Gundersen Lutheran Health System

La Crosse, WI, United States

Gundersen Lutheran Health System

La Crosse, WI, United States
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Hammes B.J.,Gundersen Lutheran Medical Foundation | Rooney B.L.,Gundersen Lutheran Health System | Gundrum J.D.,Gundersen Lutheran Medical Foundation
Journal of the American Geriatrics Society | Year: 2010

OBJECTIVES: To determine whether outcomes have changed over time for a managed, systematic approach to advance care planning (ACP). DESIGN: Retrospective comparison of medical record and death certificate data of adults who died over a 7-month period in 2007/08 with those of adults who died over an 11-month period in 1995/96. SETTING: All healthcare organizations in La Crosse County, Wisconsin. PARTICIPANTS: Five hundred forty adults who died in 1995/96 and 400 adults who died in 2007/08. INTERVENTION: A systematic ACP approach, Respecting Choices, collaboratively implemented in 1993 and continuously improved in subsequent years. MEASUREMENTS: Demographic and cause-of-death data were collected from death certificates. Type and content of any advance directive (AD), existence and content of Physician Orders for Life-Sustaining Treatment, and medical treatment provided at the location of death in the last 30 days of life were abstracted from the medical record. RESULTS: The recent data show a significantly greater prevalence of ADs (90% vs 85%, P=.02) and of availability of these directives in the medical record at the time of death (99.4% vs 95.2%, P<.001) than the data collected over 10 years ago. The new data suggest that quality efforts have improved the prevalence, clarity, and specificity of ADs. CONCLUSION: A system for ACP can be managed in a geographic region so that, at the time of death, almost all adults have an advance care plan that is specific and available and treatment is consistent with their plan. © 2010, The American Geriatrics Society.

Zlabek J.A.,Gundersen Lutheran Health System | Wickus J.W.,Gundersen Lutheran Health System | Mathiason M.A.,Gundersen Lutheran Medical Foundation
Journal of the American Medical Informatics Association | Year: 2011

There is controversy over the impact of electronic health record (EHR) systems on cost of care and safety. The authors studied the effects of an inpatient EHR system with computerized provider order entry on selected measures of cost of care and safety. Laboratory tests per week per hospitalization decreased from 13.9 to 11.4 (18%; p<0.001). Radiology examinations per hospitalization decreased from 2.06 to 1. (93 6.3%; p<0.009). Monthly transcription costs declined from $74 596 to $18 938 (74.6%; p<0.001). Reams of copy paper ordered per month decreased from 1668 to 1224 (26.6%; p<0.001). Medication errors per 1000 hospital days decreased from 17.9 to 15.4 (14.0%; p<0.030), while near misses per 1000 hospital days increased from 9.0 to 12.5 (38.9%; p<0.037), and the percentage of medication events that were medication errors decreased from 66.5% to 55.2% (p<0.007). In this manuscript, we demonstrate that the implementation of an inpatient EHR with computerized provider order entry can result in rapid improvement in measures of cost of care and safety.

McLaughlin J.R.,Kennedy Center at Mercy Medical Center | Lee K.R.,Gundersen Lutheran Health System
Journal of Arthroplasty | Year: 2014

The purpose of this study was to evaluate the efficacy of an uncemented tapered femoral component in obese patients at a mean follow-up of 23. years. We retrospectively reviewed 119 consecutive uncemented total hip arthroplasties in 105 obese patients using a tapered femoral component between 1983 and 1987. The mean body mass index of these patients was 34 (range 30-47). Complete clinical and radiographic follow-up was obtained on the 55 hips in 47 patients who survived a minimum of 18. years (range 18-27. years). Three femoral components (6%) have been revised, none for aseptic loosening. One was loose by radiographic criteria. These results demonstrate that an uncemented tapered stem can provide excellent fixation in obese patients out to 27. years. © 2014 Elsevier Inc.

Baker M.T.,Gundersen Lutheran Health System
Surgical Clinics of North America | Year: 2011

The search for the ideal weight loss operation began more than 50 years ago. Surgical pioneers developed innovative procedures that initially created malabsorption, then restricted volume intake, and eventually combined both techniques. Variations, alterations, and modifications of these original procedures, combined with intense efforts to follow and document outcomes, have led to the evolution of modern bariatric surgery. More recent research has focused on the hormonal and metabolic effects of these procedures. These discoveries at the cellular level will help develop possible mechanisms of weight loss and comorbidity reduction beyond the traditional explanation of reduced food consumption and malabsorption. © 2011 Elsevier Inc.

