Chao J.A.K.,Summa Akron City Hospital |
Firstenberg M.S.,Summa Akron City Hospital
International Journal of Critical Illness and Injury Science | Year: 2017
Our first case is an 84-year-old female diagnosed with sick sinus syndrome. She underwent implantation of dual chamber permanent pacemaker without complications. On the 8th day status-postimplantation, she returned to the emergency department (ED) with moderately severe left anterior chest pain and significant ecchymosis. She was given an initial diagnosis of shingles and discharged. Two days later, she returned to the ED with increasing chest pain, dyspnea, nausea, and vomiting. Lead migration and cardiac perforation was confirmed by chest X-ray and computed tomography (CT), respectively. She was taken to the operating room (OR) for lead repositioning, and she was discharged the next day. Our second case is a 64-year-old female with a diagnosis of 2:1 high-grade third-degree atrioventricular block. A dual chamber permanent pacemaker system was implanted without initial complication. Five days after implantation, she presented to the ED following an episode of syncope due to hypotension (67/46), shortness of breath, left flank pain, and fatigue. The initial diagnosis was sepsis. A chest CT was obtained, noting lead perforation and hemothorax. The patient was taken to the OR for lead repositioning. © 2017 International Journal of Critical Illness and Injury Science.
Frey J.,Emergency Medicine Research Center |
Zalewski J.,Summa Akron City Hospital |
Maiers J.F.,San Juan Regional Medical Center |
Bhalla M.C.,Summa Akron City Hospital
Prehospital Emergency Care | Year: 2013
Background. Identifying ST-segment elevation myocardial infarctions (STEMIs) by paramedics can decrease door-to-balloon times. While many paramedics are trained to obtain and interpret electrocardiograms (ECGs), it is unknown how accurately they can identify STEMIs. Objective. This study evaluated paramedics' accuracy in recognizing STEMI on ECGs when faced with potential STEMI mimics. Methods. This was a descriptive cohort study using a survey administered to paramedics. The survey contained questions about training, experience, and confidence, along with 10 ECGs: three demonstrating STEMIs (inferior, anterior, and lateral), two with normal results, and five STEMI mimics (left ventricular hypertrophy [LVH], ventricular pacing, left and right bundle branch blocks [LBBB, RBBB], and supraventricular tachycardia [SVT]). We calculated the overall sensitivity and specificity and the proportion correct with 95% confidence intervals (CIs). Results. We obtained 472 surveys from 30 municipal emergency medical services (EMS) agencies in five counties with 15 medical directors from seven hospitals. The majority (69%) reported ECG training within the preceding year, 31% within six months; and 74% were confident in recognizing STEMIs. The overall sensitivity and specificity for STEMI detection were 75% and 53% (95% CI 73%-77%, 51%-55%), respectively. Ninety-six percent (453/472, 95% CI 94%-98%) correctly identified the inferior myocardial infarction (MI), but only 78% (368/472, 94% CI 74%-82%) identified the anterior MI and 51% (241/472, 46%-56%) the lateral MI. Thirty-seven percent (173/472, 95% CI 32%-41%) of the paramedics correctly recognized LVH, 39% (184/472, 95% CI 35%-44%) LBBB, and 53% (249/472, 95% CI 48%-57%) ventricular pacing as not a STEMI. Thirty-nine percent (185/472, 95% CI 35%-44%) correctly identified all three STEMIs; however, only 3% of the paramedics were correct in all interpretations. The two normal ECGs were recognized as not a STEMI by 97% (459/472, 95% CI 95%-99%) and 100% (472/472, 95% CI 99%-100%). There was no correlation between training, experience, or confidence and accuracy in recognizing STEMIs. Conclusions. Despite training and a high level of confidence, the paramedics in our study were only able to identify an inferior STEMI and two normal ECGs. Given the paramedics' low sensitivity and specificity, we cannot rely solely on their ECG interpretation to activate the cardiac catheterization laboratory. Future research should involve the evaluation of training programs that include assessment, initial training, testing, feedback, and repeat training. Copyright © 2012 Informa Plc.
