Saver J.L.,University of California at Los Angeles |
Starkman S.,University of California at Los Angeles |
Eckstein M.,University of Southern California |
Stratton S.J.,Los Angeles County Emergency Medical Services EMS Agency |
And 8 more authors.
New England Journal of Medicine | Year: 2015
BACKGROUND: Magnesium sulfate is neuroprotective in preclinical models of stroke and has shown signals of potential efficacy with an acceptable safety profile when delivered early after stroke onset in humans. Delayed initiation of neuroprotective agents has hindered earlier phase 3 trials of neuroprotective agents. METHODS: We randomly assigned patients with suspected stroke to receive either intravenous magnesium sulfate or placebo, beginning within 2 hours after symptom onset. A loading dose was initiated by paramedics before the patient arrived at the hospital, and a 24-hour maintenance infusion was started on the patient's arrival at the hospital. The primary outcome was the degree of disability at 90 days, as measured by scores on the modified Rankin scale (range, 0 to 6, with higher scores indicating greater disability). RESULTS: Among the 1700 enrolled patients (857 in the magnesium group and 843 in the placebo group), the mean (±SD) age was 69±13 years, 42.6% were women, and the mean pretreatment score on the Los Angeles Motor Scale of stroke severity (range, 0 to 10, with higher scores indicating greater motor deficits) was 3.7±1.3. The final diagnosis of the qualifying event was cerebral ischemia in 73.3% of patients, intracranial hemorrhage in 22.8%, and a stroke-mimicking condition in 3.9%. The median interval between the time the patient was last known to be free of stroke symptoms and the start of the study-drug infusion was 45 minutes (interquartile range, 35 to 62), and 74.3% of patients received the study-drug infusion within the first hour after symptom onset. There was no significant shift in the distribution of 90-day disability outcomes on the global modified Rankin scale between patients in the magnesium group and those in the placebo group (P=0.28 by the Cochran-Mantel-Haenszel test); mean scores at 90 days did not differ between the magnesium group and the placebo group (2.7 in each group, P=1.00). No significant between-group differences were noted with respect to mortality (15.4% in the magnesium group and 15.5% in the placebo group, P=0.95) or all serious adverse events. CONCLUSIONS: Prehospital initiation of magnesium sulfate therapy was safe and allowed the start of therapy within 2 hours after the onset of stroke symptoms, but it did not improve disability outcomes at 90 days. Copyright © 2015 Massachusetts Medical Society.
News Article | November 21, 2016
In what is considered a victory for patient safety, hospitals across the U.S. have reduced deadly, but highly preventable, central-line bloodstream infections by 50 percent since 2008. In a new investigation of nearly 2,000 hospitals, Consumer Reports looks at the five-year track record of teaching hospitals to see which have successfully reduced these infections, and which have not. The report, available in the January issue of Consumer Reports and online at CR.org, identifies 31 U.S. teaching hospitals on its lowest-performing “zero tolerance” list and 32 on its list of top performers. The story and Ratings are free, in addition to an interactive look-up tool showing hospitals in your area and their five-year track record (go to CR.org/central-line-infections for the tool). “Because teaching hospitals are teaching our next generation of physicians, we think it’s critical to monitor them closely. Our review of their performance on controlling central-line infections is very sobering,” says Doris Peter, Ph.D., director of the Consumer Reports Health Ratings Center. “Central-line infections are highly preventable and there are no excuses for poor performance on this metric. It’s unfortunate to see so many well-known hospitals, some who tout their top rankings and awards, sitting on the sidelines of one of the biggest triumphs in patient safety.” Central-line infections derive from the intravenous lines used to supply medication, nutrients, and fluids to patients who need them the most. When not handled properly, central lines can become host to bacteria, pumping germs straight into the bloodstream of the patient. Once there, the bacteria – including deadly strains such as MRSA that aren’t easily managed with antibiotics – can spread to the heart and other organs. About 650,000 people develop infections after they are admitted to hospitals each year, and 75,000 patients die, according to the latest data from the Centers for Disease Control and Prevention. That makes hospital acquired infections the eighth leading cause of death, just behind diabetes. Central-line infections account for roughly 5 percent