Revisiting the Effect of Udenafil on Exercise Performance in Patients With Fontan Circulation: Results of a Post Hoc Analysis of the FUEL Trial.

Background: In the FUEL (Fontan Udenafil Exercise Longitudinal) trial, a positive treatment effect was identified for outcomes at the ventilatory anaerobic threshold but not for the primary outcome, oxygen consumption (Vo) at peak exercise. This disparate response may be explained by the physiologic challenge of improving peak Vo in participants with near-normal baseline exercise performance.

Methods: Participants were divided into subgroups by baseline predicted peak Vo (<80% versus ≥80%).

Methylprednisolone for Infant Heart Surgery: Subpopulation Analyses of a Randomized Controlled Trial.

Objectives: Evaluate benefits and harms of prophylactic intraoperative methylprednisolone in subpopulations undergoing infant heart surgery.

Design: Subpopulation analyses of The Steroids to Reduce Systemic Inflammation after Infant Heart Surgery (STRESS) trial, a double-blind randomized placebo-controlled trial.

Setting: Twenty-four congenital heart centers.

Reexploring the STRESS Trial: Subgroup Postoperative Outcomes Following Methylprednisolone for Infant Heart Surgery.

Unlabelled: Objective Assess the association between intraoperative methylprednisolone and specific postoperative outcomes among subgroups undergoing infant heart surgery.

Design: Subpopulation analyses of The Steroids to Reduce Systemic Inflammation after Infant Heart Surgery trial, a double-blind randomized placebo-controlled trial.

Setting: 24 congenital heart centers.

Association of cannabis use with major cardiovascular and cerebrovascular events after surgery or interventional procedures.

Background And Objectives: Previous studies reported a predisposition to major adverse cardiovascular or cerebrovascular events (MACCE) in patients consuming cannabis, which might be exacerbated by interventional or surgical procedures. This study investigated the association of nonmedical cannabis use with MACCE after interventional procedures or surgery.

Methods: 288,923 adult patients undergoing noncardiac surgery between 2008 and 2020 at a tertiary academic hospital in Massachusetts, United States, were included.

Cannabis or Cannabinoids for the Management of Chronic Noncancer Pain: Best Practice Advice From the American College of Physicians.

Description: The American College of Physicians' Population Health and Medical Science Committee (PHMSC) developed this best practice advice to inform clinicians about what is currently known about the benefits and harms of cannabis or cannabinoids in the management of chronic noncancer pain and to provide advice for clinicians counseling patients seeking this therapy.

Methods: The PHMSC considers areas where evidence is uncertain or emerging or practice does not follow the evidence to provide clinical advice based on a review and assessment of scientific work, including systematic reviews and individual studies. Sources of evidence included a living systematic review on cannabis and cannabinoid treatments for chronic noncancer pain and a series of living systematic reviews and primary studies.

Methylated Arginine Metabolites as Biomarkers for Clinical Status and Response to Type 5 Phosphodiesterase Inhibition in Patients With Fontan Circulation.

Background: There is significant interest in NO pathway modulators, specifically type 5 phosphodiesterase inhibitors (PDE5is), to treat patients with a Fontan circulation. Trials, however, have had mixed results. The relationship between the NO pathway and clinical status in patients with Fontan circulation is a significant knowledge gap.

A Bayesian Re-analysis of the Steroids to Reduce Systemic Inflammation after Infant Heart Surgery (STRESS) Trial.

Background: Prophylactic steroids are often used to reduce the systemic inflammatory response to cardiopulmonary bypass in infants undergoing heart surgery. The STRESS trial found that the likelihood of a worse outcome did not differ between infants randomized to methylprednisolone (n=599) versus placebo (n=601) in a risk-adjusted primary analysis (adjusted odds ratio [OR], 0.86; 95% CI, 0.

National practice patterns for the use of regional anesthesia for pediatric cardiac surgery: An analysis of the Society of Thoracic Surgeons congenital heart surgery database.

Background: Complications associated with suboptimal pain management after pediatric cardiac surgery have increased interest in regional anesthesia (RA). We sought to evaluate national trends and explore the association of RA with postoperative outcomes following pediatric cardiac surgery.

Methods: Patients <18 years in the Society of Thoracic Surgeons Congenital Cardiac Anesthesia Society Database from 01/2016-05/2023 were analyzed.

Urine biomarkers, acute kidney injury, and fluid overload in neonatal cardiac surgery.

Background: Cardiac surgery-associated acute kidney injury (CS-AKI) and fluid overload (FO) are common among neonates who undergo cardiopulmonary bypass, and increase mortality risk. Current diagnostic criteria may delay diagnosis. Thus, there is a need to identify urine biomarkers that permit earlier and more accurate diagnosis.

" " Exploring the Experiences of Black and Hispanic Parents following a Congenital Heart Disease Diagnosis.

