No correlation between lower extremity deep vein thrombosis and pulmonary embolism proportions in trauma: a systematic literature review.
Chemoprophylaxis; Chi Square Test; Deep vein thrombosis; Disease Surveillance – Evaluation; Emergency Patients; Fisher's Exact Test; Human; Lower Extremity – Pathology; Mechanical prophylaxis; PubMed; Pulmonary embolism; Pulmonary Embolism – Drug Therapy; Systematic Review; Ultrasound surveillance; Venous thromboembolism; Venous Thrombosis – Drug Therapy
PURPOSE: To assess the effect of surveillance on deep vein thrombosis (DVT) and pulmonary embolism (PE) rates, the efficacy of chemoprophylaxis and mechanical prophylaxis, and the relationship between DVT and PE. METHODS: A 23 year, systematic literature review was performed in PubMed. Twenty publications with \textgreater 13,000 patients were reviewed. Analyzed traits included: DVT surveillance utilization, the total number of patients included in each study, the number of patients developing DVT and/or PE, chemoprophylaxis and mechanical prophylaxis utilization. When event proportions from individual studies were combined, a weighted mean proportion was computed based on the size of each individual cohort. Combined event proportions were compared with other combined event proportions, according to differences in intervention. Inter-group event proportions were compared using Chi-Square or Fisher's exact test, as appropriate. RESULTS: DVT rates increase with surveillance (10.7% vs. 2.5%, p \textless 0.001). PE rates were similar regardless of surveillance (p = 1.0). Chemoprophylaxis lowered both DVT rates (8.2% vs. 10.7%; p \textless 0.0001) and PE rates (1.2% vs. 1.9%; p = 0.0050). Mechanical prophylaxis did not decrease DVT rates (10.2% vs. 11.5%; p = 0.2980) or PE rates (1.7% vs. 1.6%; p = 1.0). In patients with neither chemoprophylaxis nor mechanical prophylaxis, DVT rate was 11.5%, PE was 1.6%. When chemoprophylaxis and/or mechanical prophylaxis were given, DVT rate was 8.6% (p \textless 0.0189) and PE was 1.3% (p = 0.4462). PE proportions were not decreased with mechanical prophylaxis or surveillance. DVT and PE rates were not associated (p = 0.7574). CONCLUSIONS: The results suggest that PE is not associated with lower extremity DVT in adult trauma patients.
Aziz Hiba Abdel; Hileman Barbara M; Chance Elisha A
European journal of trauma and emergency surgery : official publication of the European Trauma Society
2018
2018-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1007/s00068-018-1043-3" target="_blank" rel="noreferrer noopener">10.1007/s00068-018-1043-3</a>
Chemopreventive doses of resveratrol do not produce cardiotoxicity in a rodent model of hepatocellular carcinoma.
*Chemoprevention; Analysis of Variance; Animal; Animal Studies; Animal/drug effects; Animals; Antioxidants; Behavior; Blotting; Carcinoma; Cardiotoxicity; Cardiotoxins/*toxicity; Chemoprevention; Data Analysis Software; Descriptive Statistics; Disease Models; Doppler; Dose-Response Relationship; Drug; Echocardiography; Feeding Behavior/drug effects; Female; Fisher's Exact Test; Funding Source; Heart – Drug Effects; Heart/drug effects/physiopathology; Hepatocellular – Prevention and Control; Hepatocellular/*drug therapy/pathology/physiopathology; Hepatocytes/drug effects/pathology; Humans; Liver Neoplasms/*drug therapy/pathology/physiopathology; Liver/drug effects/pathology/physiopathology; Polyphenols – Therapeutic Use; Rats; Resveratrol; Sprague-Dawley; Stilbenes/*therapeutic use; Systole/drug effects; Western
Hepatocellular carcinoma (HCC), one of the most lethal cancers, results in more than one million fatalities worldwide every year. In view of the limited therapeutic alternatives and poor prognosis of liver cancer, preventive control approaches, notably chemoprevention, have been considered to be the best strategy in lowering the present prevalence of the disease. Resveratrol, a naturally occurring antioxidant and antiinflammatory agent found in grapes and red wine, inhibits carcinogenesis with a pleiotropic mode of action. Recently, we have reported that dietary resveratrol significantly prevents chemically-induced liver tumorigenesis in rats. One of the mechanisms of resveratrol-mediated chemoprevention of hepatocarcinogenesis could be related to its antiinflammatory action through hepatic cyclooxygenase (COX-2) inhibition. Although several COX-2 inhibitors are known to exert chemopreventive efficacy, not all are considered ideal candidates for chemoprevention due to the risk of adverse cardiovascular events. Accordingly, the objective of the present study was to evaluate the role of resveratrol on cardiac performance during experimental hepatocarcinogenesis initiated with diethylnitrosamine and promoted by phenobarbital. Rats had free access to diet supplemented with resveratrol four weeks before the carcinogen injection and 14 weeks thereafter. The cardiotoxicity of resveratrol was assessed by monitoring the cardiac function using transthoracic echocardiography as well as Western blot analysis of cardiac tissue. Long-term dietary administration of resveratrol dose-dependently suppressed hepatic tumor multiplicity, the principal endpoint for evaluating the chemopreventive potential of a candidate agent. The chemopreventive effects of resveratrol were also reflected in histopathological assessment of hepatic tissues. Resveratrol did not exhibit any cardiotoxicity but rather improved the cardiac function in a dose-responsive fashion. Our results indicate that resveratrol-mediated chemoprevention of rat liver carcinogenesis is devoid of any adverse cardiovascular events. Resveratrol may be developed as a chemopreventive as well as therapeutic drug for human HCC.
