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Purpose: Many patients with mild traumatic brain injury do not fully return to work owing to persistent posttraumatic complaints. Research suggests that preventing chronic complaints might be prevented by giving cognitive behavioral therapy early after injury. Therefore, a new cognitive behavioral intervention (UPFRONT-intervention) was developed to not only prevent chronic complaints but to also establish a more successful return to work. The intervention is currently being evaluated in a multicenter randomized controlled trial design (trial number ISRCTN86191894) in mild traumatic brain injury patients who are at-risk of negative outcomes (patients with high numbers of early complaints). Two case examples are presented to demonstrate the application of the intervention. Rationale: Psychological factors, like cognitive appraisal and coping, play an important role in the persistence of posttraumatic complaints. Some patients are less able to adapt and thus to cope with the injury and its initial consequences than others. Dealing with the injury in a passive, avoidant way, focusing on negative feelings, will hamper recovery and is therefore a valuable target for an intervention. Theory into practice: The UPFRONT intervention is a short cognitive behavioral therapy intervention for patients that are at-risk of developing persistent posttraumatic complaints. Patients will undergo five sessions of cognitive behavioral therapy within 4–10 weeks after trauma. The intervention aims to enhance patients’ feeling of competency of dealing with the consequences of mild traumatic brain injury by providing psycho-education, identifying and challenging unrealistic illness perceptions and improving coping style (decreasing maladaptive coping and enhancing adaptive coping).

Objective: The most recent WHO definition of palliative care regards living as actively as possible as an important aim. We explored, over a 1-year period, the work this involves for patients with end-stage heart failure. Design: Prospective longitudinal multiple case study using qualitative interview techniques. Participants: Thirty-one respondents from two hospitals who fulfilled one or more of the following criteria: NYHA III or IV, ejection fraction B/25%, at least one hospitalization for heart failure. Main outcomes: Types and content of patient work involved in living with end-stage heart failure. Results: For patients with advanced heart failure, work consisted mainly of four types of tasks, as identified by Glaser and Strauss: ‘managing illness’, ‘everyday work to keep life going’, ‘biographical work’ and ‘arrangement work’. Conclusions: Systematic attention to patient work, for example using these four categories, could improve the quality of care from the patient’s perspective.

Objective: To explore, over a one-year period, the ideas and attitudes of patients with end-stage cardiac failure concerning dying. Design: Prospective longitudinal multiple case study using qualitative interview techniques. Participants: Thirty-one patients from two hospitals who fulfilled one or more of the following criteria: NYHA III or IV, ejection fractionB >25%, at least one hospitalization for heart failure. Main outcomes: Statements of patients with advanced heart failure, expressed in semi-structured interviews, concerning the quality of dying and medical decisions at the end of life. Results: Many respondents only thought about death during exacerbations. Mentioned aspects of appropriate dying include: a degree of usefulness, prognostic knowledge, appropriate duration and mental awareness. Few respondents were in favour of euthanasia or suicide, but all wanted life-prolonging treatment to be withheld or withdrawn when appropriate. Conclusions: Our study found some elements of ‘appropriate dying’ that differ from other studies and that are relatively specific for advanced heart failure. The tendency of patients not to think about death raises ethical concerns.

This case report describes the successful repair of an acute dissection of the ascending aorta in a 16-year-old girl. The dissection appeared to be related to the presence of an aortic coarctation. Furthermore, a bicuspid aortic valve was found. Echocardiography was helpful for quick pre-operative diagnosis. A computed tomography (CT) scan was used post-operatively to confirm these results. At the onset of extracorporeal circulation, active drainage was applied at the femoral vein by means of a routinely built-in shunt bypassing the venous reservoir. The practical implementation of this shunt is described in this report. One femoral artery and one femoral vein were cannulated, resulting in a blood flow index of 2.2l.min -1.m-2 which proved to be sufficient for blood supply to both the lower and the upper parts of the body. Successful percutaneous dilatation of the coarctation was performed five months after the first operation. Perfusion (2007) 22, 365—367.

In a clinical evaluation to study the performance of hollow-fibre membrane oxygenators, we compared the gas exchange characteristics and the production of plasma free haemoglobin for different oxygenators. In this study, the data of the Univox, Cobe-Optima, Capiox-SX, Affinity, Safe II and Sarns Turbo 440 oxygenators were evaluated during cardiac surgery in comparable patient groups. Thirteen patients scheduled for elective surgery were enrolled in each group. In all groups, cardiopulmonary bypass (CPB) was conducted using pulsatile blood flow during fibrillation and the period in which the aorta was crossclamped. Arterial and venous blood gases were determined from which oxygen transfer, carbon dioxide transfer, oxygen gradient, shunt fraction and diffusing capacity were calculated. Blood samples were taken 5, 30, 60 and 90 min after beginning CPB. As a result of our measurements we found that the gas exchange capacities of all six oxygenators are within clinically acceptable limits, although the data considering oxygen and carbon dioxide transfer showed a significantly higher capacity for the Sarns Turbo 440 oxygenator ( p < 0.05) in comparison with the other oxygenators. Plasma free haemoglobin was, however, significantly higher in the Univox and Sarns Turbo 440 groups ( p < 0.005). This difference was already present after 30 min of bypass and increased with time, and is considered as a negative aspect, in relation to optimal patient care.

Using Dutch adaptations of the State-Trait Anxiety Inventory, State-Trait Anger Scale, Zung Depression Scale, and Life Orientation Test, we attempted to identify which patients recovering in the hospital from acute myocardial infarctions required and would accept psychological care. Of 63 patients who completed the relevant questionnaires, 9 required and accepted psychological care and 6 of these were correctly predicted by the criteria (sensitivity = .67). Of the 54 patients not classified as requiring and accepting psychological care, 49 were correctly predicted (specificity = .90; efficiency = .87). Noncompletion ( n = 7) was positively associated with classification as requiring and accepting psychological care. An easy to administer brief questionnaire may help identify those patients with a recent myocardial infarction who, in the opinion of mental health care professionals, require and accept psychological care.

The purpose of this study was to create an in vitro system to quantify the fluid loss over two different types of hollow-fibre membrane oxygenators. In the first stage of the study, the circuit was primed with 0.9% NaCl and the line pressure was 200 mmHg; in the second stage, the line pressure was 400 mmHg. The experiment was repeated using bovine blood. A clear difference (p < 0.005) was found in the first stage, accumulating to 47.46 ml (SD 0.41) in the Capiox-SX group and 72.33 ml (SD 3.77) in the Univox group after 4 h. This difference persisted when using bovine blood. Surprisingly, no differences in volume loss occurred when the line pressure was increased to 400 mmHg. In conclusion, leakage in hollow-fibre microporous polypropylene membrane oxygenators can be quantified and the amount of leakage appears to be dependent on the type of membrane and the manufacturing process.

Magnetic resonance imaging of the heart, and more specifically of the left ventricle (LV), is optimized by using oblique imaging planes adapted to the long and short axes of the LV, comparable to other imaging modalities in cardiology. We report a procedure to perform two chamber views, four chamber views and true short axis views by combinations of electronic axial rotations. The technique of selecting appropriate gradient angles is explained. Thus, there is no requirement for altering patient position in the imager, while individual anatomic variations are taken into account.