Lung transplant curriculum in pulmonary/critical care fellowship training.

BACKGROUND: Lung transplantation is an evolving specialty with the number of transplants growing annually. PURPOSE: A structured lung transplant curriculum was developed for Pulmonary/Critical Care (Pulm/CC) fellows. METHODS: Scores on pulmonary in-training examinations (ITE) 2 years prior to and 3 years after implementation were reviewed as well as completion of satisfaction surveys. RESULTS: The mean pulmonary ITE score of 1st-year fellows increased from 54.2 ± 2.5 to 63.6 ± 1.2 (M ± SD), p = .002, whereas mean pulmonary ITE score for 2nd-year fellows increased from 63.0 ± 3.0 to 70.7 ± 1.2, p = .019. The combined mean pulmonary ITE score increased from 58.6 ± 2.3 to 67.1 ± 1.2, p = .001. Satisfaction surveys revealed that fellow perception of the curriculum was that the experience contributed to an overall improvement in their knowledge base and clinical skills while opportunity to perform transbronchial biopsies was available. CONCLUSIONS: A structured educational lung transplant curriculum was associated with improved performance on the pulmonary ITE and was perceived by fellows to be beneficial in their education and training while providing opportunities for fellows to perform transbronchial biopsies.

Candidemia incidence in recipients of parenteral nutrition.

BACKGROUND: The purpose of this study was to assess the incidence of candidemia in recipients of parenteral nutrition (PN) in a tertiary medical center with disease-specific guidelines for appropriate PN use. METHODS: A retrospective, medical record/database review was conducted for adult patients who received PN in a 473-bed medical center from January 2006 to October 2008. Patients receiving PN >72 hours with no recent history of fungemia or concomitant antifungal therapy were evaluated for candidemia incidence with special interest in intensive care unit (ICU) patients. Epidemiological and clinical factors promoting candidemia development, pattern of systemic antifungal therapy use, and patient outcomes were investigated. RESULTS: Of 286 PN recipients, 14 (4.9%) patients were diagnosed with new-onset candidemia, with an incidence rate of 1.6 episodes per 1000 hospital-days. In the subgroup of 177 ICU patients, 11 (6.2%) patients developed candidemia, with an incidence rate of 2.4 episodes per 1000 ICU-days. PN duration was significantly longer in the candidemia group, with a median of 17 (4-53) days compared with 8 (4-124) days in the noncandidemia group (P = .013). Severity of illness was defined as major to extreme in 83.5% of patients. Hospital mortality in the candidemia group was greater than in the noncandidemia group (35.7% vs 16.2%, P = .058). CONCLUSIONS: Guidelines for PN therapy appropriately limit unnecessary use of PN but also select out severely ill patients who are at high risk for the development of candidemia. This study generates questions for future studies, including the benefits of empirical antifungal therapy in high-risk PN recipients.

Balloon-facilitated percutaneous dilational tracheostomy tube placement: preliminary report of a novel technique.

OBJECTIVE: To describe a novel technique for percutaneous tracheotomy (PT) that could be an alternative to current dilational techniques. DESIGN: An observational animal study of PT was performed using the Seldinger guide wire technique with a tracheostomy tube preloaded onto a dilational balloon catheter. A small skin incision was done with an 11-blade scalpel, but no blunt subcutaneous tissue dissection was performed. SETTING: Animal laboratory in a university hospital. SUBJECTS: Seven adult pigs (approximate weight, 16 to 21 kg). MEASUREMENTS AND RESULTS: Successful tracheostomy was accomplished in all seven pigs without apparent complication. Vital signs and oximetry results remained unchanged throughout the procedure. The mean duration of the procedure was 5.5 min from tracheal puncture to ventilation. CONCLUSION: This novel procedure is a simple and effective means of PT tube placement without subcutaneous tissue dissection and could potentially have decreased complications when compared to the standard methods of PT currently employed in humans. Human studies are pending.