Bhalla M.C.,Summa Health System |
Mencl F.,Summa Akron City Hospital |
Gist M.A.,Summa Health System |
Wilber S.,Summa Akron City Hospital |
Zalewski J.,Summa Akron City Hospital
Prehospital Emergency Care | Year: 2013
Background. Identifying ST-segment elevation myocardial infarctions (STEMIs) in the field can decrease door-to-balloon times. Paramedics may use a computer algorithm to help them interpret prehospital electrocariograms (ECGs). It is unknown how accurately the computer can identify STEMIs. Objectives. To Determine the sensitivity and specificity of prehospital ECGs in identifying patients with STEMI. Methods. Retrospective cross-sectional study of 200 prehospital ECGs acquired using Lifepak 12 monitors and transmitted by one of more than 20 emergency medical services (EMS) agencies to the emergency department (ED) of a Summa Akron City Hospital, a level 1 trauma center between January 1, 2007, and February 18, 2010. The ED sees more than 73,000 adult patients and treats 120 STEMIs annually. The laboratory performs 3,400 catheterizations annually. The first 100 patients with a diagnosis of STEMI and cardiac catheterization laboratory activation from the ED were analyzed. For comparison, a control group of 100 other ECGs from patients without a STEMI were randomly selected from our Medtronic database using a random-number generator. For patients with STEMI, an accurate computer interpretation was "acute MI suspected." Other interpretations were counted as misses. Specificity and sensitivity were calculated with confidence intervals (CIs). The sample size was determined a priori for a 95% CI of ±10%. Results. Zero control patients were incorrectly labeled "acute MI suspected." The specificity was 100% (100/100; 95% CI 0.96-1.0), whereas the sensitivity was 58% (58/100; 95% CI 0.48-0.67). This would have resulted in 42 missed cardiac catheterization laboratory activations, but zero inappropriate activations. The most common incorrect interpretation of STEMI ECGs by the computer was "data quality prohibits interpretation," followed by "abnormal ECG unconfirmed." Conclusions. Prehospital computer interpretation is not sensitive for STEMI identification and should not be used as a single method for prehospital activation of the cardiac catheterizing laboratory. Because of its high specificity, it may serve as an adjunct to interpretation. Copyright © 2012 Informa Plc.
Goldberg E.A.,Northeast Ohio Medical University |
Venkat-Ramani T.,Summa Akron City Hospital |
Hewit M.,Northeast Ohio Medical University |
Bonilla H.F.,University of Pittsburgh
Epidemiology and Infection | Year: 2013
This 10-year retrospective study assessed the epidemiology and outcomes of patients with Fusobacterium bacteraemia (FB) at a tertiary-care hospital in the USA-this is the second study focusing on FB in adults to be conducted in the USA in 30 years. Demographic, clinical, laboratory, treatment, and outcome data were collected and statistically analysed. Nineteen patients with FB were identified, representing 0·11% of bacteraemia cases. Mean age was 58·6 years with equal gender distribution. Common comorbidities included cardiovascular disease (CVD) and immunosuppression. Thirty-day mortality was 21·1%, and 68·4% of FB patients required intensive care unit (ICU) admission. Elevated creatinine levels and mental status changes were associated with higher mortality (P = 0·0181 and 0·0374, respectively). CVD, diabetes, and ICU admission were associated with increased length of hospital stay (P = 0·0017, 0·0010, and 0·0379, respectively). The prevalence of FB at our hospital was very low, with poor outcomes associated with increased creatinine level, mental status changes, CVD, diabetes and ICU admission. © 2012 Cambridge University Press.
King A.,Austin BioInnovation Institute in Akron |
King A.,University of Akron |
Holder Jr. M.G.,Austin BioInnovation Institute in Akron |
Holder Jr. M.G.,Akron Children’s Hospital |
And 2 more authors.