Luther Daniel J; Ohanyan Vahagn; Shamhart Patricia E; Hodnichak Cheryl M; Sisakian Hamayak; Booth Tristan D; Meszaros J Gary; Bishayee Anupam
Investigational new drugs
2011
2011-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1007/s10637-009-9332-7" target="_blank" rel="noreferrer noopener">10.1007/s10637-009-9332-7</a>
Variation in hospital admission rates between a tertiary care and two freestanding emergency departments.
Admission rate; Ambulatory Care Facilities; Chi Square Test; Confidence Intervals; Emergency Service – Methods; Fisher's Exact Test; Freestanding emergency department; Human; Multiple Logistic Regression; Odds Ratio; Office Visits; Patient Admission; Patient Classification; Retrospective Design; Sex Factors; T-Tests; Tertiary Health Care
BACKGROUND: Recently, freestanding emergency departments (FSEDs) have grown significantly in number. Critics have expressed concern that FSEDs may increase healthcare costs. OBJECTIVE: We determined whether admission rates for identical diagnoses varied among the same group of physicians according to clinical setting. METHODS: This was a retrospective comparison of adult admission rates (n=3230) for chest pain, chronic obstructive pulmonary disease (COPD), asthma, and congestive heart failure (CHF) between a hospital-based ED (HBED) and two FSEDs throughout 2015. Frequency distribution and proportions were reported for categorical variables stratified by facility type. For categories with cell frequency less or equal to 5, Fisher's Exact test was used to calculate a P value. Chi square tests were used to assess difference in proportions of potential predictor variables between the HBED and FSEDs. For continuous variables, the mean was reported and Student's t-test assessed the difference in means between HBED and FSED patients. Multivariate logistic regression analyses were performed to estimate the unadjusted and adjusted prevalence odds ratio with 95% confidence interval (CI) for patient disposition outcomes associated with type of ED facility visited. RESULTS: Of 3230 patients, 53% used the HBED and 47% used the FSED. Patients visiting the HBED and FSED varied significantly in gender, acuity levels, diagnosis, and number of visits. Age was not significantly different between facilities. Multivariable adjusted estimated prevalence odds ratio for patients admitted were 1.2 [95%CI: 1.0-1.4] in the HBED facility compared to patients using FSEDs. CONCLUSION: In our healthcare system, FSEDs showed a trend towards a 20% lower admission rate for chest pain, COPD, asthma and CHF.
Simon Erin L; Dark Cedric; Kovacs Mitch; Shakya Sunita; Meek Craig A
The American journal of emergency medicine
2018
2018-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.ajem.2017.10.066" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2017.10.066</a>
Workplace Violence Training Using Simulation.
