THIS MONTH'S FOCUS:
MECHANICAL CIRCULATORY SUPPORT
NURSING, HEALTH SCIENCES & ALLIED HEALTH
Many thanks to Evgenij Potapov and Emily Stimpson for coordinating the content for this month's issue.
HAPPY NEW YEAR! WELCOME TO 2016!
VINCENT'S TWO SENSE:
Happy New Year! It is time for a new beginning. First is Matthew Carazo and Howard Eisen in the spotlight with The Microbiome and Cardiac Transplantation: What We Know and What We Need to Know. Then we start the reports from MCS with Dawn Christensen's "The Very Critical, Vastly Chaotic, Vital and Changing VAD Coordinator", followed by Theo de By's "MCS Registries: Should they be Local, Regional, National, Supra-National, Continental or Global?" and Pascal Leprince's "Joint Forces Combined in EUMS - The Number 1 MCS Meeting in Europe", before we finish with "Studying the Studies or Surfing PubMed" by Evgenij Potapov. Next we have Bernice Coleman and Kathleen Calzone with "Genetic and genomics in Transplantation: It's complicated...but are we prepared?" and Louise Fuller's "The Road to Recovery - Rehabilitation after Lung Transplantation" to start of NHSAH. Then it's "Pediatric Cardiac 'Prehab'" by Monica Horn and Jessica Greim before we finish with "Big Decisions" By Quincy Young. As Special Interest pieces we have "A Healthy Laugh" by Andrea Czarnecki-Galgon. Finally, turn to the Editor's Corner for the key summaries of the Presidents from the heart breaking, panting panicking and irradiating times of the 20th Century. On a lighter note the must read of all reads for all published 2015 is Marc Peyser and Timothy Dwyer's lively and provocative double biography - Hissing Cousins: The Untold Story of Eleanor Roosevelt and Alice Roosevelt Longworth, a great example of opposing views from the Roosevelt Ladies of the 20th Century.
IN THE SPOTLIGHT:
The Microbiome and Cardiac Transplantation: What We Know and What We Need to Know
Matthew R. Carazo, MD
Howard Eisen, MD
The microbiome is everywhere? Literally, it is: on your skin, in your enteric system, in your blood, and throughout the literature. Our first encounter with the microbiome is in utero and during birth. My first cognizant encounter was as a fourth year medical student doing a GI rotation at HUP. My GI attending physician would one day be my Department Chair when I was on faculty at Temple. My GI fellow is presently my Department Chair at Drexel. These wise men presciently identified the potential importance of the microbiome that we encountered every morning in the endoscopy suite. They pointed out that there were vast numbers of bacteria, which produce important compounds (hello, Vitamin K), and when perturbed could be catastrophic (C. difficile colitis which back then in the early 80's was an uncommon disease.) Read more →
MECHANICAL CIRCULATORY SUPPORT:
The Very Critical, Vastly Chaotic, Vital and Changing VAD Coordinator
Dawn Christensen, MS, CRNP
What exactly is a VAD coordinator? What do they actually do? Why do we need VAD Coordinators? ICCAC what? Those of us who work in VAD programs know that the presence of a VAD coordinator is crucial to the success of a program. The Joint Commission requires that all certified VAD centers have one. So why have we had such a hard time trying to explain what a VAD coordinator is and does? Why has it been so hard to identify the core knowledge necessary to perform the role? Let's start at the beginning. Read more →
MCS Registries: Should they be Local, Regional, National, Supra-National, Continental and Global?
Theo de By, MBA, BSc
No clinician would doubt the need to register the events and data with respect to the implantation and follow-up of patients with mechanical circulatory support (MCS). Information about the course of therapy in individual patients, as well as the statistical evaluation of a group of patients over time, can teach us a lot about the effectiveness of the applied therapy. Specifically when, in this relatively new form of therapy, characterized by frequent innovations of the devices, evaluation of detailed information about the successes and failures is of great importance. Read more →
Joint Forces Combined in EUMS - The Number 1 MCS Meeting in Europe
Pascal Leprince, MD, PhD
In December 2015, EUMS (the European Mechanical Circulatory Support Summit) celebrated its tenth anniversary with a meeting in Paris. EUMS was created in 2006 from a common effort of the CT surgery departments of Bad Oeynhausen (Germany) and Paris (France). The aims of the meeting are to promote experience and share multidisciplinary knowledge in the field of mechanical circulatory support (MCS). During the past 10 years, EUMS has been held alternately in Bad Oeynhausen and Paris and has regrouped between 300 and 400 participants from all over the world for two and a half days; this year participants came from 28 different countries. Read more →
Studying the Studies or Surfing PubMed
Evgenij Potapov, MD, PhD
"Long-term mechanical circulatory support is an established treatment of end stage heart failure." This is how many, if not the majority of papers start. And the words are correct. In the past, there have been many papers reporting that implanting MCS saves lives. This has now become an established scientific fact, but it is based on only one prospective randomized study for destination therapy. It is also clear that no surgeon would randomize dying patients on the waiting list for heart transplantation (HTx). The focus of prospective "survival" studies has moved from dying to stable NYHA III patients. One example is a Germany based multicenter "Early LVAD" study, which should help us to understand the value of the LVAD during waiting times for HTx. Read more →
NURSING, HEALTH SCIENCE & ALLIED HEALTH:
Genetic and Genomics in Transplantation: It's complicated...but are we prepared?