BMJ Quality and Safety | Year: 2013
This paper adopts methods from the organisational team training literature to outline how health professions education can improve patient safety. We argue that health educators can improve training quality by intentionally encouraging errors during simulation-based team training. Preventable medical errors are inevitable, but encouraging errors in low-risk settings like simulation can allow teams to have better emotional control and foresight to manage the situation if it occurs again with live patients. Our paper outlines an innovative approach for delivering team training.
Von Gruenigen V.E.,Summa Akron City Hospital
Obstetrics and Gynecology | Year: 2011
Objective: To examine lifestyle behaviors that may contribute to endometrial cancer survivor morbidity and to identify associations with quality of life. Methods: Patients with early-stage (I or II) endometrial cancer with a body mass index of at least 25 kg/m completed questionnaires on smoking, physical activity, fruit and vegetable intake, and the Functional Assessment of Cancer Therapy (FACT) and Short-Form medical outcomes (SF-36) quality-of-life surveys. Behaviors were compared with American Cancer Society 2006 guidelines for cancer survivors (150 min/wk of moderate-to-vigorous physical activity; five servings fruit and vegetables per day; no smoking). Effect size (d) was calculated for the difference in means between meeting and not meeting guidelines (d=0.5 moderate effect). Results: A total of 120 participants were enrolled. Of those, 43% had hypertension, 35% osteoarthritis, 33% metabolic syndrome, 21% type 2 diabetes mellitus, and 93% abdominal obesity. Only 12% of participants were meeting physical activity guidelines. Fifteen percent reported five or more servings of fruit and vegetables per day; mean intake was 2.6 servings per day. Seventy-four percent of participants were nonsmokers. Only 1% of participants met all three American Cancer Society guidelines; 22% met none of the recommendations. The emotional well-being (mean 17.4 [±4.1] compared with 20.1 [±4.1]; d=0.66) and fatigue scores (mean 34.6 [±9.5] compared with 40.5 [±9.6]; d=0.62) indicate that those who do not meet the guidelines had lower emotional well-being and increased fatigue. Conclusion: Endometrial cancer survivors have unhealthy lifestyles that put them at risk for morbidity. This survivor group should be offered multi-behavioral lifestyle interventions after diagnosis. © 2010 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins.
Single-fraction radiotherapy versus multifraction radiotherapy for palliation of painful vertebral bone metastases - Equivalent efficacy, less toxicity, more convenient: A subset analysis of Radiation Therapy Oncology Group trial 97-14
Howell D.D.,University of Michigan |
James J.L.,Radiation Therapy Oncology Group Statistical Center |
Hartsell W.F.,Advocate Good Shepherd Hospital |
Suntharalingam M.,University of Maryland, Baltimore |
And 7 more authors.
Cancer | Year: 2013
Background: The Radiation Therapy Oncology Group (RTOG) trial 97-14 revealed no difference between radiation delivered for painful bone metastases at a dose of 8 gray (Gy) in 1 fraction (single-fraction radiotherapy [SFRT]) and 30 Gy in 10 fractions (multifraction radiotherapy [MFRT]) in pain relief or narcotic use 3 months after randomization. SFRT for painful vertebral bone metastases (PVBM) has not been well accepted, possibly because of concerns about efficacy and toxicity. In the current study, the authors evaluated the subset of patients that was treated specifically for patients with PVBM. METHODS: PVBM included the cervical, thoracic, and/or lumbar spine regions. Among patients with PVBM, differences in retreatment rates and in pain relief, narcotic use, and toxicity 3 months after randomization were evaluated. RESULTS: Of 909 eligible patients, 235 (26%) had PVBM. Patients with and without PVBM differed in terms of the percentage of men (55% vs 47%, respectively; P =.03) and the proportion of patients with multiple painful sites (57% vs 38%, respectively; P <.01). Among those with PVBM, more patients who received MFRT had multiple sites treated (65% vs 49% for MFRT vs SFRT, respectively; P =.02). There were no statistically significant treatment differences in terms of pain relief (62% vs 70% for MFRT vs SFRT, respectively; P =.59) or freedom from narcotic use (24% vs 27%, respectively; P =.76) at 3 months. Significant differences in acute grade 2 through 4 toxicity (20% vs 10% for MFRT vs SFRT, respectively; P =.01) and acute grade 2 through 4 gastrointestinal toxicity (14% vs 6%, respectively; P =.01) were observed at 3 months, with lower toxicities seen in the patients treated with SFRT. Late toxicity was rare. No myelopathy was recorded. SFRT produced higher 3-year retreatment rates (5% vs 15%; P =.01). CONCLUSIONS: Results for the subset of patients with PVBM in the RTOG 94-17 randomized controlled trial were comparable to those for the entire population. SFRT produced less acute toxicity and a higher rate of retreatment than MFRT. SFRT and MFRT resulted in comparable pain relief and narcotic use at 3 months. © 2012 American Cancer Society.