Attitude of Health Personnel; Chi Square Test; Clinical Assessment Tools; Descriptive Statistics; Disaster Planning; Fisher's Exact Test; Health Personnel; Human; Learning Environment; Literature Review; McNemar's Test; Multidisciplinary Care Team; Nonverbal Communication; Nursing; Ohio; Qualitative Studies; Quantitative Studies; Role Playing; Self Assessment; Self Defense; Simulations; Students; Summated Rating Scaling; Validity; Videorecording; Weapons; Workplace Violence – Education
: Workplace violence in health care settings is increasing dramatically nationwide. In response, an interdisciplinary team at an Ohio health system developed and piloted a model of training to address workplace violence. The model included classroom learning, a code silver (person with a weapon or a hostage situation) simulation training, and hands-on self-defense techniques. Based on data collected in the pilot, the team revised the model to offer a more comprehensive approach; the new, revised training program is known as Violence: enABLE Yourself to Respond. The team designed four distinct five-minute simulation scenarios depicting a range of threats from "escalating behavior" to "active shooter" and enacted them with standardized participants (health care personnel trained to perform specific behaviors in educational scenarios). Immediately after each simulation, the instructors facilitated a debriefing of the participants. Participants' pre- and post-training program self-evaluations of how prepared they felt to react to violent situations, as well as experts' evaluations of the participants' performance in simulations, provided evidence of the effectiveness of the model. Analysis of the data demonstrated a statistically significant positive difference in both participants' perception of their preparedness and experts' evaluation of their performance. The combination of classroom learning and simulation training is an effective, evidence-based method to prepare employees to respond when a situation escalates to violence, including the use of a weapon. This approach was designed for acute care but can be adapted to other settings. Skills learned can be used in both personal and professional life.
Brown Robin G; Anderson Shauna; Brunt Barbara; Enos Trish; Blough Keith; Kropp Denise
The American journal of nursing
2018
2018-10
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<a href="http://doi.org/10.1097/01.NAJ.0000546382.12045.54" target="_blank" rel="noreferrer noopener">10.1097/01.NAJ.0000546382.12045.54</a>
Short-term functional decline and service use in older emergency department patients with blunt injuries.
*Activities of Daily Living; 80 and over; 80 and Over; Academic Medical Centers; Activities of Daily Living; Aged; Bone/physiopathology/therapy; Clinical Assessment Tools; Comorbidity; Confidence Intervals; Descriptive Statistics; Emergency Care – In Old Age; Emergency Patients – In Old Age; Emergency Service; Family; Female; Fisher's Exact Test; Fractures; Functional Status – In Old Age; Geriatric Assessment; Geriatric Functional Assessment; Health Resource Utilization – In Old Age; Hospital/*statistics & numerical data; Hospitals; Human; Humans; Logistic Models; Logistic Regression; Longitudinal Studies; Male; Mental Status Schedule; Nonpenetrating – In Old Age; Nonpenetrating/*physiopathology/*therapy; OARS Multidimensional Functional Assessment Questionnaire; Odds Ratio; Ohio; Outcome Assessment; Outpatients; P-Value; Predictive Value of Tests; Prospective Studies; Questionnaires; Record Review; ROC Curve; Scales; Summated Rating Scaling; Surveys and Questionnaires; T-Tests; Teaching; Treatment Outcome; Treatment Outcomes; Wounds
BACKGROUND: Injuries are a common reason for emergency department (ED) visits by older patients. Although injuries in older patients can be serious, 75% of these patients are discharged home after their ED visit. These patients may be at risk for short-term functional decline related to their injuries or treatment. OBJECTIVES: The objectives were to determine the incidence of functional decline in older ED patients with blunt injuries not requiring hospital admission for treatment, to describe their care needs, and to determine the predictors of short-term functional decline in these patients. METHODS: This institutional review board-approved, prospective, longitudinal study was conducted in two community teaching hospital EDs with a combined census of 97,000 adult visits. Eligible patients were \textgreater or = 65 years old, with blunt injuries \textless48 hours old, who could answer questions or had a proxy. We excluded those too ill