ABSTRACT
The addition of advanced practice providers (APPs; nurse practitioners and physician assistants) to a pediatric cardiac intensive care unit (PCICU) team is a health care innovation that addresses medical provider shortages while allowing PCICUs to deliver high-quality, cost-effective patient care. APPs, through their consistent clinical presence, effective communication, and facilitation of interdisciplinary collaboration, provide a sustainable solution for the highly specialized needs of PCICU patients. In addition, APPs provide leadership, patient and staff education, facilitate implementation of evidence-based practice and quality improvement initiatives, and the performance of clinical research in the PCICU. This article reviews mechanisms for developing, implementing, and sustaining advance practice services in PCICUs.
Subject(s)
Coronary Care Units/organization & administration , Critical Care/methods , Health Personnel/organization & administration , Intensive Care Units, Pediatric/organization & administration , Child , HumansABSTRACT
Atrial septal defects (ASDs) have traditionally been repaired by surgical closure. Recently, transcatheter device closure has increasingly been used with excellent results. Comparative research evaluating long-term outcomes of transcatheter technique data reveal significantly fewer complications and shorter hospital stays than those reported for surgical repairs. This article reviews relevant literature comparing safety and efficacy, costs, and complications of transcatheter device procedures with surgical closure of ASDs.
Subject(s)
Cardiac Catheterization/instrumentation , Heart Septal Defects, Atrial/surgery , Cardiac Catheterization/economics , Cardiac Catheterization/methods , Child , Child, Preschool , Costs and Cost Analysis/economics , Female , Heart Defects, Congenital/surgery , Humans , Male , Safety/economics , Treatment Outcome , United States , Vascular Surgical Procedures/economics , Vascular Surgical Procedures/instrumentationABSTRACT
Atrial septal defects have traditionally been repaired by surgical closure. Recently, transcatheter device closure has increasingly been used with excellent results. Although there is limited comparative research evaluating long-term outcomes of the transcatheter technique, preliminary data reveal significantly fewer complications and shorter hospital stays than those reported for surgical repair. This article reviews relevant literature comparing efficacy, cost, and complications of the transcatheter device procedures with the surgical closure of ASDs.
Subject(s)
Cardiac Catheterization/methods , Catheter Ablation/methods , Heart Septal Defects, Atrial/therapy , Animals , Cardiac Catheterization/adverse effects , Cardiac Catheterization/economics , Cardiac Catheterization/instrumentation , Catheter Ablation/adverse effects , Catheter Ablation/economics , Catheter Ablation/instrumentation , Cost Savings , Cost-Benefit Analysis , Disease Models, Animal , Dogs , Echocardiography, Transesophageal , Equipment Design , Heart Septal Defects, Atrial/diagnosis , Heart Septal Defects, Atrial/epidemiology , Humans , Length of Stay/statistics & numerical data , Patient Selection , Treatment OutcomeABSTRACT
BACKGROUND: Anatomic type and angiographic measurements of patent ductus arteriosus (PDA) are used to determine the suitability of transcatheter closure (TCC). The purpose of this study is to evaluate whether these PDA features can be obtained by 2-dimensional echocardiography (2DE). METHODS: We retrospectively compared PDA measurements and type from 36 patients submitted to TCC between November 1995 and October 2000. RESULTS: The patient age ranged between 2 months to 10.5 years (median = 1.2 years). A significant correlation was found between measurements of PDA minimal diameter (R(2) = 0.88) and diameter at aortic ostium (R(2) = 0.72); whereas a poor correlation existed between measurements of the ampulla length. The 2DE and angiographic PDA classification were concordant in 31 of 36 (86%) patients. CONCLUSION: Our data support the use of 2DE measurements of PDA minimal diameter and PDA diameter at the aortic end to assess suitability for TCC. In the majority of cases, PDA type can be diagnosed by 2DE.
