Kekevian A.,Crozer Chester Medical Center |
Gershwin M.E.,University of California at Davis |
Chang C.,Thomas Jefferson University
Autoimmunity reviews | Year: 2014
Idiopathic pulmonary fibrosis is a difficult disease to diagnose. Idiopathic pulmonary fibrosis is a member of a class of diseases known as idiopathic interstitial pneumonias. Other members include nonspecific interstitial pneumonia, cryptogenic organizing pneumonia, acute interstitial pneumonia, respiratory bronchiolitis-associated interstitial lung disease, desquamative interstitial pneumonia, and lymphocytic interstitial pneumonia. Usual interstitial pneumonia (UIP) is the pathological equivalent of idiopathic pulmonary fibrosis. Prior to 2011, the diagnosis was based on major and minor criteria, but because these criteria were not evidence based, the criteria were modified by consensus from the American Thoracic Society, the European Respiratory Society, the Japanese Respiratory Society, and the Latin American Thoracic Association. These new criteria now include satisfying three core requirements, including exclusion of other possible cause of interstitial lung disease, specific findings of usual interstitial pneumonia on high resolution computed tomography, and a combination of "possible UIP" findings on high resolution computed tomography and UIP findings on lung biopsy. Idiopathic pulmonary fibrosis is a severe, progressive disease with limited treatment options, and exacerbations are associated with a high degree of morbidity and mortality. Copyright © 2014 Elsevier B.V. All rights reserved.
Kekevian A.,Crozer Chester Medical Center |
Gershwin M.E.,University of California at Davis |
Chang C.,Thomas Jefferson University
Autoimmunity Reviews | Year: 2014
Idiopathic pulmonary fibrosis is a difficult disease to diagnose. Idiopathic pulmonary fibrosis is a member of a class of diseases known as idiopathic interstitial pneumonias. Other members include nonspecific interstitial pneumonia, cryptogenic organizing pneumonia, acute interstitial pneumonia, respiratory bronchiolitis-associated interstitial lung disease, desquamative interstitial pneumonia, and lymphocytic interstitial pneumonia. Usual interstitial pneumonia (UIP) is the pathological equivalent of idiopathic pulmonary fibrosis. Prior to 2011, the diagnosis was based on major and minor criteria, but because these criteria were not evidence based, the criteria were modified by consensus from the American Thoracic Society, the European Respiratory Society, the Japanese Respiratory Society, and the Latin American Thoracic Association. These new criteria now include satisfying three core requirements, including exclusion of other possible cause of interstitial lung disease, specific findings of usual interstitial pneumonia on high resolution computed tomography, and a combination of "possible UIP" findings on high resolution computed tomography and UIP findings on lung biopsy. Idiopathic pulmonary fibrosis is a severe, progressive disease with limited treatment options, and exacerbations are associated with a high degree of morbidity and mortality. © 2014 Elsevier B.V.
Evans L.,Crozer Chester Medical Center |
Kohl D.,Fitzgerald Mercy Hospital
Journal of Emergency Nursing | Year: 2014
As an emergency nurse, finding time to familiarize oneself with arterial-line monitoring or a new piece of equipment is often impossible. A group of staff nurses recognized the need for more "hands-on" learning and pursued a method to make our education more meaningful. A hospital general nursing skills day offered little benefit to ED nursing staff who are tasked with more specialized skills. It was imperative to develop an efficient process to prepare the ED nurses to provide best practice and care to their patients. © 2014 Emergency Nurses Association.
Propst K.,Crozer Chester Medical Center |
Tunitsky-Bitton E.,Cleveland Clinic |
Schimpf M.O.,University of Michigan |
Ridgeway B.,Cleveland Clinic
International Urogynecology Journal and Pelvic Floor Dysfunction | Year: 2014
Pyogenic spondylodiscitis includes a spectrum of spinal infections such as discitis, osteomyelitis, epidural abscess, meningitis, subdural empyema, and spinal cord abscess. This is a rare complication of sacral colpopexy, but can lead to devastating consequences for the patient. We present two cases of pyogenic spondylodiscitis following sacral colpopexy. In addition, we discuss 26 cases of pyogenic spondylodiscitis reported in the literature from 1957 to 2012. Techniques to decrease rates of infection include proper identification of the S1 vertebra, awareness of the suture placement depth at the level of the sacrum and at the vagina, and early treatment of post-operative urinary tract and vaginal infections. Awareness of symptoms, timely diagnosis and multidisciplinary approach to management is essential in preventing long-term complications. © The International Urogynecological Association 2013.
