Audit of telephone usage in a centralized intravenous admixture area

An audit of telephone usage in an intravenous admixture area was performed. Over a two-day period (18 hours total) 252 calls were made or received. The average length of a call was 81 seconds. Surgery and medicine nursing units accounted for the majority of the cells. Missing orders or doses were the most frequent topic of calls. Telephone communication may require a large time commitment from pharmacists and prevent them from performing activities which are more easily documentable, such as compounding intravenous admixtures.     

New-onset atrial fibrillation and outcomes following isolated coronary artery bypass surgery: A systematic review and meta-analysis

Prior meta-analyses have shown that new-onset atrial fibrillation (NOAF) occurs in up to 40% of patients following cardiac surgery and is associated with substantial major adverse cardiovascular events. The stroke and mortality implications of NOAF in isolated CABG without concomitant valve surgery is not known. We thought that NOAF would be associated with increased risk of stroke and mortality, even in patients undergoing isolated CABG. A blinded review of studies from MEDLINE, CENTRAL, and Web of Science was done by two independent investigators. Stroke, 30-day/hospital mortality, long-term cardiovascular mortality, and long-term (>1 year) all-cause mortality were analyzed. We used Review Manager Version 5.3 to perform pooled analysis of outcomes. Of 4461 studies identified, 19 studies (n = 129 628) met inclusion criteria. NOAF incidence ranged from 15% to 36%. NOAF was associated with increased risk of stroke (unadjusted OR 2.15 [1.82, 2.53] [P < .00001]; adjusted OR 1.88 [1.02, 3.46] [P = .04]). NOAF was associated with increased 30-day/hospital mortality (OR 2.35 [1.67, 3.32] [P < .00001]) and long-term cardiovascular mortality (OR 2.04 [1.35, 3.09] [P = .0007]) NOAF was associated with increased long-term all-cause mortality (unadjusted OR 1.79 [1.63, 1.96] [P < .00001]; adjusted OR 1.58 [1.24, 2.00] [P = .0002]). We found that the incidence of NOAF following isolated CABG is high and is associated with increased stroke rate and mortality. Early recognition and management of NOAF could improve outcomes.     

Infection and rejection risk after cardiac transplantation with induction vs. no induction: a multi‐institutional study

Data from Cardiac Transplant Research Database (CTRD) were analyzed from 1999 to 2006 to examine the effects of different induction strategies at the time of cardiac transplantation. A total of 2090 primary heart transplants were categorized by induction with interleukin‐2 receptor blocker (IL‐2RB), antithymocyte globulin (ATG), or no induction (NI). Probabilities for rejection and infection were estimated with parametric time‐related models. Using these models, hazard was calculated for two theoretical patient profiles, one at lower risk for rejection and higher risk of infection (Profile 1) and higher risk for rejection and lower risk of infection (Profile 2). Of the 2090 transplants, 49.8% (1095) did not receive induction, 27.3% (599) received IL‐2RB, and 18.0% (396) received ATG. Profile 1 patients had lower hazard for rejection with IL‐2RB compared to ATG and NI (p < 0.01), but at the cost of increased risk of infection (5.0 vs. 1.8 vs. 1.6, respectively, at four wk, p < 0.01). Profile 2 patients experienced a fivefold decreased hazard for rejection when treated with IL‐2RB compared with ATG and NI (p < 0.01). In patients at high risk of infection, IL‐2RB reduced risk of rejection but at the expense of increased hazard for infection.     

Operative treatment of fecal incontinence in coccyx agenesis in children after surgical correction of Hirschsprung's disease

The coccygeal agenesis is one of causes of the external anal sphincter functional insufficiency after performing operations for Hirschsprung's disease in children. The frequency of its diagnosis had constituted 6.2%, in 14.6% it was the causative factor of fecal incontinence after the operation. In coccygeal agenesis the normal anatomy of the pelvic floor muscles become disordered. It is convenient to perform the anomaly correction during the radical operation conduction for the main disease.     

The microstructure of colonies of the Connaught BCG strain

It has previously been shown that there is a certain correlation between the biological properties of BCG strains—properties on which their immunogenicity and allergenicity depend—and the macroscopic appearance of the growth of these colonies on solid and liquid media. To investigate this phenomenon in greater detail, the author examined the microstructure of colonies of the Connaught BCG strain grown on both solid and liquid media. Colonies were fixed in agar, embedded in paraffin, sectioned and stained by the Ziehl-Neelsen technique.     

The history of autism

Abstract. Autism remains a fascinating condition, perhaps the most prolifically researched of all child psychiatric disorders. Its history yields many lessons: early accounts of possible autism are, with one exception, unclear; the greatest contributions to our understanding have come from individual clinicians and researchers; the concept and definition of the disorder have changed greatly over the years; some ideas once held with conviction, were later proved to be unfounded; and socio-political shifts as well as research findings have radically altered our understanding of the syndrome as well as the care and treatment offered to people with autism.