Dealing honestly with an honest mistake

A 70-year-old woman was admitted for a symptomatic left iliofemoral deep vein thrombosis. She underwent percutaneous mechanical thrombectomy, followed by overnight thrombolysis. The next day her clot had resolved, and a culprit left iliac vein stenosis was identified. After stent placement, a heparin infusion was initiated and the patient was taken back to the ward. At 11 the evening after the procedure, the resident on call was contacted to verify the written order. The resident stated that the heparin dose was to be 250 U/h; however, the nurse documented 2500 U/h and changed the infusion pump at the patient's bedside. At 5:30 the next morning, the resident was notified that the patient's partial thromboplastin time was >300 seconds and promptly shut off the heparin infusion. No noticeable adverse events occurred because of the high heparin dosing. The charge nurse was notified, as was risk management. What should the patient be told

Open versus Endovascular Abdominal Aortic Aneurysm Repair in VA Hospitals

Background: Endovascular abdominal aortic aneurysm repair (EVAR), when compared to conventional open surgical repair, has been shown to reduce perioperative morbidity and mortality. A retrospective cohort study was performed with data from the Department of Veterans Affairs to examine outcomes in routine daily practice following EVAR and open surgical repair. Methods: In this study, I examined 30-day mortality, 1-year survival, and postoperative complications in 1957 patients who underwent elective AAA repair (EVAR n=717 (36.6%); open n=l240 (63.4%)) at 123 VA hospitals between May 1, 2001 and September 30, 2003. Also, this review investigated the influence of patient, operative, and hospital variables on outcome, and used propensity scoring to adjust for the nonrandom allocation of patients to either EVAR or open procedures. Results: Patients undergoing EVAR had significantly lower 30 day (3.1% vs. 5.7%, p=0.0079) and 1 year mortality (8.4% vs. 12.0%, p=0.0121) than patients having open repair. EVAR was positively and independently associated with a decrease in 30-day postoperative mortality (adjusted OR=0.58; 95% CI=0.35, 0.97; p=0.0367). The risk of any perioperative complication was much less following EVAR (4.5% vs. 14.2%; p<0.0001; unadjusted OR 0.48; 95% CI =0.37, 0.63; p<0.001). Patients operated on at low volume hospitals (25% of entire cohort) were more likely to have had open repair (31.6% compared to 15.9% EVAR; p <0.001) as well as a two-fold increased adjusted 30-day mortality risk (OR=2.06; 95% CI=1.32, 3.26; p=0.0015). Conclusions: In routine daily practice, patients presenting for elective AAA repair who undergo EVAR have substantially lower perioperative mortality and morbidity rates compared to patients having open repair. The benefits of a minimally invasive approach were readily apparent in this cohort; however, caution should be exercised in choosing EVAR for all elective AAA repairs until longer-term data on device durability are available. Furthermore, widely available screening programs may aid in the early detection of AAA, which would further facilitate timely surgical intervention and, ultimately, improve outcomes.Master of Public Healt

Delayed neurologic deficit after endovascular abdominal aortic aneurysm repair

AbstractParaplegia or paraparesis secondary to spinal cord ischemia is an extremely rare complication after elective repair of abdominal aortic aneurysm. We report delayed paraparesis after endovascular abdominal aortic aneurysm repair in which one hypogastric artery was unintentionally occluded due to atheroembolism. A spinal catheter was immediately inserted after onset of paraplegia to promote cerebrospinal fluid drainage, which partially reversed the neurologic deficit. Our case underscores both the importance of the critical spinal collateral supply from the hypogastric artery and the role of spinal fluid drainage to maximize spinal cord perfusion in the setting of spinal cord ischemia. (J Vasc Surg 2003;37:690-2.

Spontaneous arterial thrombosis in a patient with human immunodeficiency virus infection: Successful treatment with pharmacomechanical thrombectomy

AbstractPatients with human immunodeficiency virus (HIV) have various coagulation abnormalities as well as increased risk for development of clinical thrombosis and subsequent embolic events. We report acute lower leg ischemia caused by spontaneous atheroembolism with no identifiable source in a young patient with HIV infection. Treatment included percutaneous mechanical thrombectomy and thrombolysis, which reversed the arterial ischemia. Physicians should be aware of thromboembolic disease as a possible complication of HIV

Professional Writing in the English Classroom: Literature-Based Professional Writing: An Oxymoron Whose Time Has Come

The article discusses a study regarding the integration of professional writing in English classes. It mentions the proposal of the National Council of Teachers of English (NCTE) in its annual convention on associating professional writing with literature. It also states that connecting literature with technical writing in English classrooms provides students with opportunities to absorb real life writing experiences

Surgical intervention for complications caused by femoral artery catheterization in pediatric patients

