Matz K.,Genesys Regional Medical Center |
Britt T.,Genesys Regional Medical Center |
LaBond V.,Genesys Regional Medical Center
American Journal of Emergency Medicine | Year: 2017
Background: Overcrowding in the Emergency Department is a problem with many strategies for intervention such as the physician in triage (PIT). This brief evaluation is designed to minimize diagnostic uncertainty and expedite the work up when the patient is seen in the Emergency Department. We hypothesized that this would increase CT imaging which would be increasingly negative as the pressure to maintain throughput rises on busy days in the Emergency Department. Methods: We designed a retrospective study in which ordering patterns of Emergency physicians was explored using a group of patients with abdominal pain, presenting to triage in a 2. year period. We compared CT ordering rates on the 5% highest and lowest volume days (HD5 and LD5) and examined the bivariate relationship between volume and imaging utilization. Results: There was no statistical significance in the rate of CT's ordered collectively by PIT physicians on HD5 compared with LD5 with a p-value of 0.25. There is a trend toward increased utilization when each physician is compared to themselves on HD5 vs. LD5 but these were not statistically significant differences. The percentage of "clinically relevant" CTs was not determined to be different, but there was an increase in the LOS when a CT was ordered on both LD5 and HD5 (HD5 p-value 0.0004; LD5 p-value 0.009). Conclusion: There is no difference in CT ordering patterns for abdominal pain by PIT between HD5 and LD5. Likewise CT ordering patterns do not demonstrate a difference in percentage of clinically relevant CTs. © 2017.
Park L.,University Hospitals Case Medical Center |
Park L.,Genesys Regional Medical Center |
Schiltz C.,University Hospitals Case Medical Center |
Schiltz C.,Genesys Regional Medical Center |
And 2 more authors.
Journal of Cutaneous Medicine and Surgery | Year: 2012
Background: The cutaneous presentation of Langerhans cell histiocytosis (LCH) is very rare and can be highly variable among individuals, which can often lead to a delay in diagnosis. Objective: To discuss a case report and literature review of important clinical indicators, histology, diagnosis, evaluation, and treatment guidelines. Methods: Case report and literature review. Results: Skin biopsies positive for CD1a and/or langerin are diagnostic for LCH. A thorough review of systems, baseline laboratory tests, and imaging studies can determine the extent of LCH. Treatment of cutaneous disease is largely based on case report and small case studies, but baseline treatment should generally begin with oral or topical steroids. When patients have more severe disease that requires a systemic approach, the efficacy of therapy should be assessed 6 weeks into therapy, with subsequent treatment intensification in patients with limited response. Conclusion: Owing to the rarity of this condition, there are no specific guidelines for treatment of LCH, but guidelines put forth by the Histiocyte Society assist in categorization and basic treatment approaches for patients with systemic disease. © 2012 Canadian Dermatology Association.
Desai M.A.,Virginia Commonwealth University |
Webb H.D.,Virginia Commonwealth University |
Webb H.D.,Genesys Regional Medical Center |
Sinanan L.M.,University of North Carolina at Chapel Hill |
And 5 more authors.
Nucleic Acids Research | Year: 2015
The MBD2-NuRD (Nucleosome Remodeling and Deacetylase) complex is an epigenetic reader of DNA methylation that regulates genes involved in normal development and neoplastic diseases. To delineate the architecture and functional interactions of the MBD2-NuRD complex, we previously solved the structures of MBD2 bound to methylated DNA and a coiled-coil interaction between MBD2 and p66α that recruits the CHD4 nucleosome remodeling protein to the complex. The work presented here identifies novel structural and functional features of a previously uncharacterized domain of MBD2 (MBD2IDR). Biophysical analyses show that the MBD2IDR is an intrinsically disordered region (IDR). However, despite this inherent disorder, MBD2IDR increases the overall binding affinity of MBD2 for methylated DNA. MBD2IDR also recruits the histone deacetylase core components (RbAp48, HDAC2 and MTA2) of NuRD through a critical contact region requiring two contiguous amino acid residues, Arg286 and Leu287. Mutating these residues abrogates interaction of MBD2 with the histone deacetylase core and impairs the ability of MBD2 to repress the methylated tumor suppressor gene PRSS8 in MDA-MB-435 breast cancer cells. These findings expand our knowledge of the multi-dimensional interactions of the MBD2-NuRD complex that govern its function. © The Author(s) 2015. Published by Oxford University Press on behalf of Nucleic Acids Research.
