Published Practice Guidelines Research Articles

The relationship between antiretroviral prescription patterns and treatment guidelines in treatment-naïve HIV-1-infected patients

Reports have shown that the publication of practice guidelines does not guarantee their use in clinical practice. The objective of this study was to evaluate the agreement between antiretroviral treatments (ARTs) prescribed in clinical practice and the recommendations in published guidelines. A retrospective cohort study was carried out in ART-naïve adults of the Spanish Asociacion Medica Vach de Estudios Multicentricos (VACH) Cohort for the period from 2003 to 2006. A total of 945 patients initiated ART. Of these patients, 12.3% had a CD4 cell count above 350 cells/microL. A 'nonrecommended' antiretroviral regimen was prescribed to 5.3, 5.1 and 7.8% of patients with CD4 counts <200, 200-350 and >350 cells/microL, respectively. Multivariate analyses demonstrated that only a higher viral load was associated with the selection of a combination treatment that was recommended by the guidelines. Most patients were prescribed initial treatments in agreement with the recommendations. Appropriate routine data collection in databases can be used to evaluate the level of antiretroviral guideline compliance. We propose that routine evaluations of the guidelines must be part of quality assessment to improve medical care.

Awareness of guidelines and trends in the management of suspected pancreatic cystic neoplasms: survey results among general gastroenterologists and EUS specialists

Although pancreatic cystic neoplasms are widely recognized, practice habits among physicians and awareness of consensus guidelines are currently unknown. To assess the awareness of guidelines and describe variability in practice habits among 2 groups: (1) "general group" of gastroenterologists and surgeons and (2) "EUS group" of specialists in EUS. An online survey was sent to randomly selected gastroenterologists and surgeons and e-mailed to members of the American Society for Gastrointestinal Endoscopy (ASGE) Special Interest Group in EUS (EUS-SIG). Response rate for the general group was 8.8% (220/2500) and 9.7% for the EUS group (42/431). EUS specialists were mostly in academic practice (66.7% vs 36.3%, P < .001) and reported seeing 21 to 50 cysts per year (54.8% vs 12.3%, P < .001). The majority of the general group (64.1%) was unaware of any published practice guidelines, compared with 33.3% of EUS specialists (P < .001). Awareness of ASGE guidelines was more frequently reported than other guidelines in both groups and yet was still <50% for each group. Both demonstrated moderate consistency with the International Association of Pancreatology guidelines, appropriately answering 66.7% of the questions. For 9-mm lesions, only 25% of the questions were correctly answered in each group. EUS specialists were less likely to refer main-duct intraductal papillary mucinous neoplasms (IPMN) for surgery and more likely to opt for EUS-guided FNA (compared with high-resolution CT, MRCP, or surgery) for 9-mm, 22-mm, and 34-mm branch-duct IPMNs (P </= .001). Low response rate and recall bias. Awareness of practice guidelines about the management of suspected pancreatic cystic neoplasms is lower among general GI physicians compared with EUS specialists. Among all physicians, the greatest variability in practice is in small (<1 cm) lesions.

Effectiveness of Decentralized Community-Based Screening, Detection, and Treatment of Breast Cancer in Low-Income, Uninsured Women

Different systems exist currently in the provision of breast care to low-income, uninsured women. We assessed the efficacy of screening, diagnosis, and treatment of breast cancer in this patient population through a decentralized network of providers. We retrospectively reviewed charts of all patients referred for evaluation and treatment under the Cancer Detection Program: Every Woman Counts (CDP:EWC), the California equivalent of the National Breast and Cervical Cancer Detection and Prevention Program, in a suburban area of Los Angeles County. A total of 972 CDP:EWC screening mammograms was performed in the Antelope Valley during a 7-year study period (2000 to 2007). Sixty-two screened women aged 40 to 64 years were referred for further evaluation. Breast cancer detection rate per screening mammogram was 0.8 per cent; 80 per cent were early-stage breast cancer. The majority of the women (nine of 15) underwent breast conservation surgery. The axilla was staged using sentinel lymph node dissection and/or axillary lymph node dissection. Adjuvant chemotherapy and radiation were administered to all eligible patients. Compliance with published practice guidelines was high. This suggests that a decentralized community-based network of providers may be an effective model to deliver breast care to a low-income, uninsured patient population.

ISUOG consensus statement: what constitutes a fetal echocardiogram?