AbstractPurpose: This study evaluated the risk factors and surgical management of complications caused by femoral artery catheterization in pediatric patients. Methods: From January 1986 to March 2001, the hospital records of all children who underwent operative repairs for complications caused by femoral artery catheterization were reviewed. A prospective cardiac data bank containing 1674 catheterization procedures during the study period was used as a means of determining risk factors associated with iatrogenic femoral artery injury. Results: Thirty-six operations were performed in 34 patients (age range, 1 week-17.4 years) in whom iatrogenic complications developed after either diagnostic or therapeutic femoral artery catheterizations during the study period. Non-ischemic complications included femoral artery pseudoaneurysms (n = 4), arteriovenous fistulae (n = 5), uncontrollable bleeding, and expanding hematoma (n = 4). Operative repairs were performed successfully in all patients with non-ischemic iatrogenic femoral artery injuries. In contrast, ischemic complications occurred in 21 patients. Among them, 14 patients had acute femoral ischemia and underwent surgical interventions including femoral artery thrombectomy with primary closure (n = 6), saphenous vein patch angioplasty (n = 6), and resection with primary anastomosis (n = 2). Chronic femoral artery occlusion (> 30 days) occurred in seven patients, with symptoms including either severe claudication (n = 4) or gait disturbance or limb growth impairment (n = 3). Operative treatments in these patients included ileofemoral bypass grafting (n = 5), femorofemoral bypass grafting (n = 1), and femoral artery patch angioplasty (n = 1). During a mean follow-up period of 38 months, no instances of limb loss occurred, and 84% of children with ischemic complications eventually gained normal circulation. Factors that correlated with an increased risk of iatrogenic groin complications that necessitated surgical intervention included age younger than 3 years, therapeutic intervention, number of catheterizations (≥ 3), and use of 6F or larger guiding catheter. Conclusion: Although excellent operative results can be achieved in cases of non-ischemic complications, acute femoral occlusion in children younger than 2 years often leads to less satisfactory outcomes. Operative intervention can provide successful outcome in children with claudication caused by chronic limb ischemia. Variables that correlated with significant iatrogenic groin complications included a young age, therapeutic intervention, earlier catheterization, and the use of a large guiding catheter. (J Vasc Surg 2001;33:1071-8.

The Iowa Homemaker vol.17, no.7

Beauty from Beauty by Peggy Schenk, page 1 Through Masculine Eyes by Jim Henderson and E. L. Anderson, page 2 Use Angles and Lights for Snappy Shots by Jane Helser, page 4 Faces in Focus by Gaynold Carroll and Harriett Graves, page 5 New Style Loves by Sally, page 6 Beds for Beauty by Ruth Dahlberg, page 7 Gems in Pottery by Katherine Taube, page 8 Room for Improvement by Leah Scott, page 9 What’s New in Home Economics edited by Marjorie Pettinger, page 10 In the Still of the Night by Helen Greene, page 12 Short but Sweet by Harriet Beyer, page 13 Dessert Course, a poem by Ronny Ronningen, page 14 Controlled Curves by Gertrude E. Hendriks, page 14 First Ladies by Ruth Sawin, page 15 Complaints of Shopworn Clerks by Ruth Dahlberg, page 16 Behind Bright Jackets, page 18 Alumnae News by Faithe Danielson, page 19 Lamp Light by Mary Bush, page 20 To Whom It May Concern, a poem by Ronny Ronningen, page 20 Heart to Heart by the editor, page 2

Impacts of ambient air quality on acute asthma hospital admissions during the COVID-19 pandemic in Oxford City, UK:a time-series study

OBJECTIVES: The study aims to investigate the short-term associations between exposure to ambient air pollution (nitrogen dioxide (NO2), particulate matter pollution-particles with diameter&lt;2.5 µm (PM2.5) and PM10) and incidence of asthma hospital admissions among adults, in Oxford, UK.DESIGN: Retrospective time-series study.SETTING: Oxford City (postcode areas OX1-OX4), UK.PARTICIPANTS: Adult population living within the postcode areas OX1-OX4 in Oxford, UK from 1 January 2015 to 31 December 2021.PRIMARY AND SECONDARY OUTCOME MEASURES: Hourly NO2, PM2.5 and PM10 concentrations and meteorological data for the period 1 January 2015 to 31 December 2020 were analysed and used as exposures. We used Poisson linear regression analysis to identify independent associations between air pollutant concentrations and asthma admissions rate among the adult study population, using both single (NO2, PM2.5, PM10) and multipollutant (NO2 and PM2.5, NO2 and PM10) models, where they adjustment for temperature and relative humidity.RESULTS: The overall 5-year average asthma admissions rate was 78 per 100 000 population during the study period. The annual average rate decreased to 46 per 100 000 population during 2020 (incidence rate ratio 0.58, 95% CI 0.42 to 0.81, p&lt;0.001) compared to the prepandemic years (2015-2019). In single-pollutant analysis, we observed a significantly increased risk of asthma admission associated with each 1 μg/m3 increase in monthly concentrations of NO2 4% (95% CI 1.009% to 1.072%), PM2.5 3% (95% CI 1.006% to 1.052%) and PM10 1.8% (95% CI 0.999% to 1.038%). However, in the multipollutant regression model, the effect of each individual pollutant was attenuated.CONCLUSIONS: Ambient NO2 and PM2.5 air pollution exposure increased the risk of asthma admissions in this urban setting. Improvements in air quality during COVID-19 lockdown periods may have contributed to a substantially reduced acute asthma disease burden. Large-scale measures to improve air quality have potential to protect vulnerable people living with chronic asthma in urban areas.</p