Many thanks to Erin Wells & Jussi Tikkanen for coordinating the content for this month's issue.

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The book has been closed on 2016. Resolutions have been made, which surely some are already failing. As we look ahead, it is always wise to peer into the looking glass of time past for us to focus on improvement. A glance back to the January 2013 Issue of the Links may be worth a peek, just to see the progress we have made.

For the January 2017 issue, Erin Wells reminds us of those precious moments that can go by in a flash if we don't pause and try to suspend time for our memory. The goal is seizing such opportunities, especially those that might bring us everything we ever wanted, and even if we have just one shot. But there are those difficult and stressful moments we do not want to recall or face, instead preferring to just let them slip away. Therefore, we just might want to lose ourselves in the music. Umm, I wonder where I got these thoughts from? Such thoughts are conjured up by Monica Horn and Leah Cruz on the Fine Art of Music Theory for our patients, particularly the pediatric population. Then Rebecca Lewis shares with us the unrivaled importance of time, dedication and devotion to help a nurse capture their opportunity in becoming a master VAD coordinator in her article on Ventricular Assist Device Mentorships, while Linda Staley gives us the supremely important Paradigm Shift: End-of-Life Care with Destination Therapy LVAD. Tara Bolden, Susan Chernenko and Nikki Marks provide us some unrivaled insights on Nurse Practitioners and Patients with Prolonged Lung Transplant Hospitalizations. Of special interest, we have Stephanie Pouch's Patient Safety Alert - Report of Contaminated Organ Preservation Solution. And finally, from the Editor's Corner, there is the refulgent reflection by the inimitable Allan Glanville on How Do We Care?

Happy New Year!

Vincent Valentine, MD
Links Editor-in-Chief


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Moments in Time

Erin Wells, BSN, RN, CCTC, CPN

I have been trying to think of a way to tie in an out with the old, in with the new theme for this article without it being a little too over the top or cheesy. Last week, this popped up on my Facebook feed: My entire life can be summed up in one sentence "...well that didn't go as planned." I reposted and added I wouldn't have it any other way. The last 11 years have been a roller coaster to say the least. 7 moves, 6 jobs in 6 states, several significant family losses, 3 transplant centers, 2 fur babies and 1 husband later I never would have mapped out this path for my life. Truth be told, if there had been a category in our senior year book for most likely to never leave Louisiana, I would have taken that prize easily. This also explains why I have always felt "where do you see yourself in 5 years" is an awful interview question. Read more →


The Fine Art of Music Therapy

Monica Horn, RN, CCRN-K, CCTC
Leah Cruz, MT-BC

It has been said that music may be thought of as a universal language for expressing thoughts or feelings. As an escape, to perhaps "lose yourself in the music" there's a lift above the clouds to seize it all. Many of us find solace in listening to our favorite selections while going to and from work to help inspire anticipated management of daily interactions or to cope with stress accumulated by the end of the day. Of course, when we arrive to work or home from work, gravity "snaps us back to reality." What if we could help sick children and their families cope with illness and hospitalization through music? Historically, therapeutic use of music has been documented for rehabilitative purposes back to Orpheus and the Ancient Greeks over 2500 years ago. Patients with medical conditions including pain syndromes, neurological disorders, childhood illness-related developmental delays, psychiatric conditions or anxiety states, memory problems and communication deficits have benefited greatly from music therapy. Children who have severe heart failure awaiting heart transplantation in a hospital setting are particularly vulnerable to having acquired these conditions as well. Read more →

Ventricular Assist Device Mentorships

Rebecca Lewis, RN, MN

links imageMentoring is a crucial step in a new nurse becoming a competent nurse. It takes months to learn the many tasks and processes within a hospital, much less master them. The mentoring process nurtures the nurse during a crucial time, establishing habits that could extend through the nurses career. This highly sensitive time is crucial in developing successful nurses! It is no different as a ventricular assist device (VAD) coordinator. Whether a coordinator has moved from the bedside or another type of role, the transition to becoming a VAD coordinator takes time and patience to master the multitude of skills required. One must learn how to manage the patients on device and the devices themselves, how to triage call, the intricacies of program management such as a staff education and regulatory requirements, how to manage emergencies in the community, how to run clinic, manage patients in a myriad of non-cardiac procedures, etc. The VAD coordinator role description demands fluidity as the challenges that present to programs and patients are continually changing. Read more →

