Results of the minimally invasive coronary artery bypass grafting angiographic patency study

ObjectiveMinimally invasive coronary artery bypass grafting is safe and widely applicable, and may be associated with fewer transfusions and infections, and better recovery than standard coronary artery bypass grafting. However, graft patency rates remain unknown. The Minimally Invasive Coronary Artery Bypass Grafting Patency Study prospectively evaluated angiographic graft patency 6 months after minimally invasive coronary artery bypass grafting.MethodsIn this dual-center study, 91 patients were prospectively enrolled to undergo minimally invasive coronary artery bypass grafting via a 4- to 7-cm left thoracotomy approach. The left internal thoracic artery, the ascending aorta for proximal anastomoses, and all coronary targets were directly accessed without endoscopic or robotic assistance. The study primary outcome was graft patency at 6 months, using 64-slice computed tomography angiography. Secondary outcomes included conversions to sternotomy and major adverse cardiovascular events (Clinical Trial Registration Unique identifier: NCT01334866).ResultsThe mean age of patients was 64 ± 8 years, the mean ejection fraction was 51% ± 11%, and there were 10 female patients (11%) in the study. Surgeries were performed entirely off-pump in 68 patients (76%). Complete revascularization was achieved in all patients, and the median number of grafts was 3. There was no perioperative mortality, no conversion to sternotomy, and 2 reopenings for bleeding. Transfusion occurred in 24 patients (26%). The median length of hospital stay was 4 days, and all patients were followed to 6 months, with no mortality or major adverse cardiovascular events. Six-month computed tomography angiographic graft patency was 92% for all grafts and 100% for left internal thoracic artery grafts.ConclusionsMinimally invasive coronary artery bypass grafting is safe, feasible, and associated with excellent outcomes and graft patency at 6 months post-surgery

Long-term trends of black carbon and particle number concentration in the lower free troposphere in Central Europe

Background: The implementation of emission mitigation policies in Europe over the last two decades has generally improved the air quality, which resulted in lower aerosol particle mass, particle number, and black carbon mass concentration. However, little is known whether the decreasing particle concentrations at a lower-altitude level can be observed in the free troposphere (FT), an important layer of the atmosphere, where aerosol particles have a longer lifetime and may affect climate dynamics. In this study, we used data from two high-Alpine observatories, Zugspitze-Schneefernerhaus (ZSF) and Jungfraujoch (JFJ), to assess the long-term trends on size-resolved particle number concentrations (PNCs) and equivalent black carbon (eBC) mass concentration separated for undisturbed lower FT conditions and under the influence of air from the planetary boundary layer (PBL) from 2009 to 2018. Results: The FT and PBL-influenced conditions were segregated for both sites. We found that the FT conditions in cold months were more prevalent than in warm months, while the measured aerosol parameters showed different seasonal patterns for the FT and PBL-influenced conditions. The pollutants in the PBL-influenced condition have a higher chance to be transported to high-altitudes due to the mountainous topography, leading to a higher concentration and more distinct seasonal variation, and vice versa. The long-term trends of the measured aerosol parameters were evaluated and the decreased aerosol concentrations were observed for both FT and PBL-influenced conditions. The observed decreasing trends in eBC concentration in the PBL-influenced condition are well consistent with the reported trends in total BC emission in Germany and Switzerland. The decreased concentrations in the FT condition suggest that the background aerosol concentration in the lower FT over Central Europe has correspondingly decreased. The change of back trajectories in the FT condition at ZSF and JFJ was further evaluated to investigate the other possible drivers for the decreasing trends. Conclusions: The background aerosol concentration in the lower FT over Central Europe has significantly decreased during 2009–2018. The implementation of emission mitigation policies is the most decisive factor and the decrease of the regional airmass occurrence over Central Europe also has contributed to the decreasing trends. © 2021, The Author(s)

Seasonality of the particle number concentration and size distribution : a global analysis retrieved from the network of Global Atmosphere Watch (GAW) near-surface observatories

