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Leesburg, VA, United States

Anderson J.G.,University of Virginia | Suchicital L.,Inova Fair Oaks Hospital | Lang M.,Inova Fair Oaks Hospital | Kukic A.,Inova Fair Oaks Hospital | And 4 more authors.
Explore (New York, N.Y.) | Year: 2015

CONTEXT: Given the growth in the number of bariatric surgeries, it is important for healthcare practitioners to maximize symptom management for these patients, including the option of complementary therapies such as Healing Touch.OBJECTIVE: A quasi-experimental study was conducted to determine the feasibility of a Healing Touch intervention for reducing pain, nausea, and anxiety in patients undergoing laparoscopic bariatric surgery.DESIGN: Following surgery, a nurse administered the Healing Touch intervention once daily. Study participants reported levels of pain, nausea, and anxiety immediately before and after the Healing Touch intervention using separate numeric rating scales.RESULTS: Significant decreases in pain, nausea, and anxiety were observed immediately following the intervention on post-operative days one and two, and in pain and anxiety on post-operative day three compared with pre-intervention levels. These findings indicate that the Healing Touch intervention is feasible and acceptable to patients undergoing bariatric surgery, and significantly improved pain, nausea, and anxiety in these patients. Copyright © 2015 Elsevier Inc. All rights reserved.

Lee C.K.,Inova Loudoun Hospital | Tefera E.,MedStar Research Institute | Colice G.,Washington Hospital Center | Colice G.,George Washington University
Respiration | Year: 2014

Background: The effect of obesity on outcomes in critically ill patients requiring invasive mechanical ventilation in a medical intensive care unit (ICU) is uncertain. Objectives: This study was intended to further explore the relationship between outcomes and obesity in patients admitted to a medical ICU who required invasive mechanical ventilation. Methods: All adult patients admitted to the medical ICU at Washington Hospital Center requiring intubation and invasive mechanical ventilation for at least 24 h between January 1 and December 31, 2009, were retrospectively studied. Patients were categorized as nonobese (BMI <30) and obese (BMI ≥30). The primary outcome measure was 30-day mortality following intubation. Secondary outcomes included ICU length of stay (LOS), hospital LOS and duration of mechanical ventilation. Results: There were 504 eligible patients: 306 nonobese and 198 (39%) obese. Obese patients had significantly higher rates of diabetes (43 vs. 30%, p = 0.004), hyperlipidemia (32 vs. 24%, p = 0.04), asthma (16 vs. 8%, p = 0.004) and obstructive sleep apnea requiring continuous positive airway pressure treatment (12 vs. 1%, p < 0.001). Nonobese patients had a significantly higher rate of HIV infection (10 vs. 5%, p = 0.05) and malignancy (21 vs. 13%, p = 0.03). There were no significant differences in mortality up to 30 days following intubation and secondary outcomes between obese and nonobese patients. Multivariate analysis using logistic regression showed no significant relationship between mortality rate at 30 days following intubation and obesity. Outcomes were similar for the black obese (n = 153) and nonobese (n = 228) patients and the obese (n = 85) and very obese (n = 113) patients. Conclusions: Obesity did not influence outcomes in critically ill patients requiring invasive mechanical ventilation in a medical ICU. Black obese patients had similar outcomes to black nonobese patients, and very obese patients also had similar outcomes to obese patients. © 2014 S. Karger AG, Basel.

Background: Because of the renal elimination and increased risk for bleeding events at supratherapeutic doses of eptifibatide, the manufacturer recommends dosing adjustment in patients with renal dysfunction. Methods commonly used to estimate renal dysfunction in hospital settings may be inconsistent with those studied and recommended by the manufacturer. Objective: To compare hypothetical renal dosing adjustments of eptifibatide using both the recommended method and several other commonly used formulas for estimating kidney function. Methods: Sex, age, weight, height, serum creatinine, and estimated glomerular filtration rate (eGFR) were obtained retrospectively from the records of patients who received eptifibatide during a 12-month period. Renal dosing decisions were determined for each patient based on creatinine clearance (CrCl) estimates via the Cockcroft-Gault formula (CG) with actual body weight (ABW), ideal body weight (IBW) or adjusted weight (ADJW), and eGFR from the Modification of Diet in Renal Disease formula. Percent agreement and Cohen k were calculated comparing dosing decisions for each formula to the standard CG-ABW. Results: In this analysis of 179 patients, percent agreement as compared to CG-ABW varied (CG-IBW: 90.50%, CG-ADJW: 95.53%, and eGFR: 93.30%). All κ coefficients were categorized as good. In the 20% of patients receiving an adjusted dose by any of the methods, 68.6% could have received a dose different from that determined using the CG-ABW formula. Conclusions: In the patients with renal impairment (CrCl <50 mL/min) in this study, two thirds would have received an unnecessary 50% dose adjustment discordant from the manufacturer's recommendation. Because failure to adjust eptifibatide doses in patients with renal impairment has led to increased bleeding events, practitioners may be inclined to err on the side of caution. However, studies have shown that suboptimal doses of eptifibatide lead to suboptimal outcomes. Therefore, correct dosing of eptifibatide is important to both patient safety and efficacy.

