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Frazee S.,Christ Hospital
Dimensions of Critical Care Nursing | Year: 2011

Goal of the day is a current topic of interest in helping to provide patient- and family-centered care, increase their satisfaction, and improve patient outcomes. Despite advancements in health care and provision of evidence-based care, we often fail to meet a patient's other needs. These needs are related to personalizing care by taking evidence-based standards of care and incorporating the patient's desires and goals. To deliver patient- and family-centered care, we need to demonstrate respect for the patient and family, build trust, and integrate their desires and goals into the daily care plan. The purpose of this project was to institute a goal of the day, increase patient and family satisfaction, and monitor outcomes. Copyright © 2011 Lippincott Williams & Wilkins. Source

Slingluff Jr. C.L.,University of Virginia | Lee S.,Dana-Farber Cancer Institute | Zhao F.,Dana-Farber Cancer Institute | Chianese-Bullock K.A.,University of Virginia | And 5 more authors.
Clinical Cancer Research | Year: 2013

Purpose: This multicenter randomized trial was designed to evaluate whether melanoma helper peptides augment cytotoxic T lymphocyte (CTL) responses to a melanoma vaccine and improve clinical outcome in patients with advanced melanoma. Experimental Design: One hundred seventy-five patients with measurable stage IV melanoma were enrolled into 4 treatment groups, vaccinated with 12MHCclass I-restricted melanoma peptides to stimulate CTL (12MP, group A), plus a tetanus peptide (group B), or a mixture of 6 melanoma helper peptides (6MHP, group C) to stimulate helper T lymphocytes (HTL), or with 6 melanoma helper peptide (6MHP) alone (group D), in incomplete Freund's adjuvant plus granulocyte macrophage colony-stimulating factor. CTL responses were assessed using an in vitro-stimulated IFN-g ELIspot assay, and HTL responses were assessed using a proliferation assay. Results: In groups A to D, respectively, CTL response rates to 12 melanoma peptides were 43%, 47%, 28%, and 5%, and HTL response rates to 6MHP were in 3%, 0%, 40%, and 41%. Best clinical response was partial response in 7 of 148 evaluable patients (4.7%) without significant difference among study arms. Median overall survival (OS) was 11.8 months. Immune response to 6 MHP was significantly associated with both clinical response (P = 0.036) and OS (P = 0.004). Conclusion: Each vaccine regimen was immunogenic, but MHPs did not augment CTL responses to 12 melanoma peptides. The association of survival and immune response to 6MHP supports further investigation of helper peptide vaccines. For patients with advanced melanoma, multipeptide vaccines should be studied in combination with other potentially synergistic active therapies. © 2013 American Association for Cancer Research. Source

Campbell D.,Christ Hospital
Dimensions of Critical Care Nursing | Year: 2013

Providing care to patients in critical care units generates stress. Helping the critical care nurse manage this stress can lead to better patient experiences and higher nursing retention. While providing holistic care to patients produces better outcomes, addressing the holistic needs of the caregiver must also be considered. Included in the holistic needs of the nurse is their spiritual well-being. A study that measures spiritual well-being, stress, and nursing retention is the focus of this review. © 2013 Lippincott Williams & Wilkins. Source

Karram M.,Christ Hospital | Maher C.,Royal Brisbane and Wesley Urogynaecology
International Urogynecology Journal and Pelvic Floor Dysfunction | Year: 2013

Introduction and hypothesis: The aim was to review the safety and efficacy of surgery for posterior vaginal wall prolapse. Methods: Every 4 years and as part of the Fifth International Collaboration on Incontinence we reviewed the English-language scientific literature after searching PubMed, Medline, Cochrane library and Cochrane database of systematic reviews, published up to January 2012. Publications were classified as level 1 evidence (randomised controlled trials [RCT] or systematic reviews), level 2 (poor quality RCT, prospective cohort studies), level 3 (case series or retrospective studies) and level 4 (case reports). The highest level of evidence was utilised by the committee to make evidence-based recommendations based upon the Oxford grading system. Grade A recommendation usually depends on consistent level 1 evidence. Grade B recommendation usually depends on consistent level 2 and/or 3 studies, or "majority evidence" from RCTs. Grade C recommendation usually depends on level 4 studies or "majority evidence‟ from level 2/3 studies or Delphi processed expert opinion. Grade D "no recommendation possible" would be used where the evidence is inadequate or conflicting and when expert opinion is delivered without a formal analytical process, such as by Delphi. Results: Level 1 and 2 evidence suggest that midline plication posterior repair without levatorplasty might have superior objective outcomes compared with site-specific posterior reopair (grade B). Higher dyspareunia rates are reported when levatorplasty is employed (grade C). The transvaginal approach is superior to the transanal approach for repair of posterior wall prolapse (grade A). To date, no studies have shown any benefit of mesh overlay or augmentation of a suture repair for posterior vaginal wall prolapse (grade B). While modified abdominal sacrocolpopexy results have been reported, data on how these results would compare with traditional transvaginal repair of posterior vaginal wall prolapse are lacking. Conclusion: Midline fascial plication without levatorplasty is the procedure of choice for posterior compartment prolapse. No evidence supports the use of polypropylene mesh or biological graft in posterior vaginal compartment prolapse surgery. © 2013 ICUD-EAU. Source

Snyder M.E.,Cincinnati Eye Institute | Lindsell L.B.,Christ Hospital
Journal of Cataract and Refractive Surgery | Year: 2011

We describe a novel "hang-back" surgical approach for repairing an iridodialysis. Instead of repositioning the iris tightly to the sclera, the detached peripheral iris is suspended by a suture inside the normal iris insertion, reducing corectopia and avoiding inadvertent coverage of the trabecular meshwork by peripheral iris. A horizontal mattress suture is placed ab interno via a paracentesis site and tightened to bring the iris periphery to inside and under the limbus, as viewed from the frontal plane. This technique provides an excellent functional and cosmetic result. Financial Disclosure: Neither author has a financial or proprietary interest in any material or method mentioned. © 2011 ASCRS and ESCRS. Source

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