AORN journal
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Pulmonary artery thromboendarterectomy (PTE) is a surgical procedure that offers the only cure for chronic thromboembolic pulmonary hypertension (TPH), a progressive form of secondary pulmonary hypertension. Current estimates indicate that 1% to 5% of patients who survive a pulmonary embolus will develop chronic TPH with progressively worsening pulmonary hypertension and right-sided heart failure. This bilateral procedure is performed through a sternotomy incision using cardiopulmonary bypass, profound hypothermia, and intermittent circulatory arrest with antegrade cerebral perfusion. As an alternative to lung transplantation, PTE offers patients with chronic TPH an improved quality of life.
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THE PRIMARY TREATMENT for obstructive sleep apnea (OSA) has been continuous positive airway pressure (CPAP) therapy, but the minimum acceptable number of hours of nightly CPAP use remains unclear. INTEGRATED SOFT TISSUE and bone surgery may be a viable alternative for patients who have rejected CPAP as a treatment option. ⋯ REPEAT SLEEP TESTING conducted several years after patients have undergone combined soft tissue and bone surgery has demonstrated consistent and reliable surgical results. Patients with OSA should be offered surgery as an alternative to life-long CPAP treatment or as an option when CPAP therapy has not been successful.
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Many health care organizations are adopting crew resource management (CRM) training from the aviation industry as a patient safety practice. Although CRM has high face validity, its effects have not been thoroughly evaluated in aviation or health care. Its potential to improve team communication, coordination, and patient safety, however, makes efforts to study CRM necessary and worthwhile. This article evaluates clinicians' attitudes about and reactions to CRM after they participated in an eight-hour, commercially developed training program.
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Knee block anesthesia frequently is used for arthroscopic knee procedures by orthopedic surgeons and anesthesia care providers at Bronson Methodist Hospital, Kalamazoo, Mich. This type of regional anesthesia using local anesthetic medications provides excellent surgical conditions and prolonged postoperative analgesia. Use of this anesthetic technique avoids many of the side effects of general, spinal, and epidural anesthesia and saves time and money for patients and facilities.