Miles S.,U.S. National Institutes of Health | Massengill J.,U.S. National Institutes of Health | Gruber D.,U.S. National Institutes of Health | Speroni K.G.,Inova Loudoun Hospital | Gaynor-Krupnick D.,Loudoun Medical Group
Journal of Clinical Anesthesia | Year: 2013

Study Objective To determine whether patients receiving perioperative glycopyrrolate during midurethral sling surgery had more acute but temporary postoperative urinary retention. Design Retrospective cohort from 2006 to 2011. Setting Northern Virginia community urology practice. Measurements To minimize variability in surgical technique and postoperative care, all cases were from a single fellowship-trained urologist who performed most of the female incontinence procedures. Inclusion criteria were charts of women, 18 years of age or older, who had a primary preoperative diagnosis of stress urinary incontinence (SUI) and who underwent a midurethral sling procedure. Of 151 patients charts, 135 met study eligibility: 57 (42.2%) patients received glycopyrrolate; 78 (57.8%) did not. The postoperative course of those who did and did not receive glycopyrrolate was compared and formed the basis of group allocation. Data collected included age, body mass index, incontinence type, smoking status, diabetes mellitus, surgery performed, anesthesia type, estimated blood loss, intraoperative fluids, surgery end time to void, and postoperative urinary retention. Main Results No differences existed between the groups in baseline or surgical data. Seven patients (5.2%) had acute temporary postoperative retention, two of whom received glycopyrrolate and 5 did not (3.51% vs 6.41%; relative risk [RR] 0.55, 95% CI 0.11 -2.72, P = 0.70). Excluding those with continued persistent voiding dysfunction beyond 48 hours from surgery, only 3 patients (2.22%) had acute temporary postoperative urinary retention: one received glycopyrrolate and two did not (1.75% vs 2.56%; RR 0.68, 95% CI 0.064 - 7.36; P = 0.99). Conclusion Acute temporary postoperative urinary retention is rare after midurethral slings. Glycopyrrolate during anesthesia induction does not appear significantly to increase this rate.

Wood E.B.,Inova Loudoun Hospital
The West Indian medical journal | Year: 2010

To describe HIV-related sexual risk behaviours among late-adolescent Jamaican girls and examine whether having an age-discordant male sexual partner (> or = 2 years older) was associated with a decrease in condom use at last coitus. Utilizing an expanded Theory of Planned Behaviour a survey was designed to capture HIV-related sexual risk behaviours. Descriptive and inferential statistics were used to analyse the final sample of one hundred and eighty-four late-adolescent girls (18-21 years) in Kingston, Jamaica. At first coitus, 70.3 per cent of the survey participants had done so with an older partner. At the time of the survey, 58.7 per cent of the sample reported being in an age-discordant relationship, with age differences between 2 and 39 years. While only 12 per cent of the sample reported having more than one sexual partner 40 per cent of the sample reported that their older male partner had multiple sexual partners. Slightly more than half (58%) of late-adolescent girls reported condom use at last coitus. No significant differences were found in condom use between girls who had age-discordant partners and girls who had similar aged-partners. Sexual relationships with older male partners are common among late-adolescent Jamaican girls, and may put girls at risk for acquiring HIV through unprotected coitus and coitus with someone who has multiple partners. As Jamaica and the broader Caribbean struggle to curtail the emergent HIV epidemic among adolescent girls, age-discordant relationships are a significant area for research and prevention efforts of clinicians and public health professionals.

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