Aerosol particles are a complex component of the atmospheric system which influence climate directly by interacting with solar radiation, and indirectly by contributing to cloud formation. The variety of their sources, as well as the multiple transformations they may undergo during their transport (including wet and dry deposition), result in significant spatial and temporal variability of their properties. Documenting this variability is essential to provide a proper representation of aerosols and cloud condensation nuclei (CCN) in climate models. Using measurements conducted in 2016 or 2017 at 62 ground-based stations around the world, this study provides the most up-to-date picture of the spatial distribution of particle number concentration (N-tot) and number size distribution (PNSD, from 39 sites). A sensitivity study was first performed to assess the impact of data availability on N-tot's annual and seasonal statistics, as well as on the analysis of its diel cycle. Thresholds of 50% and 60% were set at the seasonal and annual scale, respectively, for the study of the corresponding statistics, and a slightly higher coverage (75 %) was required to document the diel cycle. Although some observations are common to a majority of sites, the variety of environments characterizing these stations made it possible to highlight contrasting findings, which, among other factors, seem to be significantly related to the level of anthropogenic influence. The concentrations measured at polar sites are the lowest (similar to 10(2) cm(-3)) and show a clear seasonality, which is also visible in the shape of the PNSD, while diel cycles are in general less evident, due notably to the absence of a regular day-night cycle in some seasons. In contrast, the concentrations characteristic of urban environments are the highest (similar to 10(3)-10(4) cm(-3)) and do not show pronounced seasonal variations, whereas diel cycles tend to be very regular over the year at these stations. The remaining sites, including mountain and non-urban continental and coastal stations, do not exhibit as obvious common behaviour as polar and urban sites and display, on average, intermediate N-tot (similar to 10(2)-10(3) cm(-3)). Particle concentrations measured at mountain sites, however, are generally lower compared to nearby lowland sites, and tend to exhibit somewhat more pronounced seasonal variations as a likely result of the strong impact of the atmospheric boundary layer (ABL) influence in connection with the topography of the sites. ABL dynamics also likely contribute to the diel cycle of N-tot observed at these stations. Based on available PNSD measurements, CCN-sized particles (considered here as either >50 nm or >100 nm) can represent from a few percent to almost all of N-tot, corresponding to seasonal medians on the order of similar to 10 to 1000 cm(-3), with seasonal patterns and a hierarchy of the site types broadly similar to those observed for N-tot. Overall, this work illustrates the importance of in situ measurements, in particular for the study of aerosol physical properties, and thus strongly supports the development of a broad global network of near surface observatories to increase and homogenize the spatial coverage of the measurements, and guarantee as well data availability and quality. The results of this study also provide a valuable, freely available and easy to use support for model comparison and validation, with the ultimate goal of contributing to improvement of the representation of aerosol-cloud interactions in models, and, therefore, of the evaluation of the impact of aerosol particles on climate.Peer reviewe

EMLA Cream is an Effective Topical Anesthetic for Bronchoscopy

BACKGROUND: EMLA cream (AstraZeneca Inc, Canada) (1:1 eutectic mixture of lidocaine 2.5% and prilocaine 2.5%) has traditionally been used for topical anesthesia of the skin. Recent reports of EMLA's use for anesthesia of the oral mucosa suggest an application in topical anesthesia for bronchoscopy

Book Reviews

Book Reviews: La 'au Hawai'i: Traditional Hawaiian Use Of Plants by Isabella Aiona Abbott; Advance Force Pearl Harbor: The Imperial Navys Underwater Assault On America by Burl Burlingame; A Century Of Philanthropy: A History Of The Samuel N. And Mary Castle Foundation by Alfred L. Castle; Mr Bligh 's Bad Language: Passion, Power And Theatre On The Bounty by Greg Dening; Treasures Of Hawaiian History: From The Collection Of The Hawaiian Historical Society by David Forbes; The Architecture Of Charles W. Dickey: Hawaii And California by Robert Jay; Native Land And Foreign Desire - Pehea La E Pono Ai? by Lilikala Kame' Eleihiwa; Anahulu: The Anthropology Of History In The Kingdom Of Hawaii by Patrick V. Kirch And Marshall Sahlins; Called From Within: Early Women Lawyers Ofhawai Ei by Mari J. Matsuda; The Apotheosis Of Captain Cook: European Mythmaking In The Pacific by Gananath Obeyesekere; Heiau Of The Island Of Hawaii by John F. G. Stokes; Polynesian Herbal Medicine by W. Arthur Whistler; Hawai'i Volcano Watch: A Pictorial History 1779-1991 by Thomas L. Wright, Taeko Jane Takahashi, And J. D. Griggs; Tide And Current: Fishponds Of Hawai'i by Carol Araki Wyba

Team communication patterns in emergency resuscitation: a mixed methods qualitative analysis

Abstract Background In order to enhance patient safety during resuscitation of critically ill patients, we need to optimize team communication and enhance team situational awareness but little is known about resuscitation team communication patterns. The objective of this study is to understand how teams communicate during resuscitation; specifically to assess for a shared mental model (organized understanding of a team’s relationships) and information needs. Methods We triangulated 3 methods to evaluate resuscitation team communication at a tertiary care academic trauma center: (1) interviews; (2) simulated resuscitation observations; (3) live resuscitation observations. We interviewed 18 resuscitation team members about shared mental models, roles and goals of team members and procedural expectations. We observed 30 simulated resuscitation video recordings and documented the timing, source and destination of communication and the information category. We observed 12 live resuscitations in the emergency department and recorded baseline characteristics of the type of resuscitations, nature of teams present and type and content of information exchanges. The data were analyzed using a qualitative communication analysis method. Results We found that resuscitation team members described a shared mental model. Respondents understood the roles and goals of each team member in order to provide rapid, efficient and life-saving care with an overall need for situational awareness. The information flow described in the interviews was reflected during the simulated and live resuscitations with the most responsible physician and charting nurse being central to team communication. We consolidated communicated information into six categories: (1) time; (2) patient status; (3) patient history; (4) interventions; (5) assistance and consultations; 6) team members present. Conclusions Resuscitation team members expressed a shared mental model and prioritized situational awareness. Our findings support a need for cognitive aids to enhance team communication during resuscitations