In 2006 the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) published practice guidelines for the sonographic screening of congenital heart disease (CHD) during the second trimester of pregnancy1. This document described two levels for screening low-risk fetuses for heart anomalies. Firstly, a ‘basic’ scan should be performed by analyzing a four-chamber view of the fetal heart. Secondly, an ‘extended-basic’ scan further examines the size and relationships of both arterial outflow tracts. The term ‘fetal echocardiogram’ was also mentioned as a more detailed sonographic evaluation to be performed by specialists in the prenatal diagnosis of CHD. Although common indications and imaging techniques were briefly discussed, it was thought important to further explain how this advanced diagnostic procedure differs from the basic and extended-basic cardiac screening examinations. A Fetal Echocardiography Task Force was subsequently asked to develop a standard description of ‘what constitutes a fetal echocardiogram’. Our original goal was to develop guidelines for a detailed examination of the fetal heart that were based on the literature and a consensus opinion of an expert panel. However, we soon realized that this project was quite different from developing minimum practice guidelines for fetal cardiac screening. There are several imaging modalities that can be used to evaluate fetal heart anomalies, ranging from M-mode techniques and color Doppler sonography to the use of four-dimensional (4D) ultrasonography with spatiotemporal image correlation (STIC). Consequently, our original efforts to develop a minimum practice guideline for fetal echocardiography evolved into a consensus statement that covers the following topics:

Pathophysiology of right ventricular failure

Right ventricular failure may be defined as the inability of the right ventricle of the heart to provide adequate blood flow through the pulmonary circulation at a normal central venous pressure. Critical care specialists encounter right ventricular failure routinely in their practice, but until recently right ventricular failure as a primary clinical entity received scant consideration. Indeed, there is still not a single published practice guideline focused on right ventricular failure. Right ventricular failure is usually due to a combination of right ventricular pressure overload and contractile abnormalities of the right ventricular free wall. Decompensation may occur abruptly and catastrophically because of unique aspects of right ventricular physiology. This review will focus on the pathophysiology of acute right ventricular failure in the critical care setting and summarize the limited management options available.

Distress Assessment: Practice Change Through Guideline Implementation

Most nurses agree that incorporating evidence into practice is necessary to provide quality care, but barriers such as time, resources, and knowledge often interfere with the actual implementation of practice change. Published practice guidelines are one source to direct practice; this article focuses on the use of the National Comprehensive Cancer Network's Clinical Practice Guidelines for Oncology: Distress Management, which articulate standards and demonstrate assessment for psychosocial distress. Planning for the implementation of the guidelines in a feasibility pilot in a busy radiation oncology clinic is described. Results indicate that adding a distress assessment using the distress thermometer and problem checklist did not present substantial burden to nurses in the clinic or overwhelm the mental health, pastoral care, or oncology social work referral sources with more patients. Understanding distress scores and problems identified by patients helped the nurses direct education interventions and referrals appropriately; improved patient satisfaction scores reflected this.

Perioperative Central Venous Cannulation: It Is Time for Action

Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. yiandoc@hotmail.comI read with great interest the excellent article by Dr. Hove et al. 1detailing their closed claims review of deaths related to anesthesia in Denmark (1996–2004). The accompanying editorial highlights the preventable deaths related to the conduct of central venous cannulation (CVC).1,2There has been a significant lag in quality improvement for CVC since its role in patient mortality and morbidity was highlighted in 1999 by the Institute of Medicine Report To Err Is Human .*It is time for the worldwide anesthesia community to develop and implement evidence-based guidelines, teaching, and standardization for the practice of CVC.To my knowledge, there is no published practice guideline for perioperative CVC, despite the fact that it is a common perioperative procedure associated with significant medical error and consequent serious patient risk. The literature review that would be part of this guideline's development would quickly prove the pivotal role of ultrasound guidance. The discussion points at this juncture are not about whether ultrasound guidance is required, but rather about the aspects of its application, such as the superiority of real-time imaging, the role of a needle guide, Doppler imaging, and/or two-dimensional imaging.3,4Furthermore, there are initiatives in progress that will greatly assist in achieving the consistently safe practice of CVC throughout medical practice. One example of these initiatives is instructive procedural videos available through the Internet, such as the series launched recently by the New England Journal of Medicine .5Perhaps the leading anesthesia journals would follow this example and include not only CVC but all procedures relevant to perioperative medicine. Another example is the development and validation of standardized teaching methods for CVC such as the tissue model technique from internal medicine.6This avenue of endeavor might be a fruitful application for anesthesia simulation as well.I congratulate Dr. Hove et al. on their excellent article, which adds further emphasis to the perioperative imperative to make CVC safe for all of our patients all of the time.Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. yiandoc@hotmail.com