Paradigm Shift: End-of-Life Care with a Destination Therapy LVAD

Linda Staley, NP

links imageHow does one handle end-of-life care with a Destination Therapy (DT) LVAD? Should it begin during the selection process, prior to advanced therapies being started or performed? How does the LVAD team ensure that the quality of life of the patient and family goals are realistic and being met? When is the right time and place to engage the hospice team for end-of-life care in a DT LVAD so that the patient and family are availed of the most support from the service? How do these questions get answered within your DT LVAD program and among your interdisciplinary team? In 2014, the Joint Commission recognized the importance of the palliative care team as part of the VAD interdisciplinary team. The Joint Commission required program leaders to integrate the palliative care team within the program's core LVAD team. Incorporating the palliative care team within the VAD programs has resulted in enhanced support for the patient and family throughout the progression of life while on LVAD support. Read more →


Nurse Practitioners and Patients with Prolonged Lung Transplant Hospitalizations

Tara Bolden, MN, NP
Susan Chernenko, MN, NP
Nikki Marks, MN, NP

We all know that the patient with a ten-day post-lung transplant hospital stay is nearing extinction. We sometimes refer to patients with rare conditions as Zebras, however, patients with short stays after lung transplant are now unicorns! All kidding aside, it is a reality that patients' length of stays is becoming increasingly long and more complex. There are a variety of reasons for this, mostly resulting from the success of lung transplantation, and in our program, successful experience with recipients with complex medical issues. Many of our patients are older, have multiple co-morbidities, and often have survived the use of life-sustaining treatments like ECLS either as a bridge to transplant, or bridge to recovery. For our patients, this results in what Frank calls "deep illness" (Frank, 1998), a state of illness that is "perceived as lasting, as affecting virtually all life choices and decisions, and as altering identity" (p. 197). This state of being results in significant physical compromise, and can also cause significant financial hardship, emotional stress and negative physical and psychological reactions for caregivers as well. Read more →


Patient Safety Alert - Report of Contaminated Organ Preservation Solution

Stephanie Pouch, MD

links imageThe Centers for Disease Control (CDC), Healthcare Resources and Services Administration (HRSA), Food and Drug Administration (FDA), and the Iowa Department of Public Health (IDPH) are actively investigating a report of bacterial contamination of the organ preservation solution, SPS-1, produced by Organ Recovery Systems (ORS). On December 12, 2016, surgeons observed a foul odor emanating from the organ preservation solution. The CDC and IDPH were notified on December 14, 2016, and samples of SPS-1 from several opened bags grew Pantoea agglomerans, Enterococcus casseliflavus, and Streptococcus mitis/oralis group. The bags with microbial growth were reported from two lots of SPS-1, PBR-0074-330 (expiration 07/01/2018) and PBR-0060-392 (expiration 06/01/2018), and ORS has recalled both lots. All organ procurement organizations (OPOs) and transplant centers need to be aware of the potentially contaminated solution. SPS-1 from the aforementioned lots should not be utilized, and centers have been instructed to recover and return any unused product to ORS. Read more →


How Do We Care?

Allan Glanville, MBBS, MD, FRACP

links imageAs the old year fades into our memory banks and the New Year begins, it is appropriate to reflect. Do we care and specifically how do we care? How do we care for our sick patients, those being worked up for listing for transplantation, those needing assist devices, those on the active waiting list for whom the bell might toll, those who are struggling with the failure of transplantation to meet their ideals and aspirations, those who have achieved a better quality and duration of life from transplant but fear that their graft might be failing and the broader family of loved ones who sit patiently and quietly (well not always quietly!) as we pontificate about diagnostic investigations, progress and potentially beneficial therapies, all of which come with side effects that are sometimes worse than the underlying condition itself. In large units that are well resourced the thoracic surgeon and pulmonologist do not stand alone. They are flanked by a veritable army of nursing healthcare scientists and allied health clinicians who provide the majority of care and often know more about the day to day thoughts, feelings and activities of their patients than the medical practitioner. Read more →


Vincent G Valentine, MD

Editorial Staff

"I lose myself in music because I can't be bothered explaining what I feel to anyone else around me."
— Robert Smith of the Cure, for the Cure with great music by the Cure

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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.