Congenital heart disease
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Congenital heart disease · May 2015
Perceptions of 24/7 In-house Attending Coverage on Fellow Education and Autonomy in a Pediatric Cardiothoracic Intensive Care Unit.
The 24/7 in-house attending coverage is emerging as the standard of care in intensive care units. Implementation costs, workforce feasibility, and patient outcomes resulting from changes in physician staffing are widely debated topics. Understanding the impact of staffing models on the learning environment for medical trainees and faculty is equally warranted, particularly with respect to trainee education and autonomy. ⋯ Our prospective study, showing initial concerns about limiting the learning environment in transitioning to 24/7 in-house attending coverage did not result in diminished perceptions of the educational experience for our fellows but revealed an expected decrease in fellow autonomy. The study indirectly facilitated open discussions about methods to preserve fellow education and warranted autonomy in our PCTU; however, continued efforts are needed to achieve the optimal balance between supervised training and the transition to autonomous practice.
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Congenital heart disease · Mar 2015
Pulse fluoroscopy radiation reduction in a pediatric cardiac catheterization laboratory.
To determine if lower starting pulse fluoroscopy rates lead to lower overall radiation exposure without increasing complication rates or perceived procedure length or difficulty. ⋯ For pediatric cardiac catheterizations, a starting pulse fluoroscopy rate of 7.5 frames per second exposes physicians and their patients to significantly less radiation with no impact on procedural difficulty or outcomes. This quality improvement study has resulted in a significant practice change in our pediatric cardiac catheterization laboratory, and 7.5 frames per second is now the default fluoroscopy rate.
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Congenital heart disease · Mar 2015
Multicenter StudyIdentifying predictors of hospital readmission following congenital heart surgery through analysis of a multiinstitutional administrative Database.
Despite resource burdens associated with hospital readmission, there remains little multiinstitutional data available to identify children at risk for readmission following congenital heart surgery. ⋯ Readmissions following congenital heart surgery are common and associated with significant resource consumption. While we describe independent predictors that may identify patients at risk for readmission prior to hospital discharge, there likely remains other unreported factors that may contribute to readmission following congenital heart surgery.
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Congenital heart disease · Mar 2015
Risk factors for major adverse events late after Fontan palliation.
Risk factors for major adverse events late after Fontan palliation are unknown. Prior studies have suggested ventricular function and morphology as important risk factors. The aim of this study is to (1) characterize the late major adverse event profile in adult Fontan patients and (2) identify additional risk factors that may contribute to adverse outcomes. ⋯ In adult Fontan patients surviving >15 years post-Fontan, portal hypertension, oxygen desaturation, and need for pacemaker were predictive of adverse events. Traditional measures may not predict late-term outcomes in adult survivors; further study of the liver's role in late outcomes is warranted.
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Congenital heart disease · Jan 2015
Vancomycin-associated acute kidney injury in pediatric cardiac intensive care patients.
Acute kidney injury (AKI) is a significant source of morbidity among critically ill pediatric patients, including those that have undergone cardiac surgery. Vancomycin may contribute to AKI in pediatric patients admitted to a cardiac intensive care unit. ⋯ Vancomycin-associated AKI occurs infrequently in the pediatric cardiac intensive care population and is strongly associated with patient critical illness.