Dean D.E.,Summit County Medical Examiners Office |
Jamison J.M.,Wright State University |
Lane J.L.,Summa Akron City Hospital
Journal of Forensic Sciences | Year: 2014
Peritonitis secondary to spontaneous rupture/perforation of the gall bladder is a rare condition overall and is even less common in the forensic population. We report the case of a middle-aged man who died from generalized peritonitis from gall bladder perforation due to acute acalculous cholecystitis. This condition usually occurs in critical patients with systemic illness, and although the exact pathogenesis remains unclear, the development of acalculous cholecystitis appears to be multifactorial. Antemortem diagnosis is reliant upon clinical presentation, laboratory data, and radiologic studies. Surgery and appropriate antibiotics are mainstays of treatment; however, there is an emerging role for minimally invasive procedures. Histopathologic features show significant overlap with the calculous type. Although increasing numbers of acalculous cholecystitis have been diagnosed in the critically ill, the fatal presentation of a perforated gall bladder following an undiagnosed case of acute acalculous cholecystitis is unusual in a nonhospitalized and ambulatory man. © 2014 American Academy of Forensic Sciences.
Von Gruenigen V.E.,Summa Akron City Hospital |
Powell D.M.,Summa Akron City Hospital |
Sorboro S.,Summa Akron City Hospital |
McCarroll M.L.,Summa Center for Womens Health Research |
Kim U.,Summa Akron City Hospital
American Journal of Obstetrics and Gynecology | Year: 2013
Hospitals and health care systems are already seeing the effect of health care reform with declining dollars. Hospital services, which had narrow financial margins in the past, will have further challenges. This article will review definitions, challenges, and potential financial solutions for labor and delivery units. Improving quality, efficiency, and cost requires substantial physician cooperation in the changing paradigm from physiciancentric care to the transparent safety of teams. The financial contribution margin should increase the net revenue, but significant volumes are also needed. The challenge of this model for obstetrics is the slowing birth rate with the ultimate limitation for growth. Therefore, cost containment is imperative for sustainability. Standardization of hospital policies and procedures can improve quality and cost-savings with new incentive models. Examples include decreasing expensive pharmaceuticals, minimizing elective inductions of labor, and encouraging breast-feeding. As providers of health care to women, we all must engage in the triple aim of (1) improving the experience of care, (2) improving the health of populations, and (3) reducing per capita costs of health care. Although accountable care organizations presently are focused on Medicare populations for cost containment, all health care providers and institutions must be vigilant on both quality costeffective care for sustainability, especially in obstetrics. © 2013 Mosby, Inc. All rights reserved.
Radwany S.M.,Summa Health System |
Von Gruenigen V.E.,Summa Akron City Hospital
Clinical Obstetrics and Gynecology | Year: 2012
Palliative care improves the quality of life of patients and their families through the prevention and treatment of distressing symptoms while addressing the psychological, social, and spiritual aspects of patient care. Emerging paradigms of delivery promote early involvement in the disease trajectory and specialty approaches to care. Interdisciplinary assessment and shared decision making are important components. Throughout the disease course, aggressive symptom management can improve patients' quality of life and their ability to tolerate and continue treatment. End-of-life care focuses on comfort, control, meaning, and support that become particularly intense when death is imminent. © 2012, Lippincott Williams & Wilkins.