 Congenital heart disease (CHD) is an important contributor to pediatric morbidity and mortality. Unfortunately, disparities in the diagnosis and treatment of CHD exist across racial and ethnic groups. The objective of this study was to share the experiences of Hispanic and Black families with CHD to better understand their needs.

Considerations for Anesthesia in Older Adults with Cannabis Use.

Over the past decade, legislative changes occurred in the USA and the western world that were followed by a substantial increase in reported use of cannabis among the general population. Among patients undergoing anesthesia for surgery or interventional procedures, older patients-often defined as adults over 65 years-are one of the fastest-growing populations. Within this group, the prevalence of cannabis use almost tripled over the past decade.

Enhancing Inpatient Sleep Environments: A Design Thinking Case Study.

Research shows how vital sleep is to total health, with poor sleep having a strong correlation with morbidity and mortality, yet fewer than half of top hospitals have sleep-friendly practices. This article describes a project motivated by the lived experiences of a nurse manager and a hospitalist who partnered to improve the sleep environments on two inpatient units. They used design thinking, empathizing with the patients' experiences with the sleep environment, to design interventions to promote quality sleep.

Pain Medication Data from the 2021 and 2022 National Football League Prescription Drug Monitoring Program.

We report 2021 and 2022 prescription drug monitoring program data that include pain medication prescriptions, including over-the-counter medications, issued to NFL players by either club physicians or external medical providers and entered in the NFL electronic medical record. Of 3142 players who signed a contract with at least one NFL Club during the 2021 season, there were 14,903 prescriptions for pain medications issued to 2207 players. During the 2022 season, there were 14,880 prescription pain medications issued to 2189 players (out of a population of 3152).

Improving Patient Experience and Team Engagement with Environmental Services: Application of Watson's Theory of Human Caring.

Patient experience and team engagement are key performance indicators in organizational strategic planning. Health-care organizations have a seldom-used resource within acute care settings that expands the ability to improve patients' experiences of their care as well as their own team engagement. Environmental services (ES) staff, the second largest health-care workforce, spend an average of 10 min per patient day interacting with patients and families.

Cannabis and Pregnancy.

Purpose Of Review: We review recent evidence describing the effects of prenatal exposure to cannabis in pregnant individuals.

Recent Findings: In the context of changing cannabis policy, more pregnant individuals are using cannabis, despite profound risks. Recent studies show possible perinatal and longitudinal neurodevelopment risks associated with cannabis use during pregnancy and lactation.

Additive value of invasive haemodynamic assessment for predicting post-operative outcomes after Fontan.

Routine pre-Fontan cardiac catheterization remains standard practice at most centres. However, with advances in non-invasive risk assessment, an invasive haemodynamic assessment may not be necessary for all patients.Using retrospective data from patients undergoing Fontan palliation at our institution, we developed a multivariable model to predict the likelihood of a composite adverse post-operative outcome including prolonged length of stay ≥ 30 days, hospital readmission within 6 months, and death and/or transplant within 6 months.

Preoperative Hemodynamics Impact the Benefit of Fenestration on Fontan Postoperative Length of Stay.

Background: Utilization of Fontan fenestration varies considerably by center.

Objectives: Using a multicenter Pediatric Heart Network dataset linking surgical and preoperative hemodynamic variables, the authors evaluated factors associated with use of Fontan fenestration and the impact of fenestration on post-Fontan length of stay (LOS).

Methods: Patients 2 to 6 years old at Fontan surgery from 2010 to 2020 with catheterization<1 year prior were included.

Surgical Modulation of Pulmonary Artery Shear Stress: A Patient-Specific CFD Analysis of the Norwood Procedure.

Purposr: This study created 3D CFD models of the Norwood procedure for hypoplastic left heart syndrome (HLHS) using standard angiography and echocardiogram data to investigate the impact of shunt characteristics on pulmonary artery (PA) hemodynamics. Leveraging routine clinical data offers advantages such as availability and cost-effectiveness without subjecting patients to additional invasive procedures.

Methods: Patient-specific geometries of the intrathoracic arteries of two Norwood patients were generated from biplane cineangiograms.

No vaccine interference between bovine coronavirus and bovine herpesvirus-1 in a randomized trial when coadministrating two intranasal modified-live viral vaccines to neonatal calves.

Objective: Compare immune responses induced by 2 commercial intranasal (IN) modified-live viral (MLV) vaccines given individually or coadministered and evaluate prevention of infection and lung pathology following bovine herpesvirus-1 (BHV-1) challenge.

Animals: 36 male Holstein calves (ages, 5 to 12 days).

Methods: In a randomized complete block design, each calf received an IN injection of either vaccine diluent (Placebo), an MLV vaccine containing bovine herpesvirus-1 (BHV-1; N3), bovine coronavirus vaccine (BC), or both N3 and BC (BC + N3) with a booster 4 weeks later.