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Higher mean arterial pressures during cardiopulmonary bypass can be achieved in a technically safe manner and effectively improve outcomes after coronary bypass.

Background Within 1 year after percutaneous coronary intervention, more than 20% of patients experience new adverse events. Physical activity confers a 25% reduction in mortality; however, physical activity is widely underused. Thus, there is a need for more powerful behavioral interventions to promote physical activity. Our objective was to motivate patients to achieve an increase in expenditure of 336 kcal/wk or more at 12 months as assessed by the Paffenbarger Physical Activity and Exercise Index. Methods Two hundred forty-two patients were recruited immediately after percutaneous coronary intervention between October 2004 and October 2006. Patients were randomized to 1 of 2 groups. The patient education (PE) control group (n=118) (1) received an educational workbook, (2) received a pedometer, and (3) set a behavioral contract for a physical activity goal. The positive affect/self-affirmation (PA) intervention group (n=124) received the 3 PE control components plus (1) a PA workbook chapter, (2) bimonthly induction of PA by telephone, and (3) small mailed gifts. All patients were contacted with standardized bimonthly telephone follow-up for 12 months. Results Attrition was 4.5%, and 2.1% of patients died. Significantly more patients in the PA intervention group increased expenditure by 336 kcal/wk or more at 12 months, our main outcome, compared with the PE control group (54.9% vs 37.4%, P=.007). The PA intervention patients were 1.7 times more likely to reach the goal of a 336-kcal/wk or more increase by 12 months, controlling for demographic and psychosocial measures. In multivariate analysis, the PA intervention patients had nearly double the improvement in kilocalories per week at 12 months compared with the PE control patients (602 vs 328, P=.03). Conclusion Patients who receive PA intervention after percutaneous coronary intervention are able to achieve a sustained and clinically significant increase in physical activity by 12 months. Trial Registration clinicaltrials.gov Identifier: NCT00248846

e Rapid and definitive diagnosis of viral respiratory infections is imperative in patient triage and management. We compared the outcomes for adult patients with positive tests for respiratory viruses at a tertiary care center across two consecutive influenza seasons (winters of 2010-2011 and 2012). Infections were diagnosed by conventional methods in the first season and by multiplex PCR (FilmArray) in the second season. FilmArray decreased the time to diagnosis of influenza compared to conventional methods (median turnaround times of 1.7 h versus 7.7 h, respectively; P ‫؍‬ 0.015); FilmArray also decreased the time to diagnosis of non-influenza viruses (1.5 h versus 13.5 h, respectively; P < 0.0001). Multivariate logistic regression found that a diagnosis of influenza by FilmArray was associated with significantly lower odds ratios (ORs) for admission (P ‫؍‬ 0.046), length of stay (P ‫؍‬ 0.040), duration of antimicrobial use (P ‫؍‬ 0.032), and number of chest radiographs (P ‫؍‬ 0.005), when controlling for potential confounders. We conclude that the rapid turnaround time, multiplex nature of the test (allowing simultaneous detection of an array of viruses), and superior sensitivity of FilmArray may improve the evaluation and management of patients suspected of having respiratory virus infections. R espiratory viruses can cause not only mild upper respiratory tract infections but severe pneumonia, especially in immunocompromised hosts. Rapid and definitive diagnosis is critical in the management of viral respiratory infections and in timely isolation of infected patients. The 2009 H1N1 pandemic revealed the need for better diagnostic tests for influenza viruses. In addition, overlapping clinical presentations impede clinicians' ability to predict causative pathogens (whether bacterial or viral) and may lead to unnecessary antimicrobial use (1, 2). Nucleic acid amplification testing (NAAT)-based methods for detection of viral pathogens are increasingly used due to their excellent sensitivity and specificity and their ability to detect a wide spectrum of viral agents. Therefore, NAAT has many potential advantages over traditional methods, such as rapid antigen testing (which is Ͻ40 to 60% sensitive for influenza in adults), direct fluorescent-antibody (DFA) testing (which requires specialized laboratory training), or viral culture (which can take up to 10 days for a result) (3). Multiplex PCR using FilmArray (BioFire Diagnostics, Inc., a bioMérieux company, Salt Lake City, UT) is an NAAT method which can detect multiple viral pathogens with a single test (4). The FilmArray respiratory viral panel (RVP) was FDA cleared in May 2011 to detect 15 respiratory viral pathogens: influenza A virus and subtypes (influenza A H1, influenza A H1 2009, and influenza A H3 viruses), influenza B virus, parainfluenza 1 virus, parainfluenza 2 virus, parainfluenza 3 virus, parainfluenza 4 virus, respiratory syncytial virus (RSV), human metapneumovirus, adenovirus, rhinovirus/enterovirus, coronavirus NL63, and coronavirus HKU1.In Febr...

Elderly patients can safely receive controlled hypotensive epidural anesthesia with this protocol. There was no evidence of greater risks, or early benefits, with the use of the more markedly hypotensive range.