Is Aortic Valve Repair Reproducible? Analysis of the Learning Curve for Aortic Valve Repair

BACKGROUND: Aortic valve (AV) preservation and repair, although effective, is performed in a limited number of centres. Lack of wider application might be due to challenges in dissemination of tacit surgical knowledge. We examined the learning curve in 2 centres that initiated dedicated programs in AV repair. METHODS: Prospectively collected data on the first 100 (cohort A) and 150 consecutive patients (cohort B) who underwent AV repair surgery were analyzed. Safety end points included mortality, myocardial infarction or stroke, early AV repeat surgery, re-exploration for bleeding, or pacemaker implantation. Efficiency was assessed according to aortic crossclamp and cardiopulmonary bypass times. Efficacy parameters included residual aortic insufficiency or stenosis. Indices of case complexity included presence of severe aortic insufficiency, nontrileaflet AV, and associated cardiac procedures. Each cohort was divided into 3 equal tertiles (T1, T2, and T3). RESULTS: Early mortality was ≤ 1% in both cohorts. In cohort A, a total of 12 safety events occurred with a significant reduction in incidence over the tertiles (18%, 15%, and 3%, in T1, T2, and T3, respectively; P = 0.05). In cohort B, 20 safety events occurred in 18 patients with a trend toward reduction of incidence over tertiles (20%, 12%, and 8%, in T1, T2, and T3, respectively; P = 0.14). aortic crossclamp and cardiopulmonary bypass times decreased significantly after T2 in cohort A and T1 in cohort B (P < 0.01). Intraoperative procedural efficacy was similar across tertiles in both cohorts. CONCLUSIONS: Procedural safety and efficiency improves with experience whereas efficacy is consistent over time. AV repair is reproducible and appears to have a learning curve of approximately 40-60 cases.Introduction : La préservation et la réparation de la valve aortique (VA), bien qu'efficace, est réalisée dans un nombre limité de centres. Le manque d'application plus large pourrait être dû à des défis en matière de diffusion des connaissances tacites en chirurgie. Nous avons examiné la courbe d'apprentissage dans les deux centres qui ont initié des programmes dédiés à la réparation de la VA. Méthodes : Les données recueillies de façon prospective sur les 100 premiers patients qui ont subi une chirurgie de réparation de VA (cohorte A) et les 150 suivants (cohorte B) ont été analysées. Les points limites de sécurité incluent la mortalité, l’infarctus du myocarde ou l’accident vasculaire cérébral, la reprise précoce d’une chirurgie de la VA, le ré-examen pour saignement, ou l’implantation d'un stimulateur cardiaque. L'efficience a été évaluée en fonction du temps de clampage de l’aorte et la durée du pontage cardiopulmonaire. Les paramètres d’efficacité inclurent une insuffisance aortique résiduelle ou une sténose. Les indices de complexité des cas inclurent l’existence d'une insuffisance aortique sévère, d’une VA non trifoliée, et des procédures cardiaques associées. Chaque cohorte a été divisée en trois terciles égaux (T1, T2 et T3). Résultats : La mortalité précoce était ≤ 1 % dans les deux cohortes. Dans la cohorte A, un total de 12 événements touchant la sûreté ont eu lieu avec une réduction significative de l'incidence sur les terciles (18 %, 15 % et 3 %, pour T1, T2, et T3, respectivement, P = 0,05). Dans la cohorte B, 20 événements liés à la sûreté sont survenus chez 18 patients avec une tendance à la réduction de l'incidence à travers les terciles (20 %, 12 % et 8 %, en T1, T2 et T3, respectivement; P = 0,14). La durée du clampage aortique et le temps de circulation extracorporelle ont diminué de façon significative après le T2 pour la cohorte A et le T1 pour la cohorte B (P < 0,01). L’efficacité de la procédure per-opératoire était similaire entre les terciles pour les deux cohortes. Conclusions : La sécurité et l'efficience des procédures s’améliorent avec l'expérience alors que l'efficacité est constante dans le temps. La restauration de la VA est reproductible et semble correspondre à une courbe d'apprentissage d'environ 40-60 cas

Communication and team situation awareness in the OR: Implications for augmentative information display

Team Situation Awareness (TSA) is one of the critical factors in effective Operating Room (OR) teamwork and can impact patient safety and quality of care. While previous research showed a relationship between situation awareness, as measured by communication events, and team performance, the implications for developing technology to augment and facilitate TSA were not examined. This research aims to further study situation-related communications in the cardiac OR in order to uncover potential degradation in TSA which may lead to adverse events. The communication loop construct-the full cycle of information flow between the participants in the sequence-was used to assess susceptibility to breakdown. Previous research and the findings here suggest that communication loops that are open, non-directed, or with delayed closure, can be susceptible to information loss. These were quantit

Additional file 1: of Team communication patterns in emergency resuscitation: a mixed methods qualitative analysis

Appendix A. Questionnaire for stakeholder interviews. Appendix B. Communication categories observed during live resuscitation observations. Appendix C. Types of information exchanges observed during live resuscitations. Appendix D. Examples of team communication in live resuscitation observations. (DOC 160 kb