Letter: Prostaglandins and pre-eclampsia.
Explore the source record for details and available documents.
Apgar Score↗
Biomedical subjects
B Sheppard
Publications and source records attributed to B Sheppard.
Simultaneous antegrade and retrograde reperfusion after cardioplegic arrest for coronary artery bypass.
Retrograde coronary sinus reperfusion with warm blood during proximal anastomoses permits completion of myocardial revascularization under a single cross-clamp application. Reperfusion with both antegrade (via arterial and vein grafts) and retrograde (via coronary sinus catheter) warm blood has raised concerns about maldistribution of perfusate or overpressurization of capillary beds. This prospective, randomized design compares postcardioplegic myocardial recovery among patients receiving retrograde reperfusion only and patients receiving simultaneous antegrade/retrograde reperfusion. Twenty-four patients were selected among all presenting as outpatients for elective coronary artery bypass (CAB). Each patient underwent CAB with cardioplegic arrest and single cross-clamp technique. During proximal anastomoses the heart was reperfused with warm blood from the cardiopulmonary bypass (CPB) circuit. Twelve received retrograde reperfusion only, and 12 received simultaneous antegrade/retrograde reperfusion via an internal mammary artery (IMA) graft, all vein grafts, and the coronary sinus catheter. Vein graft perfusion was interrupted in each vein as the proximal anastomosis was performed. Myocardial recovery time (interval from initiating reperfusion until electrical and mechanical activity), cardioversion incidence, requirement for inotropic support, and Swan-Ganz hemodynamic parameters measured immediately 6 and 24 hours postoperatively were compared between groups. There were no differences between groups in age, ventricular function, number of grafts, or CPB time. Also, there were no differences in cardioversion, inotropic need, or postoperative hemodynamic performance. Myocardial recovery time was reduced in patients receiving simultaneous antegrade/retrograde reperfusion (13.9+/-7.0 vs 2.6+/-2.1 minutes). Simultaneous reperfusion of warm blood antegrade and retrograde is not deleterious to the myocardium. More rapid recovery of myocardial function may represent a shorter period of warm ischemia but does not appear to translate to improved postoperative myocardial performance.
Aged↗
Raising the profile of nursing: how to organise a study day.
This article provides practical advice of organising a study day. It is based on the authors' experience of organising a successful event in their own hospital.
Education, Nursing, Continuing↗
Patients' views of rehabilitation.
Patients and nurses may not appreciate the differences between acute care settings and rehabilitation units. The relative informality and 'hands-off' approach of nurses in the latter can lead to confusion and misunderstanding for people whose exclusive experience of nursing is in the acute sector. At the behest of concerned nurses on a rehabilitation unit, the author conducted interviews with discharged patients to try to establish what their perceptions of the unit were, and how these influenced their progress. The results suggested that the patients' misconceptions may have been hindering their rehabilitation potential. The nurses subsequently devised an action plan to improve understanding of the unit's aims and practices. Follow-up interviews after the plan's implementation showed that it had been successful in improving patients' understanding and engagement with the rehabilitation process.
Attitude to Health↗