to participate; skilled nursing home patients; those admitted for surgery, major trauma, or acute medical conditions; patients with poor baseline function; and previously enrolled patients. Interviewers collected baseline data and the used the Older Americans Resources and Services (OARS) questionnaire to assess function and service use. Potential predictors of functional decline were derived from prior studies of functional decline after an ED visit and clinical experience. Follow-up occurred at 1 and 4 weeks, when the OARS questions were repeated. A three-point drop in activities of the daily living (ADL) score defined functional decline. Data are presented as means and proportions with 95% confidence intervals (CIs). Logistic regression was used to model potential predictors with functional decline at 1 week as the dependent variable. RESULTS: A total of 1,186 patients were evaluated for eligibility, 814 were excluded, 129 refused, and 13 were missed, leaving 230 enrolled patients. The mean (+/-SD) age was 77 (+/-7.5) years, and 70% were female. In the first week, 92 of 230 patients (40%, 95% CI = 34% to 47%) had functional decline, 114 of 230 (49%, 95% CI = 43% to 56%) had new services initiated, and 76 of 230 had an unscheduled medical contact (33%, 95% CI = 27% to 39%). At 4 weeks, 77 of 219 had functional decline (35%, 95% CI = 29% to 42%), 141 of 219 had new services (65%, 95% CI = 58% to 71%), and 123 of 219 had an unscheduled medical contact (56%, 95% CI = 49% to 63%), including 15% with a repeated ED visit and 11% with a hospital admission. Family members provided the majority of new services at both time periods. Significant predictors of functional decline at 1 week were female sex (odds ratio [OR] = 2.2, 95% CI = 1.1 to 4.5), instrumental ADL dependence (IADL; OR = 2.5, 95% CI = 1.3 to 4.8), upper extremity fracture or dislocation (OR = 5.5, 95% CI = 2.5 to 11.8), lower extremity fracture or dislocation (OR = 4.6, 95% CI = 1.4 to 15.4), trunk injury (OR = 2.4, 95% CI = 1.1 to 5.3), and head injury (OR = 0.48, 95% CI = 0.23 to 1.0). CONCLUSIONS: Older patients have a significant risk of short-term functional decline and other adverse outcomes after ED visits for injuries not requiring hospitalization for treatment. The most significant predictors of functional decline are upper and lower extremity fractures.
Wilber Scott T; Blanda Michelle; Gerson Lowell W; Allen Kyle R
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2010
2010-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1553-2712.2010.00799.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2010.00799.x</a>
Improving Vitamin D Levels in Hospitalized Individuals at Risk of Falls.
Ohio; Aged; Accidental Falls; Human; Chi Square Test; Fisher's Exact Test; Retrospective Design; OHIO; ACCIDENTAL falls; CHI-squared test; DIETARY supplements; DISEASE complications; FISHER exact test; HOSPITAL care of older people; RETROSPECTIVE studies; THERAPEUTIC use of vitamin D; VITAMIN D; VITAMIN D deficiency; Dietary Supplementation; Hospitalized; Vitamin D – Blood; Vitamin D Deficiency – Complications; Vitamin D – Therapeutic Use
The article reports on research which was conducted to investigate vitamin D levels and vitamin D supplementation in hospital patients at risk of falls. Researchers evaluated the vitamin D levels of 190 patients. They found that 63.7% were vitamin D deficient, that 40.4% of patients with deficiency were aged 65 and older and that screening for vitamin D deficiency and vitamin D supplementation were suboptimal.
Prater Janna; Greene Giesele R; Rowland Douglas Y; Chaiban Joumana T
Journal of the American Geriatrics Society
2014
2014-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/jgs.13060" target="_blank" rel="noreferrer noopener">10.1111/jgs.13060</a>
Cocooning: Influenza Vaccine for Parents and Caregivers in an Urban, Pediatric Medical Home.
Adult; Female; Male; Aged; Child; Infant; Caregivers; Parents; Nurse Practitioners; Human; Chi Square Test; Funding Source; Middle Age; Fisher's Exact Test; Adolescence; Pearson's Correlation Coefficient; Preschool; McNemar's Test; Pediatricians; Wilcoxon Rank Sum Test; Influenza – Prevention and Control – In Infancy and Childhood; Influenza – Risk Factors; Influenza Vaccine – Administration and Dosage
White PC; Baum DL; Ross H; Falletta L; Reed MD
Clinical pediatrics
2010
2010
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/0009922810374353" target="_blank" rel="noreferrer noopener">10.1177/0009922810374353</a>
Correlation of noninvasive cerebral oximetry with cerebral perfusion in the severe head injured patient: a pilot study.