Pabona J.M.P.,University of Arkansas for Medical Sciences |
Zhang D.,Crozer Chester Medical Center |
Ginsburg D.S.,Crozer Chester Medical Center |
Simmen F.A.,University of Arkansas for Medical Sciences |
Simmen R.C.M.,University of Arkansas for Medical Sciences
Journal of Clinical Endocrinology and Metabolism | Year: 2015
Context: Late-term pregnancy may lead to maternal and neonatal morbidity and mortality. Mice null for the progesterone receptor co-regulator Krüppel-like Factor 9 (KLF9) exhibit delayed parturition and increased incidence of neonatal deaths. Objective: Our aim is to evaluate the contribution of myometrial KLF9 to human parturition. Design: Myometrial biopsies were obtained fromwomenwith term (>37 to≤41 wk) and late-term (>41 wk) pregnancies during cesarean delivery and assessed for gene and protein expression. Human myometrial cells transfected with nontargeting or KLF9 small interfering RNAs (siRNA) were treated with the progesterone antagonist RU486 and analyzed for pro-inflammatory chemokine/ cytokine gene expression. Setting: The study took place in a University-affiliated tertiary care hospital and University research laboratory. Patients: Term patients (n -8) were in spontaneous active labor whereas late-term patients (n -5) were either in or were induced to active labor, prior to elective cesarean delivery. Outcome Measures: Steroid hormone receptor, contractility, and inflammation-associated gene expression in myometrial biopsies and in siKLF9-transfected, RU486-treated human myometrial cells was associated with KLF9 expression levels. Results: Myometrium from women with late-term pregnancy showed lower KLF9, total PGR, and PGR-A/PGR-B isoform expression. Transcript levels of select chemokines/cytokines were up- (CSF3, IL1, IL12A, TGFB2) and down- (CCL3, CCL5, CXCL1, CXCL5, IL15) regulated in late-term relative to term myometrium. Knock-down of KLF9 expression in RU486-treated human myometrial cells modified the expression of PGR and labor-associated cytokines, relative to control siRNA-treated cells. Conclusions: Myometrial KLF9 may contribute to the onset of human parturition through its regulation of PGR expression and inflammatory signaling networks. © 2015 by the Endocrine Society.
Leopold N.A.,Crozer Chester Medical Center |
Daniels S.K.,Baylor College of Medicine
Dysphagia | Year: 2010
Swallowing is an act requiring complex sensorimotor integration. Using a variety of methods first used to study limb physiology, initial efforts to study swallowing have yielded information that multiple cortical and subcortical regions are active participants. Not surprisingly, the regions activated appear to overlap those involved in both oral and nonoral motor behaviors. This review offers a perspective that considers the supranuclear control of swallowing in light of these physiological similarities. © 2009 Springer Science+Business Media, LLC.
Gawchik S.M.,Crozer Chester Medical Center
Mount Sinai Journal of Medicine | Year: 2011
Allergy to natural rubber latex is an important clinical condition that occurred after the institution of universal precautions to protect healthcare workers. A rapid increase and production of both examination and surgical gloves resulted in an epidemic of allergy to latex protein. Healthcare workers in both the medical and dental environments, as well as specific groups of individuals including those with spina bifida, myelodysplasia, and food allergies (banana, kiwi, avocado, and others), were at increased risk of sensitization. Clinical symptoms in the latex allergic individual ranged from type I hypersensitivity reaction including rhinoconjunctivitis, asthma, and systemic reaction to type IV hypersensitivity reaction, which occur from the chemicals added during the manufacturing process. Diagnosis of latex allergy is based on a clinical history that correlates the development of symptoms in relationship to exposure. In the United States there are no skin tests approved by the Food and Drug Administration. Therefore a combination of clinical judgment and serologic testing such as ImmunoCAP and Immulite is helpful. The primary treatment of latex allergy is avoidance of exposure to the latex protein. © 2011 Mount Sinai School of Medicine.