Optimizing Maintenance Therapy for Chronic Obstructive Pulmonary Disease: Strategies for Improving Patient-Centered Outcomes

Background: Chronic obstructive pulmonary disease (COPD) is associated with substantial morbidity and mortality. Published practice guidelines and treatment algorithms for COPD are designed to increase awareness of the problem and improve patient care; however, <40% of subjects diagnosed with COPD are receiving appropriate maintenance therapy. Objective: This paper reviews the use of maintenance therapy in COPD and examines the optimal timing for initiating such therapy based on the available literature. Methods: Relevant publications were identified through a search of MEDLINE (1995-May 2007) using the terms COPD, guidelines, treatment, maintenance therapy, bronchodilator, ipratropium, tiotropium, β-agonist, salmeterol, and inhaled corticosteroid. English-language publications discussing pharmacologic maintenance therapy for COPD, including practice statements/guidelines, randomized controlled clinical trials, systematic reviews, and meta-analyses, with a focus on agents currently approved for use in the United States, were selected for inclusion. Results: Although guidelines and algorithms agree on the importance of regularly scheduled maintenance therapy to reduce symptoms of COPD, minimize activity limitations, and improve health status, the timing of the initiation of such therapy is debatable. In most instances, maintenance medications, which include long-acting β 2-agonists, long-acting anticholinergics, and combination products, are prescribed late in the disease process and mainly for patients with severe disease. However, there is increasing evidence that the use of maintenance therapy early in the disease process may be associated with improvements in such outcomes as lung function, symptoms, exercise tolerance, exacerbations of COPD, and quality of life. Conclusion: The high burden associated with COPD highlights the need to initiate maintenance therapy before a substantial decline in lung function has occurred.

Factors that can be used to predict release rates for wildlife casualties

AbstractOf the wildlife casualties admitted to rehabilitation centres in England, less than half are subsequently released back into the wild. If the factors associated with survival within rehabilitation centres can be determined, they may be used to focus efforts on individuals with high chances of successful recovery, and thus improve welfare by devoting resources to those animals that are more likely to benefit. We analysed the medical record cards of eight species admitted to four wildlife rehabilitation centres run by the Royal Society for the Prevention of Cruelty to Animals between 2000-2004 to determine those factors that affected the chance of survival in care until release, and whether trends in predictive factors occurred across taxonomic groups. We found that the most important predictive factor, across all species, was the severity of the symptoms of injury or illness. Factors commonly used as important indicators of rehabilitation success in published practice guidelines, such as mass and age, were not found to affect survival significantly. Our results highlight the importance of triage based on clinical diagnosis as soon as a wildlife casualty is admitted, and indicate that although the ethos of many rehabilitation centres is to attempt the treatment of all wildlife casualties, the attempted treatment of those with severe injuries may be adversely affecting welfare by prolonging suffering.

Propositions of interpretative comments for thyroid function tests

In the field of thyroid disease, a number of governmental organisms or professional associations have published practice guidelines containing laboratory-related recommendations, eg the Haute autorité de la santé (HAS), or the American Thyroid Association (ATA). Among the physicians who prescribe thyroid function tests, all have not read and memorized all these recommendations. In order to help them to better integrate these recommendations in their practice, we have composed a thesaurus of ready-made interpretative comments, trying to adapt our proposed comments to each possible combination of results of TSH and/or free T4 and/or free T3. The laboratorians who would prefer to use only the comments based strictly on the recommendations of HAS and/or ATA, will be able to select among our comments what is really validated by these two organizations. In addition, our work aims at enabling the patients who want it, to benefit from written information, which may be complementary to the more often spoken information provided by the clinicians.