Adult; Female; Male; Prospective Studies; Confidence Intervals; Human; Convenience Sample; Chi Square Test; Data Analysis Software; Pilot Studies; Middle Age; Fisher's Exact Test; Pearson's Correlation Coefficient; T-Tests; Oximetry; Monitoring; Linear Regression; Tissue Perfusion; Intracranial Pressure; Head Injuries – Therapy
BACKGROUND: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in trauma patients. Cerebral perfusion pressure (CPP) directed ICU management is recommended for patients with severe TBI. It, however, requires an invasive device to measure intracranial pressure (ICP). Transcranial cerebral oximetry is a noninvasive method utilizing near-infrared technology to indirectly measure cerebral saturation (StCO2). METHODS: A prospective observational study was performed at a Level I trauma center. Data were collected hourly for the first 6 days on four patients with severe TBI. Each patient had ICP monitoring and StCO2 (INVOS, Somanetics) assessed from each frontal lobe. CPP directed care was used. RESULTS: Four patients with TBI, with admission GCS scores of 4, 4, 7, and 8, all had subdural hematomas and contusions; three had subarachnoid hemorrhage (SAH); one had an epidural hematoma (the only death; day 6); two had craniotomies. In the first 48 hours when CPP \textgreater or = 70, StCO2 was 71 +/- 9, while it was 61 +/- 9 when CPP \textless 70 (p \textless 0.0001). This relationship was constant for all study days, with p \textless 0.0001. Moreover, CPP \textless 70 correlated with StCO2 with r = 0.8l and r(2) = 0.66. StCO2 \textgreater or = 75 was associated with CPP \textgreater or = 70 96.4% of the time (95% CL, 94.3-98.5%). StCO2 \textless 55 was associated with CPP \textless 70 68.2% of the time (95% CL, 57-79.4%). Also, 13.4% of observations with CPP \textgreater or = 70 had StCO2 \textless 60, suggesting the potential of cerebral ischemia in the face of 'normal' CPP. The StCO2 patches were user-friendly and not technically finicky. CONCLUSION: In this pilot study, StCO2 correlated significantly with CPP. A StCO2 \textgreater or = 75 suggests that CPP is adequate, while \textless 55 suggests an inadequate CPP. Although these results should be confirmed in a larger study, StCO2 may serve as a noninvasive measurement of cerebral perfusion in the patient with a TBI or, at the very least, a sensitive indicator for the need to begin monitoring the ICP.
Dunham CM; Sosnowski C; Porter J M; Siegal J; Kohli C
Journal of Trauma
2002
2002-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/00005373-200201000-00009" target="_blank" rel="noreferrer noopener">10.1097/00005373-200201000-00009</a>
Dactylitis: implications for clinical practice.
Adult; Female; Male; Prospective Studies; Human; Chi Square Test; Descriptive Statistics; Middle Age; Fisher's Exact Test; Diagnosis; Differential; Fingers; Toes; Gout – Complications
OBJECTIVES: To assess the specificity of dactylitis for the diagnosis of spondyloarthropathy, sarcoidosis, and gout; and to characterize dactylitis specifically associated with gout. METHODS: Dactylitis was prospectively assessed among all individuals presenting to the Arthritis Center of Northeast Ohio from 1986 to 1996. RESULTS: Dactylitis was observed in 12% of individuals with spondyloarthropathy, 17% with sarcoidosis, and 5% with gout, but not in 96 patients with rheumatoid arthritis or in 2,434 patients with osteoarthritis, neck or back pain, or collagen vascular diseases. Among individuals with spondyloarthropathy, dactylitis was present in 22% with psoriatic, 28% with Reiter's syndrome, and only 7% with undifferentiated spondyloarthropathy. Gouty dactylitis was found only in individuals with polyarticular disease. CONCLUSIONS: Dactylitis is a valuable clue in the differential diagnosis of arthritis. Compared with the wider spectrum in children, sausage-shaped digits have only a few known causes in adults: Reiter's syndrome, psoriatic arthritis, sarcoidosis, flexor tendon sheath infections, and gout. In our series, the presence of dactylitis eliminated rheumatoid arthritis from the differential diagnosis. Copyright (c) 1998 by W.B. Saunders Company
Rothschild B M; Pingitore C; Eaton M
Seminars in Arthritis & Rheumatism
1998
1998-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0049-0172(98)80027-9" target="_blank" rel="noreferrer noopener">10.1016/s0049-0172(98)80027-9</a>
Onset of exercise increases lumbar sympathetic nerve activity in rats.
Rats; Exercise; Heart Rate; Lumbar Vertebrae; Funding Source; Data Analysis Software; Fisher's Exact Test; One-Way Analysis of Variance; Two-Tailed Test; Paired T-Tests; Animal Studies; Spinal Nerves; Sympathetic Nervous System – Physiology
DiCarlo S E; Chen C; Collins H L
Medicine & Science in Sports & Exercise
1996
1996-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/00005768-199606000-00006" target="_blank" rel="noreferrer noopener">10.1097/00005768-199606000-00006</a>
The Effect of Pharmacy-Led, Small-Group Academic Detailing on Prescribing Patterns in an Ambulatory Care Clinic.