News Article | November 11, 2016
The International Association of HealthCare Professionals is pleased to welcome Dana N. Snell-Hargrove, DO, Obstetrician and Gynecologist, to their prestigious organization with her upcoming publication in The Leading Physicians of the World. She is a highly trained and qualified obstetrician and gynecologist with an extensive expertise in all facets of her work. Dr. Snell-Hargrove has been in practice for more than 17 years and is currently serving patients within her own practice in Fort Worth, Texas. Additionally, she is affiliated with North Hills Hospital and the Medical Center Alliance. Dr. Dana N. Snell-Hargrove gained her Doctor of Osteopathic Medicine Degree in 1999 from the Michigan State University College of Osteopathic Medicine. She then went on to complete her internship, residency and then fellowship at Genesys Regional Medical Center in Grand Blanc, Michigan. Dr. Snell-Hargrove is certified by the American Board of Obstetrics and Gynecology, and keeps on top of the latest advances in her field through her membership of professional organizations including the American Osteopathic Association and the American College of Osteopathic Obstetricians and Gynecologists. When she is not assisting patients, Dr. Snell-Hargrove enjoys singing in church, swimming and playing volleyball. Learn more about Dr. Snell-Hargrove by reading her upcoming publication in The Leading Physicians of the World. FindaTopDoc.com is a hub for all things medicine, featuring detailed descriptions of medical professionals across all areas of expertise, and information on thousands of healthcare topics. Each month, millions of patients use FindaTopDoc to find a doctor nearby and instantly book an appointment online or create a review. FindaTopDoc.com features each doctor’s full professional biography highlighting their achievements, experience, patient reviews and areas of expertise. A leading provider of valuable health information that helps empower patient and doctor alike, FindaTopDoc enables readers to live a happier and healthier life. For more information about FindaTopDoc, visit http://www.findatopdoc.com
Khorfan F.M.,Genesys Regional Medical Center |
Khorfan F.M.,Michigan State University |
Smith P.,Office of Research |
Watt S.,Office of Research |
And 2 more authors.
Chest | Year: 2011
Background: Tachycardia and tachyarrhythmias are associated with increased morbidity and mortality in adult patients in the ICU. This study examines the effects of nebulized bronchodilator therapy (albuterol and ipratropium) on heart rate and arrhythmias in this population and tests the proposition that levalbuterol is safer than albuterol in that regard. Methods: The design was a randomized, single-blind, crossover, prospective study in 70 critically ill adult patients treated with nebulized bronchodilators. Patients were randomized to nebulized albuterol alternating with levalbuterol every 4 to 6 h. Group A received albuterol 2.5 mg alternating with levalbuterol 0.63 mg. Group B received albuterol 2.5 mg alternating with levalbuterol 1.25 mg. All patients received nebulized ipratropium bromide with each treatment. Heart rate was recorded before and after each treatment. Cardiac rhythm was continuously monitored using electronic telemetry units. Results: In group A, mean ± SD change in heart rate after albuterol 2.5 mg (n = 303) was 0.89 ±4.5 beats/min compared with 0.85 ± 5.3 beats/min after levalbuterol 0.63 mg (n = 301)(P =.89). In group B (n = 114), heart rate decreased 0.16 ± 5.1 beats/min after albuterol 2.5 mg compared with an increase of 1.4 ± 5.4 beats/min after levalbuterol 1.25 mg (n = 118)(P =.03). Five events of arrhythmias (0.6%) occurred during the course of 836 treatments. Four consisted of occasional premature ventricular contractions. Only one patient stopped treatment because of a 5-beat run of ventricular tachycardia (one in 70 patients [1.4%]). Conclusions: In critically ill adult patients, nebulized albuterol and ipratropium does not cause significant tachycardia or tachyarrhythmias. Substitution of levalbuterol for albuterol to avoid tachycardia and tachyarrhythmias is unwarranted. Trial registry: ClinicalTrials.gov; No.: NCT01151579; URL: www.clinicaltrials.gov. © 2011 American College of Chest Physicians.
Carroll C.L.,Connecticut Childrens Medical Center |
Ramachandran P.,Genesys Regional Medical Center
Chest | Year: 2014
The Internet has fundamentally transformed the way patients and health-care providers communicate and interact. The use of digital tools and social media platforms, such as blogs, Facebook, Instagram, and Twitter, have empowered patients to expand their health-care knowledge and have provided practitioners with new ways to gain knowledge, lead discussions, promote causes, and build relationships with patients and other providers. In this article, we discuss the difference between digital communication, static one-way digital presence, and two-way social media connections. We also describe ways to establish and foster your digital profile, review the benefits and risks of engaging professionally in social media, and describe ways in which digital and social media tools may prove useful in both reimbursement and practice management. © 2014 American College of Chest Physicians.
