by the CGT----CAT mutation at codon 393. These oligonucleotide probes should prove useful as an alternative method for early detection of the ATIII variants.     

Intravenous fluids in minor gynaecological surgery. Their effect on postoperative morbidity

Postoperative morbidity was assessed in 100 patients who underwent minor gynaecological procedures. Fifty patients received intra-operative crystalloid (1000 ml compound sodium lactate solution) and the remaining fifty none. Identical short-acting intravenous anaesthetic techniques were used in both groups. There was no statistically significant difference between the groups in symptoms of nausea, vomiting, headache and drowsiness within the first 6 hours after operation. Patients who received intra-operative fluids exhibited a decreased incidence of dizziness within the first 6 hours and a decreased incidence of nausea when questioned at 3 days compared with those who did not receive any fluid; the difference was statistically significant.