Perioperative Prophylaxis for Total Artificial Heart Transplantation.

BACKGROUND: Practice variation regarding perioperative antimicrobial prophylaxis in total artificial heart transplantations (TAH-t) across institutions is unknown. The aim of our survey was to assess the current practices for prevention of infection in TAH-t recipients among different programs. METHODS: An electronic survey was sent to programs that implant Syncardia TAH (Syncardia Systems, Tuscon, Ariz, USA). Proportions were analyzed for categorical variables; means and SDs were analyzed for continuous variables. RESULTS: The majority of centers (80.8%) had a formal surgical infection prophylaxis protocol. For non-penicillin-allergic patients, five (20.1%) institutions reported using a 4-drug regimen, seven (29.2%) used a 3-drug regimen, five (20.1%) used a 2-drug regimen, and seven (29.2%) used a cephalosporin alone. Similar data was seen in the penicillin-allergic patients. Infections were reported to occur postoperatively in 52.2% centers. During the first month after TAH-t, bacteremia represented 27.3%, driveline infections 27.2%, pulmonary infections 9%, and mediastinal infections 18.2%. The most common organisms seen within the first month were Candida spp., Escherichia coli, and Pseudomonas aeruginosa (21.4%). In 65% of centers, the mean rate of death post-TAH-t due to infection was 14.5% (SD, 22.3%). The mean rate of patients surviving until orthotopic heart transplantation was 58.6% (SD, 27.7%). CONCLUSIONS: Preventing infections post-TAH-t is key to decreasing morbidity and mortality. All institutions administered perioperative prophylaxis for TAH-t with significant variation among the centers. The majority of the centers have a formal perioperative prophylactic protocol.

The natural evolution of postpartum fatigue among a group of primiparous women.

A prospective, longitudinal study was conducted to examine the natural evolution of levels of fatigue, as measured by the Visual Analogue Scale-F, among a group of 36 primiparous women during the first 6 weeks postpartum. The results revealed that this group of women experienced higher levels of morning fatigue across the 6 weeks than had previously been reported. Their morning fatigue peaked at 4 weeks and then slowly decreased. At the 6th week, the group mean for morning fatigue was 1.42 points (on a 100-point scale) lower than at the 1st week postpartum, suggesting women do not completely recover from the effects of pregnancy, childbirth, and transition to parenthood by 6 weeks postpartum. Maternal age and length of labor were found to be significantly related to the levels of fatigue and energy at various times during the 6 week postpartum period.

Competency-based orientation in pediatric critical care.

Having recognized the need to update and modify their orientation program, a PICU nursing management team decided to develop a competency-based program. The goal was to facilitate transition of an orientee into a competent entry-level practitioner. This article outlines the procedure used to develop the initial phases: lists of competencies, competency evaluation worksheet and performance checklists. Later, various learning options and additional evaluation methods will be explored.

The impact of the first child on marital happiness.

The effects of the first child on parent's marital happiness were studied using a sample of 185 subjects. Marital happiness scores were found to be lower in the subjects who were pregnant, those with 5-month-old children, and those with 24-month old children than the childless couples. This study suggests trends indicating that first children may influence marital happiness in a negative manner. These findings will assist nurses in the preparation of families for childbearing and the potential changes that may result.

Parental grieving and perceptions regarding health care professionals' interventions.

The death of a neonate, infant, or child is a tragedy that greatly impacts on many individuals' lives. Nurses and other health-care professionals provide care for not only the dying child but also the grieving parents and families. It is imperative that health care professionals are cognizant of the components and intensity of parental grieving and the critical role that they must assume in supporting bereaved parents prior to, at the time of, and after the child's death. The purpose of this study was to measure the intensity of parental grieving and collect information from bereaved parents regarding their perception of health care professionals' interventions. The results indicated that bereaved parents' intensity of grieving scores were generally higher than those reported on the TRIG norms. In response to The Bereavement Questionnaire, they were able to identify what health care professionals did or said that was helpful or unhelpful before, during, and after their child's death.