Adrenergic Beta-Antagonists -- Therapeutic Use; Adult; Ambulatory Care Facilities; Chi Square Test; Descriptive Statistics; Diabetes Mellitus; Education; Essential Hypertension -- Drug Therapy; Fisher's Exact Test; Human; Hyperlipidemia -- Drug Therapy; Medically Underserved Area; Metformin -- Therapeutic Use; Non-Traditional; Outcomes of Education; Pharmacy Service; Physicians -- Education; Prescribing Patterns -- Education; Statins -- Therapeutic Use; Type 2 -- Drug Therapy
Background: While academic detailing seems to be the most promising intervention to improve prescribing patterns, implementation could be challenging for small community practices. Objective: A pharmacy-led, interactive, and tailored small-group academic detailing in a federally qualified health center is described. The primary objective of the study was to determine if the small-group academic detailing improved the prescribing patterns of the medical providers for select disease states: type 2 diabetes mellitus (T2DM), hyperlipidemia (HLD), and essential hypertension (HTN). Methods: Prescribing patterns in a federally qualified health center were examined in relation to small-group academic detailing sessions from April 2010 to March 2015. The markers for improvement were the increase in utilizing metformin and statins in patients diagnosed with T2DM and HLD, respectively, and the reduction of β-blocker use in patients diagnosed with essential HTN. Changes in prescribing patterns were evaluated using Pearson's χ2 and Fisher's exact tests. Results: The average number of active, adult patients with T2DM, HLD, and essential HTN was 839, 1768, and 2547, respectively. Utilization of metformin in T2DM increased from 5.5% at baseline to 37.7%, statin utilization in HLD increased from 77.1% to 86.9%, and β-blocker use in HTN decreased from 17.9% to 13.8% (P < .005). Conclusions: A pharmacy-led, small-group academic detailing program improved and maintained appropriate prescribing patterns in an underserved community practice. This study serves as a successful pilot emphasizing the pharmacist's role as an educator and a resource to medical providers regarding appropriate medication use.
Awad Magdi H; Ulbrich Timothy R; Furdich Kenneth M; Schneider Stacy R; Gothard M David
Journal of Pharmacy Technology
2019
2019-04
<a href="http://doi.org/10.1177/8755122518818826" target="_blank" rel="noreferrer noopener">10.1177/8755122518818826</a>
Improving a mature palliative care program at a Level I trauma center.
Advance Directives; Confidence Intervals; Data Analysis Software; Depression; Descriptive Statistics; Documentation; Electronic Health Records; Fisher's Exact Test; Frailty Syndrome; Hospital Programs; Human; Palliative Care; Pearson's Correlation Coefficient; Quality Improvement; Questionnaires; Simulations; Trauma Centers
Background: Similar to the significant rise in the geriatric population in the United States, trauma centers have seen an increase in geriatric trauma patients. These patients present with additional challenges such as a higher likelihood of undertriage, mortality, and frailty. In addition, the varying presence of advanced directive documentation increases the importance of early palliative care consultations for geriatric trauma patients. Objective: In 2018, a Level I trauma center in the Midwest reviewed the American College of Surgeons Trauma Quality Improvement Program's Palliative Care Best Practice Guideline to identify opportunities for improvement to strengthen the collaboration between the palliative care consult service and trauma program. Methods: The guideline drove improvements, which included documentation changes (i.e., expansion of palliative care consultation triggers, frailty assessment, advanced directives questions, depression screening, and addition of palliative care consultation section on the performance improvement program form) and training (1-hr lecture on palliative care and 5-hr palliative care simulation training) opportunities. Results: A 3-month manual chart review (March 2019 through May 2019) revealed that by May 2019, 87.2% of admitted geriatric trauma patients received frailty assessments, which surpassed the benchmark (>85%). In addition, advanced care planning questions (i.e., health care power of attorney, do not resuscitate order, or living will) exceeded the benchmarks set forth by the guideline (>90%), with all of the questions being asked and documented in 95.7% of those same patient charts by May 2019. Conclusion: This quality improvement project has applicability for trauma centers that treat geriatric trauma patients; using the guidelines can drive changes to meet individual institution needs.
Moran ME; Soltis M; Politis T; Gothard MD; George RL
Journal Of Trauma Nursing
2021
2021-04-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1097/JTN.0000000000000569" target="_blank" rel="noreferrer noopener">10.1097/JTN.0000000000000569</a>