Interventions for the Management of Weight and Body Composition Changes in Women With Breast Cancer

Weight gain and body composition changes are common during the first year after breast cancer diagnosis. Women who are overweight or obese at the time of diagnosis or who gain weight following diagnosis are at higher risk for adverse clinical outcomes. Unhealthy weight conditions, compounded or caused by weight gain after diagnosis, are a considerable challenge for women with breast cancer during and after treatment. Despite the prevalence of weight gain in women with breast cancer as well as its adverse effects, little research has examined preventive and therapeutic interventions targeting reduction of weight and/or body fat. The purpose of this article is to update the state of knowledge on weight gain and body composition changes in women with breast cancer. Current evidence from weight intervention studies, including diet, exercise, and combined approaches for weight loss-or for prevention of weight gain-are reviewed. Along with published practice guidelines, the currently available information provides guidance for oncology nurses on the methods that can impact unhealthy weight conditions associated with breast cancer.

Application of the Recent American Practice Resources for Risk Stratification System for Patients Presenting to a Japanese Emergency Department Because of Syncope

The American College of Physicians (ACP) and the American College of Emergency Physicians (ACEP) recently published practice guidelines and recommendations for evaluation of patients with syncope based on historical, physical, and ECG findings. The objective of the present study was to determine if risk stratification using these practice resources is valid in a series of Japanese patients. A total of 912 consecutive patients brought to our emergency department between 1988 and 1997 because of syncope were identified. Follow-up information about mortality was obtained for 707 patients by means of mailed questionnaires and from medical records, and the mortality data were analyzed by the actuarial life-table method. A total of 187 patients who fulfilled the admission criteria according to the ACP guidelines were found to have higher overall and cardiac mortality than the other 520 patients (P < 0.0001), and 153 patients who fulfilled the admission criteria according to the ACEP recommendations also had higher overall and cardiac mortality than the other 554 patients (P < 0.0001). The recent American practice recommendations can be used for risk stratification of syncope patients in Japan. Historical, physical, and ECG findings available on presentation can be used to stratify the risk of mortality in patients brought to Japanese emergency departments because of syncope.

Safety considerations for erythropoietin treatment in patients with cancer

Cancer-related anaemia, which affects many patients with cancer, can effectively be treated by erythropoietic proteins. Erythropoietic proteins increase haemoglobin levels, reduce the risk for transfusions and also improve the quality of life of patients. When used according to published practice guidelines, these proteins benefit many patients and are generally well tolerated. Important side effects are hypertension and thromboembolic events, either of which occurs in < 10% of the patients. Administration only in anaemic patients, avoidance of target haemoglobin levels > 130 g/l, proper dose adjustments and close monitoring during treatment will ensure the clinical safety of these proteins. However, the association between erythropoietic proteins and outcome of anticancer therapy, including survival, requires further study.

A questionnaire survey on the management of Graves’ orbitopathy in Europe

To determine management patterns among clinicians who treat patients with Graves' orbitopathy (GO) in Europe. Questionnaire survey including a case scenario of members of professional organisations representing endocrinologists, ophthalmologists and nuclear medicine physicians. A multidisciplinary approach to manage GO was valued by 96.3% of responders, although 31.5% did not participate or refer to a multidisciplinary team and 21.5% of patients with GO treated by responders were not managed in a multidisciplinary setting. Access to surgery for sight-threatening GO was available only within weeks or months according to 59.5% of responders. Reluctance to refer urgently to an ophthalmologist was noted by 32.7% of responders despite the presence of suspected optic neuropathy. The use of steroids was not influenced by the age of the patient, but fewer responders chose to use steroids in a diabetic patient (72.1 vs 90.5%, P<0.001). Development of cushingoid features resulted in a reduction in steroid use (90.5 vs 36.5%, P<0.001) and increase in the use of orbital irradiation (from 23.8% to 40.4%, P<0.05) and surgical decompression (from 20.9 to 52.9%, P<0.001). More ophthalmologists chose surgical decompression for patients with threatened vision due to optic neuropathy, who were intolerant to steroids than other specialists (70.3 vs 41.8%, P<0.01). Deficiencies in the management of patients with GO in Europe were identified by this survey. Further training of clinicians, easier access of patients to specialist multidisciplinary centres and the publication of practice guidelines may help improve the management of this condition in Europe.

