Central Baptist Hospital

Central City, KY, United States

Central Baptist Hospital

Central City, KY, United States

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Reddy V.Y.,Mount Sinai School of Medicine | Exner D.V.,Libin Cardiovascular Institute of Alberta | Cantillon D.J.,Cleveland Clinic | Doshi R.,University of Southern California | And 11 more authors.
New England Journal of Medicine | Year: 2015

BACKGROUND Cardiac pacemakers are limited by device-related complications, notably infection and problems related to pacemaker leads. We studied a miniaturized, fully selfcontained leadless pacemaker that is nonsurgically implanted in the right ventricle with the use of a catheter. METHODS In this multicenter study, we implanted an active-fixation leadless cardiac pacemaker in patients who required permanent single-chamber ventricular pacing. The primary efficacy end point was both an acceptable pacing threshold (.2.0 V at 0.4 msec) and an acceptable sensing amplitude (R wave .5.0 mV, or a value equal to or greater than the value at implantation) through 6 months. The primary safety end point was freedom from device-related serious adverse events through 6 months. In this ongoing study, the prespecified analysis of the primary end points was performed on data from the first 300 patients who completed 6 months of followup (primary cohort). The rates of the efficacy end point and safety end point were compared with performance goals (based on historical data) of 85% and 86%, respectively. Additional outcomes were assessed in all 526 patients who were enrolled as of June 2015 (the total cohort). RESULTS The leadless pacemaker was successfully implanted in 504 of the 526 patients in the total cohort (95.8%). The intention-to-treat primary efficacy end point was met in 270 of the 300 patients in the primary cohort (90.0%; 95% confidence interval [CI], 86.0 to 93.2, P = 0.007), and the primary safety end point was met in 280 of the 300 patients (93.3%; 95% CI, 89.9 to 95.9; P<0.001). At 6 months, device-related serious adverse events were observed in 6.7% of the patients; events included device dislodgement with percutaneous retrieval (in 1.7%), cardiac perforation (in 1.3%), and pacing-threshold elevation requiring percutaneous retrieval and device replacement (in 1.3%). CONCLUSIONS The leadless cardiac pacemaker met prespecified pacing and sensing requirements in the large majority of patients. Device-related serious adverse events occurred in approximately 1 in 15 patients. (Funded by St. Jude Medical; LEADLESS II ClinicalTrials .gov number, NCT02030418.). © 2015 Massachusetts Medical Society. All rights reserved.


Chan J.W.,University of Kentucky | Castellanos A.,Central Baptist Hospital
Graefe's Archive for Clinical and Experimental Ophthalmology | Year: 2010

Background: Anti-tumor necrosis factor alpha (TNF α) agents have been increasingly used to treat patients with Crohn's disease, psoriatic arthritis, rheumatoid arthritis, ankylosing spondylitis, and persistent uveitis. We describe a 68-year-old man with Crohn's esophagitis who developed a possible bilateral toxic anterior optic neuropathy during infliximab infusion. Methods: This is an observational case report, with review of the PubMed literature from 1977 to present. Results: This 68-year-old man with a 2-year history of Crohn's esophagitis developed acute bilateral visual loss during his third infliximab infusion. His clinical features and laboratory tests were characteristic for a bilateral anterior optic neuropathy. Only three cases of possible infliximab-associated anterior optic neuropathy have been reported in the literature to date. Conclusion: It is important to consider the possibility of anterior optic neuropathy, in addition to retrobulbar optic neuritis, in patients who experience sudden-onset visual loss while being treated with infliximab. © 2009 Springer-Verlag.


Lee E.J.,Central Baptist Hospital | Frazier S.K.,University of Kentucky
Journal of Pain and Symptom Management | Year: 2011

Context: Acupressure is a noninvasive strategy used to manage various symptoms. Objectives: The purpose of this article was to review randomized controlled trials that investigated the efficacy of acupressure for the management of symptoms. Methods: A literature search was conducted in the Cumulative Index to Nursing and Allied Health Literature, Medline, and PubMed using the key words acupressure, clinical trial, human, and/or randomized. Randomized clinical trials published between January 1, 2000 and January 31, 2010, which used acupressure as the sole intervention for one group, were included when they were written in English and when there were four or more studies of the efficacy of acupressure for that particular symptom. Results: Forty-three studies were included in this review. Investigators in 16 of 23 studies concluded acupressure was effective, primarily for the management of nausea and vomiting in patients during pregnancy and during chemotherapy. Investigators in nine of 10 studies concluded that acupressure was effective for pain in patients with dysmenorrhea, during labor and after trauma. Investigators of four studies concluded that acupressure was effective in the management of dyspnea and investigators in six studies concluded that acupressure was effective in improving fatigue and reducing insomnia in a variety of populations. However, evaluation of the randomized controlled trial reports indicated a significant likelihood of bias. Conclusion: Acupressure may be a useful strategy for the management of multiple symptoms in a variety of patient populations, but rigorous trials are needed. Inclusion of acupressure as an intervention may improve patient outcomes. © 2011 U.S. Cancer Pain Relief Committee Published by Elsevier Inc. All Rights reserved.


