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Use of a disinfectant cap on IV needleless connectors in addition to an existing standard central line bundle was associated with decreased CLABSI and costs.

Nasogastric/nasoenteric (NG/NE) feeding tube placements are associated with adverse events and, without proper training, can lead to devastating and significant patient harm related to misplacement. Safe feeding tube placement practices and verification are critical. There are many procedures and techniques for placement and verification; this paper provides an overview and update of techniques to guide practitioners in making clinical decisions. Regardless of placement technique and verification practices employed, it is essential that training and competency are maintained and documented for all clinicians placing NG/NE feeding tubes. This paper has been approved by the American Society for Parenteral and Enteral Nutrition (ASPEN) Board of Directors.

Conclusion:Celiprolol appears effective in preventing major complications in patients with vascular Ehlers-Danlos syndrome.Summary: Ehlers-Danlos syndrome is a heterogeneous group of connective tissue disorders. It results from a number of mutations in the COL3A1 gene that cause defects in pro1 (III) chain of collagen type 2. The vascular form of Ehlers-Danlos is the most severe variant of Ehlers-Danlos and is autosomal dominant. Median survival is 40 to 50 years. Major complications include vascular dissection or rupture or rupture of hollow organs (uterus, intestine). Complications are usually seen by age 20 years and by age 40, 90% of patients have sustained a major event.Vascular Ehlers-Danlos patients have decreased intima-media thickness (IMT). (Boutouyie P, et al, Circulation 2004;109:1530-35). Decreases in IMT may lead to decreased resistance to mechanical stress. The authors proposed that treatment with celiprolol may prevent vascular events associated with Ehlers-Danlos syndrome by reducing heart rate and therefore pulsatile mechanical stresses on weakened collagen fibers in the arterial wall of patients with Ehlers-Danlos syndrome.The Beta-Blockers in Ehlers-Danlos Syndrome Treatment (BBEST) trial used a multicenter randomized open-trial design but with blinded evaluation of clinical events. Patients with clinical Ehlers-Danlos syndrome using the Villefranche diagnostic criteria were identified and randomly assigned to treatment with celiprolol or no treatment. There were 53 patients included in the study and 33 had proven mutations in COL3A1. Mean age at study entry was 35 Ϯ 12 years. Female/male ratio was 2:1. Fifty-five percent had previous clinical events, and 21% had a family history of clinical events related to Ehlers-Danlos. Patients were randomly assigned to celiprolol or no treatment with stratification by age (Յ32 or Ͼ32 years). Celiprolol was up titrated every 6 months by steps of 100 mg to a maximum of 400 mg twice daily. Primary end points were arterial events, rupture, or dissection, fatal or not.Of the 53 patients in the study, 25 were assigned to celiprolol and 28 to the control group. Mean follow up was 47 Ϯ 5 months. The trial was stopped early for treatment benefit. Primary end points were reached by 5 (20%) in celiprolol group and by 14 (50%) in the control group (hazard ratio, 0.36; 95% CI, 0.15-0.88; P ϭ .040). Adverse events included severe fatigue in one patient after starting celiprolol at 100 mg daily and mild fatigue in two patients related to dose up titration.