Posttraumatic Stress Disorder Among Military Returnees From Afghanistan and Iraq

Posttraumatic Stress Disorder Among Military Returnees From Afghanistan and Iraq

Reifying Relevance in Mild Cognitive Impairment: An Appeal for Care and Caution

Reifying Relevance in Mild Cognitive Impairment:An Appeal for Care and Caution Janice E. Graham (bio) and Karen Ritchie (bio) Keywords Alzheimer’s disease, construction, dementia, market forces, mild cognitive impairment We thank the reviewers for their thoughtful comments that probe shadowy areas in our argument, and we welcome this opportunity to elucidate our position. First, we are not repudiating the natural and social facts of pathologic brain degeneration and the physical and cognitive impairments that manifest in people affected by dementia disorders. We are, however, questioning the epistemology, politics, and persistence by some to harden the construct of mild cognitive impairment (MCI) prematurely as a "natural" precursor to dementia. We suggested insufficiencies in viewing MCI as prodromal to Alzheimer's disease (AD; Graham and Ritchie 2006, 36), and pointed to evidence for the prognostic irrelevance of some MCI subcategories (35). The commentators have read our manuscript as suggesting that AD and MCI are different kinds, and that a diagnosis of AD is more "real" than that of MCI. But AD is also fraught with classification issues, as we describe in the section of our paper that deals with consensus committees, published practice guidelines, and the determination of treatment efficacy. Like MCI, AD is a heterogeneous condition, but unlike MCI, AD is a constructed practical kind that does some "work" beyond essentialist (neural degeneration, brain atrophy) claims. Its criteria identify people with well-defined dementia symptoms and multiple cognitive and functional impairments who are in need of, and benefit from, support. Even with these criteria, however, there have been great attempts to achieve definitional accuracy in dementia diagnoses. Practical refinements to the differential diagnosis of dementia based on solid research evidence have made way for more specific recognitions of vascular dementias, dementia of the Lewy body type, and other subtypes beyond AD. So AD too has been subject to more careful, more cautious operationalization in recent years, with research supporting multiple factors and the comorbidity of several types (kinds) of dementia in any one individual. Our paper takes up concerns that are not resolved for dementia and suggests that the nascent category of MCI is still so insufficiently defined as to be ambiguous, and as such, is in danger of identifying individuals with what will be, and has [End Page 57] already been, linked to a debilitating and deeply stigmatizing and fatal disorder (AD). We are not contesting the reality that some people begin to display early signs of cognitive loss, nor are we suggesting that symptoms be ignored; as researchers, we stand behind the careful tracking of symptoms and signs in patients and research participants as an essential clinical and research practice. In a era where the public has been made wary of the potentially fatal effects of new treatments whose more careful scrutiny in specific populations would have saved lives (e.g., Fontanarosa, Rennie, and DeAngelis 2004; Psaty and Furberg 2005), and made all the more popular by what Kramer coined "diagnostic bracket creep" (1993, 15), we are questioning the drivers and value of a premature diagnostic classification whose definitional accuracy is neither sufficient nor effective for specific identification of individuals. That matters of fact are constructed does not take away from their natural fact. Some people have subjective reports or show objective evidence of cognitive decline while having preserved activities of daily living—the construction of this evidence indicates they are not normal and they are not demented. Based on such evidence, where then does the balance of probability for MCI lie? A multidisciplinary international group of experts gathered in Stockholm in 2003 to discuss MCI concepts (Winblad et al. 2004). They acknowledged that the heterogeneous etiology of MCI contributes to "some confusion concerning the specific boundaries of the condition", stating that this "not normal, not demented" condition is nonetheless "useful both clinically and as a research entity" (p. 241). Importantly, they concluded that MCI needs "better definition" (p. 246). It was at this stage that we first wrote our manuscript, and in the subsequent two years we have eagerly awaited new studies, and the recognition of flexible, practical subtypes to evolve. We state "that MCI cannot be considered to be a separate clinical entity" (Graham and...

Selecting Appropriate Management Strategies for Chronic Hepatitis B

BACKGROUND Hepatitis B virus (HBV) infection is a significant problem. In the United States estimates indicate that 0.3% of the population (1.25 million individuals) have chronic hepatitis B infection. METHODS Review of published practice guidelines and literature on management of hepatitis B to determine: 1) Which persons in Western populations are at the highest risk for HBV infection and should be screened for HBV seromarkers to identify those who are chronically infected and those who need to be protected with hepatitis B vaccine; 2) The importance of regular monitoring in persons with chronic hepatitis B, the frequency of monitoring, and which tests should be performed; 3) How to identify the patients who are appropriate candidates for antiviral therapy. RESULTS Recommendations for screening, diagnosis, monitoring, and treatment of chronic HBV infection are reviewed. Important differences are discussed between the Practice Guidelines for chronic hepatitis B developed by the American Association for the Study of Liver Diseases (AASLD), the European Association for the Study of the Liver (EASL), and the Asian Pacific Association for the Study of the Liver (APASL). In addition, this article reviews which patients who are no covered by these Guidelines might be candidates for antiviral therapy. DISCUSSION Established practice guidelines provide direction to providers for the diagnosis and management of chronic HBV infection to reduce the risk of serious sequelae. However, not all patients with chronic hepatitis B are identified, and many of those who are diagnosed do not receive adequate management and follow-up.