Snyder C.C.,University of Cincinnati | Barton J.R.,Central Baptist Hospital | Habli M.,Cincinnati Childrens Hospital Medical Center | Sibai B.M.,University of Texas Health Science Center at Houston
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2013

Objective: To report maternal and perinatal outcomes in obstetric patients with severe sepsis and septic shock. Methods: We performed a retrospective study of obstetric patients admitted to an intensive care unit (ICU) for severe sepsis/septic shock. Maternal clinical characteristics, hemodynamic profiles, laboratory findings, and perinatal outcomes were evaluated. Patients with severe sepsis (N = 20) and septic shock (N = 10) were compared using Fisher's Exact and Mann-Whitney U tests. Results: Pyelonephritis was the most common etiology overall (37%) and acute respiratory distress syndrome (ARDS) was the most common organ injury in both severe sepsis (50%) and septic shock (80%). Liver dysfunction was present in cases with increased morbidity as a late finding and was the least frequent organ injury. Patients with septic shock had significantly higher rates of disseminated intravascular coagulation (DIC) (p = 0.01), altered mental status (p ≤ 0.001), total bilirubin >4mg/dl (p = 0.04), failure in ≥3 organ systems (70% vs. 15%, p = 0.005), and maternal death (30% vs. 0%, p = 0.03). All patients with septic shock were delivered during hospitalization vs. 40% with severe sepsis. 71% of viable pregnancies required emergent cesarean delivery, and 50% of these for worsening respiratory function. Conclusions: ARDS is frequently found in critically ill obstetric patients with severe sepsis/septic shock and is associated with a high risk of emergent cesarean delivery. © 2013 Informa UK, Ltd.


Hill K.S.,Central Baptist Hospital
Journal of Nursing Administration | Year: 2010

This department highlights nursing leaders who have demonstrated the ability to inspire and lead change. This competency is seen in the ability to create, structure, and implement organizational change through strategic vision, risk taking, and effective communication. Each article showcases a project of a nurse leader who demonstrates change in a variety of environments ranging from acute care hospitals to home care and alternative practice settings. Included are several "lessons learned" applicable to multiple settings that provide insight for other nurses in executive practice. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Wang J.,University of Wisconsin - Madison | Li J.,University of Wisconsin - Madison | Tussey K.,Central Baptist Hospital | Ross K.,Central Baptist Hospital
IEEE Transactions on Systems, Man, and Cybernetics Part A:Systems and Humans | Year: 2012

In this paper, a simulation model of an emergency department (ED) at a large community hospital, Central Baptist Hospital in Lexington, KY, is developed. Using such a model, we can accurately emulate the patient flow in the ED and carry out sensitivity analysis to determine the most critical process for improvement in quality of care (in terms of patient length of stay). In addition, a what-if analysis is performed to investigate the potential change in operation policies and its impact. Floating nurse, combining registration with triage, mandatory requirement of physician's visit within 30 min, and simultaneous reduction of operation times of some most sensitive procedures can all result in substantial improvement. These recommendations have been submitted to the hospital leadership, and implementations are in progress. © 2012 IEEE.