Ecker K.L.,Crozer Chester Medical Center |
Donohue P.K.,Johns Hopkins University |
Kim K.S.,Johns Hopkins University |
Shepard J.A.,Johns Hopkins University |
Aucott S.W.,Johns Hopkins University
Journal of Perinatology | Year: 2013
Objective: To determine trends in late-onset neonatal infections and risk factors for ampicillin/penicillin-resistant microorganisms. Study Design: Data on 584 infants with positive blood, urine or cerebrospinal fluid cultures for bacteria or fungi at 8-30 days of age from 1990 to 2007 were examined and divided into three epochs, based on intrapartum antibiotic prophylactic (IAP) practices. Pathogens and antibiotic resistance were compared among epochs. Result: The number of candidal infections increased over time for the entire population (P=0.006). There was an increased incidence of Gram-negative (P=0.009) and candidal infections (P=0.014) among very low-birthweight infants. Only Escherichia coli infections showed increasing ampicillin resistance over epochs (P=0.006). In regression analysis, ampicillin/penicillin resistance increased with IAP use (odds ratio 2.05). Conclusion: Changing microorganisms and increasing antibiotic resistance in late-onset neonatal infections are likely multifactorial but are increased with IAP use, which may identify an at-risk population. Increasing Candida infections require further investigation. Copyright © 2013 Nature America, Inc.
Goldman R.E.,Crozer Chester Medical Center |
Bajo A.,MAKO Surgical |
Simaan N.,Vanderbilt University
IEEE Transactions on Robotics | Year: 2014
During exploration through tortuous unstructured passages by continuum robots, methods are required to minimize the force interaction between the environment and the robot along its length. This paper presents and evaluates an algorithm for compliant motion control of continuum robots subjected to multiple unknown contacts with the environment. A mapping of external wrenches to a generalized force in the configuration space of a multisegment continuum robot is presented and related to measured joint-level actuation forces. These measurements are applied as inputs to a low-level compliant motion controller. Friction and modeling uncertainties, presenting an unknown nonlinear deviation from the nominal system model, are corrected via a feed-forward estimate provided by a support vector machine. The controller is evaluated on Ø9 and Ø5 mm multisegment continuum robots. We quantify the minimal interaction forces needed to generate compliant motion and demonstrate the ability of the controller to minimize interaction forces during insertion through tortuous passages. © 2014 IEEE.
Cachecho R.,Crozer Chester Medical Center |
Dobkin E.,Crozer Chester Medical Center
Journal of Trauma and Acute Care Surgery | Year: 2012
BACKGROUND: Ventilator-associated pneumonia (VAP) increases mortality and length of stay and escalates the cost of care. Our institution embarked on a project to eradicate VAP. METHODS: We compared the outcome of trauma patients admitted in period 1 (P1) (January 2005 to December 2006) and period 2 (P2) (January 2006 to December 2009). Team building, culture change, and the ventilator bundle were introduced and modified during P1 and were fully implemented in P2. Outcome data were calculated for both periods. The Center for Disease Control VAP definition was used. The VAP rate was calculated as VAP/1,000 ventilator days. Chi-square and t test statistics were used as appropriate. Data were considered statistically significant if p ≤ 0.05. RESULTS: In total, 299 trauma patients were admitted in P1 and 655 in P2. The two groups were identical in age, Injury Severity Score, mortality, and non-VAP. There was a trend toward a shorter length of stay in P2 (p = 0.06). The days on ventilator was significantly shorter in P2 compared with P1 (p = 0.05). The VAP rate dropped significantly from 7.9/1,000 in P1 to 1.0/1,000 in P2 (p = 0.04). The Appropriate Care Measure score increased from 45% in early P1 to 91% in late P2 (p = 0.0001). CONCLUSION: The application of the VAP bundle, a checklist, and the multidisciplinary team approach resulted in significant improvement of VAP in all trauma patients admitted to the shock trauma unit and to the decrease in days on ventilator in the trauma patients. This intervention did not affect mortality or the rate of non-VAP in the trauma patients. LEVEL OF EVIDENCE: Therapeutic study, level IV. © 2012 Lippincott Williams & Wilkins.