Farley N.E.,Gundersen Lutheran Health System
The International journal of oral & maxillofacial implants | Year: 2013

Recent clinical studies have shown that implant placement is highly predictable with computer-generated surgical guides; however, the reliability of these guides has not been compared to that of conventional guides clinically. This study aimed to compare the accuracy of reproducing planned implant positions with computer-generated and conventional surgical guides using a split-mouth design. Ten patients received two implants each in symmetric locations. All implants were planned virtually using a software program and information from cone beam computed tomographic scans taken with scan appliances in place. Patients were randomly selected for computer-aided design/computer-assisted manufacture (CAD/CAM)-guided implant placement on their right or left side. Conventional guides were used on the contralateral side. Patients underwent operative cone beam computed tomography postoperatively. Planned and actual implant positions were compared using three-dimensional analyses capable of measuring volume overlap as well as differences in angles and coronal and apical positions. Results were compared using a mixed-model repeated-measures analysis of variance and were further analyzed using a Bartlett test for unequal variance (α = .05). Implants placed with CAD/CAM guides were closer to the planned positions in all eight categories examined. However, statistically significant differences were shown only for coronal horizontal distances. It was also shown that CAD/CAM guides had less variability than conventional guides, which was statistically significant for apical distance. Implants placed using CAD/CAM surgical guides provided greater accuracy in a lateral direction than conventional guides. In addition, CAD/CAM guides were more consistent in their deviation from the planned locations than conventional guides.

Al Harakeh A.B.,Gundersen Lutheran Health System
Surgical Clinics of North America | Year: 2011

Despite the well-documented safety of laparoscopic RYGB, several short-term and long-term complications, with varying degrees of morbidity and mortality risk, are known to occur. Bariatric surgeons, all too familiar with these complications, should be knowledgeable in risk-reduction strategies to minimize the incidence of complication occurrence and recurrence. Bariatric and nonbariatric surgeons who evaluate and treat abdominal pain should be familiar with these complications to facilitate early recognition and intervention, thereby minimizing the associated morbidity and mortality. © 2011 Elsevier Inc.

Gundersen Lutheran Health System | Date: 2013-04-02

Reagents, methods, and kits for the classification of cancer that comprise or employ antibodies that bind specific regions of CD43. One method includes contacting tissue with an antibody capable of specifically binding the cytoplasmic tail of CD43, contacting the tissue with an antibody capable of specifically binding the extracellular domain of CD43, and resolving cellular localization of any binding to the tissue with the antibody capable of specifically binding the cytoplasmic tail of CD43 and the antibody capable of specifically binding the extracellular domain of CD43. The binding patterns of the antibodies can be used to characterize cancer as more aggressive or less aggressive and can distinguish small cell lung cancer from non-small cell lung cancer. The cancer may therefore be treated in accordance of the characterization.

Patel N.Y.,Gundersen Lutheran Health System | Riherd J.M.,Gundersen Lutheran Health System
Surgical Clinics of North America | Year: 2011

Focused assessment with sonography for trauma (FAST) is an invaluable adjunct in the management of trauma patients for detection of free intra-abdominal and pericardial fluid. Over the past 2 decades, the use of this technique has increased significantly. This article reviews the clinical application and future direction of FAST. © 2011 Elsevier Inc.

Kothari S.N.,Gundersen Lutheran Health System
Surgical Clinics of North America | Year: 2011

This article reviews the use of radiological imaging in the post-gastric bypass patient. A thorough understanding of the reconstructed anatomy is critical to interpret imaging abnormalities, when present. Radiological imaging can help guide the surgeon's management in this specific patient population. © 2011 Elsevier Inc.

Jarman B.T.,Gundersen Lutheran Health System
Surgical Clinics of North America | Year: 2011

There is a variety of options available to image the small bowel depending on the clinical scenario. This article describes multiple imaging options and focuses on several clinical scenarios common to general surgeons. © 2011 Elsevier Inc.

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