Errors in Pressure Gradient Measurement in Prosthetic Aortic Valves Due To Pressure Recovery: Type, Size, and Flow Rate Effects In Vitro

We assessed errors in valvular pressure gradients due to pressure recovery, the variation in aortic pressure with distance from the valve, to explain errors in catheter measurements and simultaneous continuous-wave Doppler/catheter studies. Ten types and three sizes of valves were tested in vitro. Aortic pressure was measured by catheter between 1 and 6 cm from the valve. Pressure recovery was quantified as the slope of the gradient with distance from the annulus. Valve type, size, and flow rate effects were determined by analysis of variance. Relationships between Doppler and maximal catheter gradients were also analyzed statistically. The slope of pressure recovery was significantly higher in smaller valves (P< 0.01), in bioprosthetic rather than mechanical valves (P < 0.001), and at higher flows (P < 0.0001). Doppler I catheter slopes were dependent on valve type and size, with more overestimation by Doppler in mechanical (P < 0.01) and larger valves (P < 0.01). Errors due to catheter positioning are more likely wherever effects of pressure recovery are higher: in bioprosthetic valves, smaller valves, and at higher flow rates. Pressure recovery can explain overestimation by Doppler only if localized gradients closer than 1 cm from the valve exist. Clinicians should be aware of these effects of pressure recovery when making major diagnostic and therapeutic decisions.     

Organizing Quality Assurance in a Maternal-Child Heath Division

The 10-step monitoring and evaluation process is described and applied to a maternal-child health division of a 300-bed tertiary care hospital. Examples of specific important aspects of care and indicators are given. The organized plan developed for this division is examined using the Joint Commission on Accreditation of Healthcare Organization's guidelines.     

Clinical Evaluation of a 1,450-nm Diode Laser as Adjunctive Treatment for Refractory Facial Acne Vulgaris

BACKGROUND Despite aggressive multitreatment medical acne regimens, many patients demonstrate modest benefit. The 1,450-nm diode laser has been shown to improve acne in a study setting.
OBJECTIVE Herein we evaluate the use of this laser as an adjunctive tool in the management of refractory facial acne vulgaris.
MATERIALS AND METHODS Thirteen patients were treated. Lesion counts, clinical evaluation, and digital photography were performed at baseline and at all follow-up visits. Patients received an average of three treatments. Acne severity index and patient satisfaction were assessed. Patients continued their medical acne regimen where applicable.
RESULTS Mean total lesion and inflammatory lesion counts decreased from 66 ± 14 and 23 ± 5 at baseline to 34 ± 12.9 and 14 ± 7 after three treatments ( p <.05). Side effects were mild, including erythema lasting up to 24 hours.
CONCLUSION The 1,450-nm diode laser provides moderate improvement of refractory acne vulgaris. Our findings support the use of this device as an adjunctive treatment for acne management.     

Effects of a Specialized Prenatal Adolescent Program on Maternal and Infant Outcomes

The effects of a specialized prenatal educational program on perinatal outcomes in an urban adolescent maternity term population were examined. Fifty pregnant adolescents attended the program and 50 nonattenders served as controls. All subjects delivered at the same large metropolitan hospital. The data supported the hypotheses predicting that those adolescents exposed to the educational program and their infants would demonstrate fewer perinatal complications than those not exposed to the program. When analyzed by age, attenders and their infants in both groups (13 to 15 and 16 to 18 years of age) had fewer complications than nonattenders. Attenders also demonstrated lower frequencies of several obstetric and postnatal complications than did nonattenders. This study underscores the positive effects a specialized education program can have on adolescent perinatal outcomes.