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Seattle, WA, United States

Watson N.F.,Harborview Medical Center
CONTINUUM Lifelong Learning in Neurology | Year: 2013

Purpose of Review: An understanding of the impact of sleep on neurologic disorders, and the impact of neurologic disorders on sleep, provides fresh opportunities for neurologists to improve the quality of life and functioning of their patients.Recent Findings: Sleep-disordered breathing (SDB) is a risk factor for cerebrovascular disease and should be considered in all TIA and stroke patients. Sleep disorders can amplify nociception and worsen headache disorders; and some headaches, including those related to SDB and hypnic headache, are sleep specific. REM sleep behavior disorder may be an early sign of neurodegenerative disease. Focal lesions of almost any etiology (eg, multiple sclerosis and CNS malignancies) in the hypothalamus, basal forebrain, or brainstem may result in sleep disturbance, sleepiness, and insomnia. Sleep-related hypoventilation and fatigue are common in neuromuscular disease. SDB and epilepsy are mutually facilitatory, and poor sleep can exacerbate epilepsy.Summary: Continued surveillance for sleep disorders by neurologists is rewarded by new treatment avenues in their patients with the possibility of improved clinical outcomes. © 2013 American Academy of Neurology. Source

Zaratkiewicz S.,Harborview Medical Center
Journal for healthcare quality : official publication of the National Association for Healthcare Quality | Year: 2010

Hospital-acquired pressure ulcers (HAPUs) are a national concern due to patient morbidity, treatment cost, and reimbursement issues. Stages III and IV pressure ulcers (PUs) that occur during hospitalization are among the conditions considered preventable by the Centers for Medicare and Medicaid Services (CMS). Harborview Medical Center (HMC), located in Seattle, WA, is a Level 1 trauma/burn center and safety net hospital serving diverse populations. HMC is committed to providing excellence in care including optimal skin care and PU prevention to people from all walks of life. At HMC a new system for monitoring daily PU incidence, completing monthly multidisciplinary intensive reviews on HAPUs, and application of an algorithm used to determine if HAPUs were avoidable was developed and implemented. This system has assisted HMC in addressing PU tracking, prevention, compliance with regulatory mandates and has improved skin-related outcomes. © 2010 National Association for Healthcare Quality. Source

By 2015, most of the people living with the human immunodeficiency virus (HIV) in the United States will be aged 50 and older. Many will have known their HIV status for at least a decade, and most will have received antiretroviral therapy for some, if not all, of the time since testing positive. As these individuals advance in years, they frequently acquire diseases more commonly associated with aging than with HIV. This represents a unique challenge for today's medical providers. Although these individuals may appear considerably older than their chronological age, they are typically too young to see a geriatrician. An HIV specialist, although knowledgeable in the nuances of antiretroviral therapy, may be less comfortable managing multiple age-related illnesses. Similarly, a geriatrician experienced in managing multiple, age-related conditions may be less familiar with adjusting HIV-related therapies. In this era of caring for older adults with HIV, these two medical disciplines are finding they have much to learn from each other. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society. Source

Toogood P.A.,Harborview Medical Center | Vail T.P.,University of California at San Francisco
Journal of Arthroplasty | Year: 2015

The present study evaluated the frequency of periprosthetic fractures and tested the hypothesis that this population's demographics and outcomes are unique as compared with other arthroplasty patients. The National Hospital Discharge Survey provided the raw data. Individuals admitted with a primary TKA, primary THA, or revision TJA were selected. Annual rates were then calculated and demographics and outcomes compared. 30,624 patients were reviewed. The proportion of admissions for periprosthetic fractures ranged from 4.2% to 7.4% annually. As compared to patients admitted for other TJA diagnoses, individuals admitted with periprosthetic fracture were older, were more often female, were more often admitted emergently/urgently, had longer lengths of stay, had higher rates of discharge to places other than home, and had a significantly elevated mortality. © 2015 Elsevier Inc. Source

Routt Jr. M.L.C.,Harborview Medical Center
Journal of the American Academy of Orthopaedic Surgeons | Year: 2012

Posterior pelvic percutaneous fixation following either closed or open reduction is a popular procedure. Knowledge of the posterior pelvic anatomy, its variations, and related imaging is critical to performing reproducibly safe surgery. The dysmorphic sacrum has several key characteristics. The upper portion of the sacrum is relatively colinear with the iliac crests on the outlet radiographic view. Other characteristics include the presence of mammillary bodies (ie, underdeveloped transverse processes) at the sacral mid-alar area, anterior upper sacral foramina that are not circular, residual upper sacral disks, an acute alar slope oriented from cranial-posterior-central to caudal-anterior-lateral on the outlet and lateral views of the sacrum, a tongue-in-groove sacroiliac joint surface visualized on CT, and cortical indentation of the anterior ala on the inlet radiographic view. The surgeon must be knowledgeable about individual patient anatomy to ensure safe iliosacral screw placement. Source

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