O'Neill R.,Genesys Regional Medical Center |
Morales J.,Genesys Regional Medical Center |
Jule M.,Genesys Regional Medical Center
Journal of Emergency Medicine | Year: 2012
Background: Early goal-directed therapy (EGDT) has been shown to reduce mortality in patients with severe sepsis/septic shock, however, implementation of this protocol in the emergency department (ED) is sometimes difficult. Objectives: We evaluated our sepsis protocol to determine which EGDT elements were more difficult to implement in our community-based ED. Methods: This was a non-concurrent cohort study of adult patients entered into a sepsis protocol at a single community hospital from July 2008 to March 2009. Charts were reviewed for the following process measures: a predefined crystalloid bolus, antibiotic administration, central venous catheter insertion, central venous pressure measurement, arterial line insertion, vasopressor utilization, central venous oxygen saturation measurement, and use of a standardized order set. We also compared the individual component adherence with survival to hospital discharge. Results: A total of 98 patients presented over a 9-month period. Measures with the highest adherence were vasopressor administration (79%; 95% confidence interval [CI] 69-89%) and antibiotic use (78%; 95% CI 68-85%). Measures with the lowest adherence included arterial line placement (42%; 95% CI 32-52%), central venous pressure measurement (27%; 95% CI 18-36%), and central venous oxygen saturation measurement (15%; 95% CI 7-23%). Fifty-seven patients survived to hospital discharge (Mortality: 33%). The only element of EDGT to demonstrate a statistical significance in patients surviving to hospital discharge was the crystalloid bolus (79% vs. 46%) (respiratory rate [RR] = 1.76, 95% CI 1.11-2.58). Conclusion: In our community hospital, arterial line placement, central venous pressure measurement, and central venous oxygen saturation measurement were the most difficult elements of EGDT to implement. Patients who survived to hospital discharge were more likely to receive the crystalloid bolus. Copyright © 2012 Elsevier Inc. Printed in the USA. All rights reserved.
Moore M.A.,Genesys Regional Medical Center |
Barber K.R.,Genesys Regional Medical Center |
Britt T.,Genesys Regional Medical Center
Emerging Health Threats Journal | Year: 2012
Background: Emergency physicians see many people who present to the emergency department stating that they are immunized against tetanus, when in fact, they are not. The patient history is not dependable for determining true tetanus status and simple patient surveys do not provide actual prevalence. The objective of this study was to determine the prevalence of tetanus status by antibody titer seropositivity and quantify such status among patients reporting tetanus protection. Methods: This study is a single center prospective convenience sample of patients presenting to the emergency department 12 years of age or older. Patients deemed study candidates and willing to be in the study filled out an eight-question questionnaire that included the question 'is your tetanus shot up to date'. A blood sample was then drawn for tetanus antibody titer and quantified according to a pre-determined cutoff for protection. Results: A total of 163 patients were enrolled. Of patients responding yes to the query 'is your tetanus shot up to date' 12.8% (N=5) of them were not seropositive. Of the 26 people who were seronegative in the study all had been to a doctor in the past year and 88.5% (N=23) had been to their family physician. Conclusion: The study suggests that it may be difficult to trust the tetanus immunization history given by patients presenting to the emergency room. The study also observed that a large percentage of patients who were serenegative were seen by a primary care physician and not had a necessary tetanus immunization. © 2012 Kimberly Barber et al.
O'Neill R.,Genesys Regional Medical Center |
Silver M.,Genesys Regional Medical Center |
Khorfan F.,Genesys Regional Medical Center
Journal of Emergency Medicine | Year: 2012
Background: Lead dislodgement has been shown to be the most common complication in the first 30 days after pacemaker insertion. Although it is rare, pneumopericardium with tamponade can also result. Objectives: We present a case of an extremely rare delay from cardiac pacemaker insertion to lead migration with resulting pneumopericardium and cardiac tamponade. Case Report: A 65-year-old woman with a past medical history significant for congestive heart failure, chronic obstructive pulmonary disease, and third-degree heart block, requiring pacemaker insertion 2 years prior with a revision 1 year prior, presented to the Emergency Department complaining of sudden-onset pleuritic chest pain. Her work-up revealed a pneumopericardium with atrial pacemaker lead migration into the right middle lobe of the lung. She suddenly developed hypotension and respiratory distress and required pericardiocentesis and, ultimately, surgical repair for a perforated right atrium. Conclusion: Pacemaker migration can lead to pneumopericardium and tamponade, even up to 1 year after placement. © 2012 Elsevier Inc.
Vanhecke T.E.,Genesys Regional Medical Center
Reviews in Cardiovascular Medicine | Year: 2011
Replacement of functional myocytes with crosslinked collagen as a result of tissue fibrosis is a final common pathway that is central to the progression of heart failure (HF), irrespective of etiology. In response to a variety of mechanical and neurohormonal stimuli, macrophages secrete galectin-3, which works as a paracrine and endocrine factor to stimulate additional macrophages, pericytes, myofibroblasts, and fibroblasts. The response to this signal is cellular proliferation and secretion of procollagen I. This protein is then irreversibly crosslinked to form collagen and result in cardiac fibrosis. With a commercially available assay, galectin-3 can now be measured in blood and has been found to aid in the prognosis of both systolic and nonsystolic HF. Measurement of galectin-3 before hospital discharge, on outpatient evaluation for suspected HF, and approximately twice per year for those with stable symptoms is supported by the evidence available at this time. Levels ≥ 25.9 ng/mL, independent of symptoms, clinical findings, and other laboratory measures, predict a patient who is likely to have rapid progression of HF, resulting in hospitalization and death. In addition, a doubling in galectin-3 level over the course of 6 months, irrespective of baseline value, identifies a high-risk patient in whom additional care management efforts and advanced therapies could be warranted. © 2011 MedReviews®, LLC.