A unique facial structure and deformity of the cervical spine is associated with a difficult airway. We report here a 10-year-old girl with Hajdu-Cheney syndrome who developed progressive basilar impression and medullary compression for which foramen magnum decompression was performed. After slow induction of anesthesia, we were able to perform fiberoptic orotracheal intubation via a VBM bronchoscope airway. This case report contributes to the accumulation of knowledge about anesthesia for this rare syndrome.”
“Objective: In an effort to decrease healthcare costs, we investigated
our laboratory billing practices at a tertiary academic medical center to determine where we could apply Sigma Sigma tools to improve these processes.
Methods and Results: During the find protocol period of June 2009 to February 2010, we identified an estimated $1.9 million in charges for laboratory tests performed, but not billed for. Using SIPOC analytics, we determined that a large percentage of these unbilled tests were ordered by outreach services ($529,000). Applying interventions that included creation of CPT-driven lab test requisitions for Medicare-approved test panels, and training physicians and office managers to better match CPT codes with lab requests, we improved the rate of unbilled tests https://www.selleckchem.com/products/VX-770.html from 25% to 2.6%.
Conclusion: The application of Six Sigma quality improvement tools to the clinical laboratory setting helped identify
specific billing processes to improve (laboratory tests performed but not billed for), apply specific interventions to improve our billing processes, and create solutions to improve and maintain improved performance of our billing practices.”
“Purpose of review
To highlight the recent developments in hemodynamic monitoring during liver and lung transplantation.
Recent findings
Even though a consensus on intraoperative hemodynamic monitoring is still lacking, the most frequently monitoring
tool used is the pulmonary artery catheter (PAC). The filling LY2603618 price pressures are widely accepted as not being able to accurately define cardiac preload. On the contrary, the use of transesophageal echocardiography (TEE), although it is operator dependent and requires a prolonged training, is increasing during the intraoperative period to directly evaluate the cardiovascular function. New frontiers have been opened by the transpulmonary thermodilution: intrathoracic blood volume has been shown to have a better correlation with preload than the filling pressures. The advanced modified PAC permits evaluation of the right heart function and preload. Recently, right ventricular end diastolic volume has been shown to correlate better with preload than the filling pressures and also the left ventricular end diastolic area.
Summary
The PAC still represents the most used intraoperative hemodynamic monitoring technique. TEE is increasing in popularity.