Is routine extubation overnight safe in cardiac surgery patients?

Objectives

Expedient extubation after cardiac surgery has been associated with improved outcomes, leading to postoperative extubation frequently during overnight hours. However, recent evidence in a mixed medical-surgical intensive care unit population demonstrated worse outcomes with overnight extubation. This study investigated the impact of overnight extubation in a statewide, multicenter Society of Thoracic Surgeons database.

“Virginia Woolf's The Waves: A Lyrical ‘Sense of Continuity’ in a Sea of Dissociation”

ABSTRACT

The Waves, written in 1931 by Virginia Woolf, is an astounding depiction of an internal landscape richly full of dissociative phenomena. Although applauded for its genius and considered by many to be her highest literary achievement, critics complained that the language of the characters seemed artificial and a departure from the usual interior monologue appearing in other works that utilized stream of consciousness writing at the time. Woolf believed this work to be misunderstood as she often felt herself. This paper illustrates how The Waves might metaphorically connote the internal experiences of dissociating. The narrative of the novel illuminates the mapping of Woolf's internal system as it changes across a life span. Woolf deftly submerged not only the facts of her personal life in The Waves but, more important, revealed through both her literary method and language the dissociative nature of her own mind. By extrapolating from Woolf's autobiographies, journals, and letters, the parallels between fact and fiction become apparent.     

Traumatic spinal cord injury in West Virginia: Disparities by insurance and discharge disposition from an acute care hospital

Context: Medicaid has been linked to worse outcomes in a variety of diagnoses such as lung cancer, uterine cancer, and cardiac valve procedures. It has furthermore been linked to the reduced health-related quality of life outcomes after traumatic injuries when compared to other insurance groups. In spinal cord injury (SCI), the care provided in the subacute setting may vary based upon payor status, which may have implications on outcomes and cost of care.

Design: A retrospective review utilizing the institutional trauma databank was performed for all adult patients with spinal cord injury since 2009. Pediatric patients were excluded. Insurance type, race, length of stay, discharge status (alive/dead), discharge disposition, injury severity score (ISS), and hospital charges billed were recorded.

Results: Two hundred patients were identified. Overall 27.5% of patients with SCI during the period of our review were Medicaid beneficiaries. ISS was similar between Medicaid and non-Medicaid patients, but the Medicaid beneficiaries were younger (37 vs 50 years of age; P?<?.001). Medicaid beneficiaries had a significantly longer length of stay (20.9 days; P?<?.001) when compared to all other patients. They furthermore were more likely to be discharged home or to a skilled nursing facility rather than an acute rehabilitation center. Inpatient charges billed for Medicaid beneficiaries were significantly higher than those of non-Medicaid patients (203,264 USD vs 140,114 USD; P?=?.015), likely reflecting the increased length of stay while awaiting appropriate disposition.

Conclusion: Medicaid patients with SCI in West Virginia had a longer hospital stay, higher charges billed, and were more likely to be discharged home or to a skilled nursing facility rather than an acute rehabilitation center, when compared to non-Medicaid patients. The lack of availability of rehabilitation facilities for Medicaid beneficiaries likely explains this difference.     

Crude 4-methylcyclohexanemethanol (MCHM) did not cause skin irritation in humans in 48-h patch test

Crude 4-methylcyclohexanemethanol (MCHM) is an industrial chemical used to wash and clean coal. On January 9th, 2014 approximately 10,000 gallons of a mixture containing crude MCHM were released into the Elk River near Charleston, West Virginia, contaminating the local water supply. Following the spill, residents reported numerous health complaints, and sought medical attention for ailments including rashes and itching. The relationship between the complaints and the spill were unknown, as such symptoms are reported frequently in the background. In this study, the primary irritation potential of crude MCHM was evaluated in 206 individuals who underwent 48?hour semi-occluded patch testing. MCHM concentrations assessed in this study were 1, 5, 15, and 100?ppm. No appreciable skin reactions were observed in individuals at any concentration. Three of the five concentrations evaluated were above the highest measured concentration of MCHM in the tap water of residents in West Virginia (3.7?ppm). The results of this study suggest that crude MCHM would not be a dermal irritant for the vast majority, if not all, potentially exposed persons at the concentrations in the water reported after the spill.