Magnesium and cardiac surgery.

Magnesium depletion was found to occur commonly after cardiac surgery in children and to cause significant neurological and cardiac symptoms. This discovery, in the absence of previous detailed documentation, inspired investigations to determine the relationship of cardiac surgery to changes in magnesium metabolism. A number of patient groups were studied, including both children and adults undergoing various operations. The studies demonstrated an almost universal occurrence of magnesium depletion during and after cardiac surgery, but also demonstrated that supplementation may be preventive. The patterns and aetiology of the changes and their clinical significance are presented and discussed in the light of recent reports from other authors.     

Day case ligation of patent ductus arteriosus in preterm infants: a 10 year review.

Since 1978, 136 preterm babies received ligation of a patent ductus arteriosus as day cases. A total of 122 babies whose notes were available for review, with a median gestational age of 27 weeks (range 23-35) and median birth weight of 960 g (range 470-2750), were transported distances of up to 80 miles. The median ages at ligation with and without previous medical management with indomethacin were 23 and 15 days, respectively. One hundred and ten (90%) babies were dependent on ventilatory support, but extubation was achieved at a median time of 10 days after ligation, regardless of postnatal age at the time of ligation. There were no deaths associated with the operation, and no complications resulting from transportation. The hospital mortality was 15 (12.3%), and the most important (and significant) adverse factor was a preoperative fractional inspiratory oxygen content greater than 0.3. The results of this study show that day case ligation of the patent ductus arteriosus is safe, and if it is carried out early will reduce the time before extubation and discharge from the intensive care unit.     

Models for individual oral health promotion and their effectiveness: a systematic review

Background:  There is a recognized need to deliver oral health information to people during clinical encounters to enable them to develop personal skills in managing their own oral health. Traditional approaches to individual oral health education have been shown to be largely ineffective and new approaches are required to address personal motivations for preventive behaviour. This systematic review aims to identify and assess the effectiveness of behaviour models as a basis for individual oral health promotion.
Methods:  Electronic databases were searched for articles evaluating the effectiveness of health behaviour models in oral and general health between 2000 and 2007. Eighty-nine studies were retrieved and data were extracted from the 32 studies that met the inclusion criteria.
Results:  Thirty-two studies were identified in the fields of clinical prevention and health education, motivational interviewing (MI), counselling, and models based interventions. MI interventions were found to be the most effective method for altering health behaviours in a clinical setting.
Conclusions:  There is a need to develop an effective model for chairside oral health promotion that incorporates this evidence and allows oral health professionals to focus more on the underlying social determinants of oral disease during the clinical encounter. There is potential to further develop the MI approach within the oral health field.     

Multiple pulmonary microemboli complicating pneumonectomy

Pulmonary embolism is widely recognized to complicate abdominal and lower limb orthopedic surgical procedures, but in comparison, it is seldom recognized to hamper the postoperative progress of patients after thoracic operations. We present 4 patients in whom multiple pulmonary emboli developed after pneumonectomy, 2 of whom were treated successfully. We discuss the mostly atypical presentation and the physiological and clinical consequences, and also suggest a mode of management.     

Nurse-led preoperative screening and targeted optimization of pulmonary dysfunction in patients undergoing cardiac surgery

Postoperative pulmonary dysfunction prolonging intensive care treatment after cardiac surgery most commonly occurs in patients with a background of pre-existing pulmonary dysfunction. However, many patients have occult dysfunction and present primarily after surgery. We describe and discuss the results of a respiratory optimization program utilizing a peak expiratory flow rate below 400 L/min as a screening test to identify patients in a nurse-directed preoperative clinic.     

Dental service provision in Victorian residential aged care facilities

BACKGROUND: The Australian population is ageing, and a growing proportion of elderly Australians are now living in residential aged care facilities (RACFs). These residents are at high risk of developing dental diseases, have more teeth present now than at any time in the past 50 years and often have difficulty maintaining adequate oral hygiene. Traditionally, dental service provision has been problematic and sporadic for these residents. METHODS: A postal survey of a random sample of Victorian general dentists and Directors of Nursing (DONs) of Victorian RACFs was undertaken in 2006 to ascertain the participation of dentists in the provision of dental care and to identify factors impacting on the organization and provision of dental care for residents. RESULTS: The response rate for dentists was 57.3 per cent, and for DONs 64.4 per cent. Half of the dentists reported that they had provided care to residents of aged care facilities in the past 12 months, and they spent an average of one hour per month providing care. Overall, dentists were concerned with their level of undergraduate education and training in various aspects of dentistry for residents of aged care facilities. DONs reported significant difficulty obtaining adequate dental care for their residents. Common problems identified by both dentists and DONs included a preference for dentists to treat residents in their own practice, dentists not willing to go to RACFs and a lack of portable dental equipment for dentists to use. CONCLUSIONS: There were low levels of interest and participation from Victorian dentists in providing dental care for residents of aged care facilities. Dentists had a strong preference for treating patients at their own practice, and there were a number of significant barriers that appeared to impact on the provision of dental care in RACFs.     

Isolated severe ischemic tricuspid regurgitation: successful surgical repair

Tricuspid regurgitation (TR) is a common association of left-sided valvular lesions that is occasionally seen with ischemic heart disease. However, isolated ischemic TR requiring surgical intervention is extremely rare, with very few reported cases. The case is presented of a 59-year-old woman who, after extensive non-cardiac investigations, was eventually diagnosed with severe functional TR due to chronic myocardial ischemia. The patient underwent successful surgical treatment.