Cardiomyoplasty: treatment of the failing heart using the skeletal muscle wrap.

Surgical methods of augmenting cardiac function are gaining credibility among researchers as animal and human clinical trials continue around the world. The procedures themselves may vary slightly depending upon protocol and surgeon preference, but generally involve the use of skeletal muscle such as the latissimus dorsi. The muscle may be wrapped around the heart or the aorta, or fashioned into a separate pumping chamber. The muscle is then stimulated with specialized burst pacing, the resultant contractions providing circulatory support. This article describes preoperative, intraoperative, postoperative, and follow-up patient and family care for those undergoing skeletal muscle wrap procedures. If trials continue to produce positive results, these interventions may become an important bridge to transplant. Moreover, with the scarcity of donor hearts, the implications for skeletal muscle wrapping as a long-term alternative to transplant are promising.

Re-evaluation of the tympanic thermometer in the emergency department.

STUDY OBJECTIVE: A study was undertaken to re-evaluate tympanic temperatures using a commonly used portable infrared tympanic thermometer. DESIGN: Temperatures were recorded sequentially at two body sites using an electronic digital thermometer and an infrared tympanic thermometer. The tympanic thermometer was set to the core equivalency setting. SETTING: The emergency department of a Level 2 trauma center. TYPE OF PARTICIPANTS: Seventy-nine pediatric patients presenting to the ED. MEASUREMENTS AND MAIN RESULTS: Mean temperatures in the tympanic and rectal temperature groups were 38.5 +/- 1.08 C and 38.8 +/- 1.02 C, respectively (P greater than .05). The overall correlation of rectal and tympanic temperatures was 0.93 (P much less than .001). Stratifying the data by age resulted in a weakened correlation for patients 3 months of age and younger. For all strata, the sensitivity, specificity, positive predictive value, and negative predictive value of the tympanic thermometer for predicting fever were 96.6%, 100%, 100%, and 90.1%, respectively; for patients more than 3 months of age, the values were 100% in all categories. CONCLUSION: Our findings indicate that the First Temp infrared tympanic thermometer accurately detected fever in a pediatric population more than 3 months old. Results were inconclusive in patients less than 3 months old.

Permanent pacemakers: the nurse's role in patient education and follow-up care.

Educating cardiac patients in how to lead an active life after a permanent pacemaker implant presents many challenges for nurses involved in their care. Suitable educational material delivered during both the inpatient and the outpatient phases of care can foster a positive attitude and independence in these patients. Nurses are becoming increasingly independent in their management of the follow-up care of these patients. Guidelines for the assessment of pacemaker function, detection of malfunction, and reprogramming techniques are provided.