Barton J.R.,Central Baptist Hospital | Barton J.R.,University of Texas Health Science Center at Houston | Sibai B.M.,Central Baptist Hospital | Sibai B.M.,University of Texas Health Science Center at Houston
Obstetrics and Gynecology | Year: 2012

Pregnancies complicated by severe sepsis and septic shock are associated with increased rates of preterm labor, fetal infection, and preterm delivery. Sepsis onset in pregnancy can be insidious, and patients may appear deceptively well before rapidly deteriorating with the development of septic shock, multiple organ dysfunction syndrome, or death. The outcome and survivability in severe sepsis and septic shock in pregnancy are improved with early detection, prompt recognition of the source of infection, and targeted therapy. This improvement can be achieved by formulating a stepwise approach that consists of early provision of time-sensitive interventions such as: aggressive hydration (20 mL/kg of normal saline over the first hour), initiation of appropriate empiric intravenous antibiotics (gentamicin, clindamycin, and penicillin) within 1 hour of diagnosis, central hemodynamic monitoring, and the involvement of infectious disease specialists and critical care specialists familiar with the physiologic changes in pregnancy. Thorough physical examination and imaging techniques or empiric exploratory laparotomy are suggested to identify the septic source. Even with appropriate antibiotic therapy, patients may continue to deteriorate unless septic foci (ie, abscess, necrotic tissue) are surgically excised. The decision for delivery in the setting of antepartum severe sepsis or septic shock can be challenging but must be based on gestational age, maternal status, and fetal status. The natural inclination is to proceed with emergent delivery for a concerning fetal status, but it is imperative to stabilize the mother first, because in doing so the fetal status will likewise improve. Prevention Aggressive treatment of sepsis can be expected to reduce the progression to severe sepsis and septic shock and prevention strategies can include preoperative skin preparations and prophylactic antibiotic therapy as well as appropriate immunizations. © 2012 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams &Wilkins.


Stewart W.S.,Central Baptist Hospital | Pettit H.,Central Baptist Hospital
American Journal of Emergency Medicine | Year: 2013

Background Current reversal options for warfarin-related bleeding are limited but include fresh frozen plasma, recombinant factor VIIa, or a prothrombin complex concentrate (PCC). There are little data discussing the use of activated 4-factor PCC for warfarin reversal. Objectives This review will summarize our experiences with FEIBA (Baxter, Deerfield, IL), an activated 4-factor PCC, for the reversal of warfarin-related bleeding in a community hospital. Methods A protocol was put in place in March of 2011, which outlined the use of FEIBA for the emergent reversal of warfarin-related coagulopathy. A low fixed dose was given based on international normalized ratio (INR). For an INR less than 5.0, 500 U of FEIBA was administered. For an INR greater than or equal to 5.0, 1000 U of FEIBA was given. Intravenous vitamin K was given concurrently regardless of INR. Results Sixteen patients were treated with FEIBA per the protocol. Average patient age was 73 years. Intracranial hemorrhage was the most common indication for reversal. Mean pre-treatment INR was 3.56 (1.3-6.8); mean post-treatment INR was 1.16 (1.01-1.32). Two of the patients required a second 500-U dose, per the protocol, for an INR that had not yet normalized. Bleeding appeared clinically controlled in 93% of cases. Eighty-seven percent of patients survived to discharge. There were no signs or symptoms of thrombosis in any of the cases. Conclusions Emergent reversal of warfarin utilizing a fixed, low dose of FEIBA appears to be efficacious, consistent, and safe. Further comparator studies with other reversal agents are needed. © 2013 Elsevier Inc.


Type 2 diabetes mellitus is a highly prevalent disease characterized by insulin resistance, hyperglycemia, and diminished pancreatic β-cell function. Conventional insulin products used to manage this disease include regular human insulin and intermediate-acting human insulin. However, due to several limitations imposed by human insulins, such as onset and duration of action that do not coincide with physiologic needs and increased risk of hypoglycemia, insulin analogs were developed. Because they more closely mimic the physiologic action of endogenous insulin, insulin analogs are associated with more effective glucose control, a lower risk of hypoglycemia, greater convenience, and, in some instances, less weight gain. Switching from human insulin to insulin analogs is easily accomplished. Several studies have demonstrated a high rate of success with patient-initiated, self-adjusted dosing algorithms compared to investigator/clinician-initiated dose adjustments. These studies and several other published guidelines on insulin analogs provide patients and clinicians with information pertaining to better treatment options and can help increase overall patient satisfaction. © 2013 Informa UK, Ltd.


Hill K.S.,Central Baptist Hospital
Journal of Nursing Administration | Year: 2010

In the United States, the issue of aging workers in the nursing workforce is one of growing concern with greater than 33% of RNs older than 50 years. The implementation of creative strategies to offset the loss of nurses' experiential knowledge has the potential to improve patient care and reduce risk to patients. The author proposes a program of phased retirement as an innovative approach to the anticipated loss of nursing knowledge related to retirement of the nursing workforce. The business case for support for phased retirement is discussed. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

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