Management of Diabetes During Acute Stroke and Inpatient Stroke Rehabilitation

Golden SH, Hill-Briggs F, Williams K, Stolka K, Mayer RS. Management of diabetes during acute stroke and inpatient stroke rehabilitation. Objectives To summarize evidence on the impact of hyperglycemia on stroke outcomes and to present therapy algorithms for inpatient management in diabetic stroke patients. Data Sources Guidelines for inpatient management of diabetes were reviewed and extracted from a technical review and recommendations from 2 national diabetes and endocrine organizations. MEDLINE database searches were conducted using key words: stroke, diabetes, hyperglycemia, hypoglycemia, inpatient, hospitalized, treatment, outcomes, disability, self-management, and education. Study Selection Studies were selected that specifically addressed the impact of the following in stroke patients: hyperglycemia and diabetes on rehabilitation outcomes, management strategies for hyperglycemia and diabetes, and strategies for facilitating diabetes self-management. Data Extraction Two authors independently extracted data and management practices from selected articles and published practice guidelines. Data Synthesis Diabetes is prevalent in stroke patients and results in poorer inpatient hospital and rehabilitation outcomes. Management of diabetes in stroke patients is further complicated by impairments in mobility and vision, necessitating accommodation strategies and tools for self-management. Optimal management of hyperglycemia using insulin or oral hypoglycemic agents results in reduced morbidity and mortality among diabetic inpatients. Conclusions To achieve inpatient glycemic management targets, use of clinical management algorithms, self-management tools, and systems approaches such as diabetes management teams are useful.

Rapid and Rational Echocardiographic-Assisted Management of Cardiogenic Shock After Coronary Artery Bypass Surgery

IN THE EARLY 1980s, when transesophageal echocardiography (TEE) was first used in the operating room, its main application was the assessment of global and regional left ventricular function. 1 Kahn R.A. Intraoperative echocardiography. in: Kaplan J.A. Reich D.L. Kondstadt S.N. Cardiac Anesthesia. (ed 4). WB Saunders, Philadelphia, PA1999: 401-483 Google Scholar Since then, there have been numerous technical advances in TEE, and the number of clinical applications has markedly increased. 1 Kahn R.A. Intraoperative echocardiography. in: Kaplan J.A. Reich D.L. Kondstadt S.N. Cardiac Anesthesia. (ed 4). WB Saunders, Philadelphia, PA1999: 401-483 Google Scholar The American Society of Anesthesiologists has published practice guidelines for the use of perioperative TEE, but the role and effect of TEE outside the cardiac operating room are still poorly explored. 2 Denault A.Y. Couture P. McKenty S. et al. Perioperative use of transesophaegal echocardiography by anesthesiologists Impact in non-cardiac surgery and in the intensive care unit. Can J Anesth. 2002; 49: 287-293 Crossref PubMed Scopus (89) Google Scholar The clinical applications of TEE have been studied in many conditions and gradually applied in the critical care setting. Echocardiography has been applied perioperatively with a limited but focused purpose, to diagnose rapidly developing perioperative hemodynamic collapse. 3 Cahalan M. Rescue transesophageal echocardiography. IARS review course lecture. Anesth Analg. 2004; 98: 10-13 Google Scholar , 4 Augoustides J. Weiss S.J. Pochettino A. Hemodynamic monitoring of the postoperative adult cardiac surgical patient. Semin Thorac Cardiovasc Surg. 2000; 12: 309-315 Abstract Full Text PDF PubMed Scopus (11) Google Scholar , 5 Griffin M.J. Hines R.L. Management of perioperative ventricular dysfunction. J Cardiothorac Vasc Anesth. 2001; 5: 90-106 Abstract Full Text Full Text PDF Scopus (17) Google Scholar

We "strongly feel" that vancomycin should be included as an option in published practice guidelines for antibacterial prophylaxis in surgery,*

We "strongly feel" that vancomycin should be included as an option in published practice guidelines for antibacterial prophylaxis in surgery,*