Bernice Coleman, PhD, ACNP-BC, FAAN
Kathleen Calzone, PhD, RN, APNG, FAAN
It's been a long time since the human genome was explicated in 2003. No one questions the importance of genetic and genomic influences on the development of cardiovascular or thoracic diseases. In fact, among transplant patients, individual patient responses to treatments, most notably medications, vary from expected outcomes, to no effect or deleterious effects. While great strides in genetics and genomics have been seen in transplantation particularly as it relates to the use of Allomap; new findings on the horizons related to the use of genome-wide association studies, next generations sequencing exploration and cell free DNA methodologies continue to provide promise to improve patient outcomes. Read more →
The Road to Recovery - Rehabilitation after Lung Transplantation
Louise Fuller, PT
The definition of rehabilitation is the act of restoring something to its original state and comes from the latin re meaning "again" and habitare meaning "make fit". Exercise rehabilitation is an established element of care after lung transplantation (LTX). There is evidence about improving functional exercise capacity & muscle strength, but what about the patients' experience of post transplantation rehabilitation? What elements of the rehabilitation program are more useful to them? It can be challenging commencing an exercise program for many patients given the reduction in physical activity pre transplantation. Read more →
Pediatric Cardiac "Prehab"
Monica Horn, RN, CCRN, CCTC
Jessica Greim, PT, DPT
Cardiac rehabilitation (rehab) programs are therapeutically guided efforts usually aimed at recovery after heart surgery or other functional restorations. A tolerance-limited version of this sort of therapy, a cardiac "prehabilitation" ("prehab"), may be instituted for waitlisted cardiac failure patients in order to prevent further deconditioning before heart transplantation. Unlike adult heart failure patients, infants and younger children may not be able to recognize or verbally express activity intolerance during physical therapy sessions. Trained-eyes monitoring the child and supervising individually measured/planned activity prevent syncopal events or sudden death. Read more →
Quincy Young, PhD, RPsych
If you are like most people who work in medicine, you probably think that you make rational and purely data-driven medical decisions. Well, I'm going to kick off this article with some bad news for you. You don't. There is a substantial body of research describing cognitive errors and biases that come to play in decision making that often lead us to make irrational decisions. Medical decision making is not at all immune to these errors and biases, and may even be the perfect breeding ground for them. As professionals working in the area of transplantation, we make difficult decisions all the time, with life-and-death consequences. The scarcity of suitable organs makes listing decisions in transplant more difficult than decision making in many other medical settings. Read more →
OF SPECIAL INTEREST:
A Healthy Laugh
On April 20, 2010 the phone next to bed rang at 1:30 in the morning. My husband and I both woke up and knew it was "the" call. My transplant coordinator calmly told me that a new set of lungs were being prepared for me. The next few hours were a blur of activity. The drive to the hospital, being prepped, calling family and friends and then the wait in the pre-op area with my husband. I'm not sure if it came too slowly or too quickly, but it was time to head to the OR. Show time. Read more →
ISHLT NEWS AND ANNOUNCEMENTS:
ISHLT International Traveling Scholarships Awarded for December 2015
Daniel R. Goldstein, MD
Stephan Ensminger, MD, DPhil
Daniel Kreisel, MD, PhD
The ISHLT community extends to every corner of the globe and our members offer world leading expertise in every aspect of heart and lung transplantation, mechanical circulatory support, pulmonary hypertension and management of the failing heart or lungs. We encourage you to take advantage of being part of this amazing community by applying for an ISHLT International Traveling Scholarship. On behalf of the ISHLT, we would like to congratulate the following December 2015 International Traveling Scholarship Recipients. Read more →
From the Great Depression and World War II to the Cold War and Nuclear Arms Race: FDR, Harry and Ike
Vincent Valentine, MD
Franklin Delano Roosevelt was born in Hyde Park, New York on January 30, 1882. An admirer of his fifth cousin, Theodore Roosevelt (Teddy), he graduated from Harvard, attended Columbia Law School, married his distant cousin Eleanor Roosevelt (niece of Teddy) practiced law in New York City, was elected New York state Senator and became widely known by his initials, "FDR." He was appointed Assistant Secretary of the U.S. Navy in 1913 (the same position Teddy served in the 1890s) by President Wilson and kept this position through World War I. Read more →
"Leadership is the art of getting someone to do something you want done because he wants to do it."
— Dwight D Eisenhower
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Disclaimer: Any opinion, conclusion or recommendation published by the Links is the sole expression of the writer(s) and does not necessarily reflect the views of the ISHLT.