of all hospital infections, but are considered a critical subset because: While other hospital infections have stayed steady or declined only slightly in recent years, those linked to central lines were cut in half between 2008 and 2014, according to the CDC. “It’s one of the nation’s greatest patient safety success stories ever,” says Arjun Srinivasan, M.D., associate director for Healthcare Associated Infection Prevention Programs at the CDC. “Hospitals are moving in the right direction, but progress is slowing and too many hospitals have not adequately addressed the problem over the past five years,” says Consumer Reports’ Peter. What Can Be Done Consumer Reports’ nine-page investigation outlines the Pronovost principles developed 15 years ago to prevent central-line infections. It also includes profiles of two hospitals, Shore Medical Center in New Jersey and Mount Sinai St. Luke’s-Roosevelt in New York, that give insight into how they successfully battled this infection, and how they continue to be vigilant and improve. The story also includes 15 steps that consumers can take to stay safe in the hospital (see sidebar). From a policy standpoint, CR has worked successfully at the state level to get laws passed that require hospitals to publicly report hospital infections for more than a decade. And while President Barack Obama’s Affordable Care Act included a provision that lowered Medicare payments to hospitals that had too many infections, more can be done at the federal government to give the public more timely and actionable information, says Lisa McGiffert, director of Consumer Reports’ Safe Patient Project (SafePatientProject.org). “We think there are many requirements that could keep patients safe. For example, the federal government should require hospitals to immediately report infection outbreaks or infection-control breaches to patients, healthcare providers, state and federal agencies, and the public. In essence, we’re saying that when there is an outbreak, if the hospital knows, then everyone should know,” says McGiffert. Complete hospital lists and Ratings are available in the magazine story and online. The list below reveals the 31 lowest scoring U.S. teaching hospitals at preventing central-line infections in intensive care units from January 1, 2011 to December 31, 2015. Hospitals appear in alphabetical order. Atlanta Medical Center (Atlanta, GA) Banner- University Medical Center Tucson (Tucson, AZ) Brooklyn Hospital Center (Brooklyn, NY) Community Regional Medical Center (Fresno, CA) Cooper University Health Care (Camden, NJ) Dartmouth – Hitchcock Medical Center (Lebanon, NH) Emory University Hospital Midtown (Atlanta, GA) Eskenazi Health (Indianapolis, IN) George Washington University Hospital (Washington, DC) Grady Memorial Hospital (Atlanta, GA) Holy Cross Hospital (Silver Spring, MD) Howard University Hospital (Washington, D.C.) Hurley Medical Center (Flint, MI) Indiana University Health University Hospital (Indianapolis, IN) Interim LSU Public Hospital (New Orleans, LA) Long Beach Memorial Medical Center (Long Beach, CA) MacNeal Hospital (Berwyn, IL) Maine Medical Center (Portland, ME) Maricopa Integrated Health System (Phoenix, AZ) Nebraska Medicine - Nebraska Medical Center (Omaha, NE) Palmetto Health Richland (Columbia, SC) Robert Wood Johnson University Hospital (New Brunswick, NJ) Ronald Reagan UCLA Medical Center (Los Angeles, CA) SUNY Downstate Medical Center University Hospital (Brooklyn, NY) Truman Medical Center - Hospital Hill (Kansas City, MO) Tulane Medical Center (New Orleans, LA) UC San Diego Health (San Diego, CA) UF Health Jacksonville (Jacksonville, FL) University Hospital (Newark, NJ) University Medical Center of El Paso (El Paso, TX) University of Iowa Hospitals and Clinics (Iowa City, IA) About Consumer Reports Consumer Reports is the world’s largest and most trusted nonprofit consumer organization, working to improve the lives of consumers by driving marketplace change. Founded in 1936, Consumer Reports has achieved substantial gains for consumers on food and product safety, financial reform, health reform, and many other issues. The organization has advanced important policies to prohibit predatory lending practices, combat dangerous toxins in food, and cut hospital-acquired infections. Consumer Reports tests and rates thousands of products and services in its 50-plus labs, state-of-the-art auto test center, and consumer research center. It also works to enact pro-consumer laws and regulations in Washington, D.C., in statehouses, and in the marketplace. An independent nonprofit, Consumer Reports accepts no advertising, payment, or other support from the companies that create the products it evaluates. _______________ JANUARY 2017 © 2016 Consumer Reports. The material above is intended for legitimate news entities only; it may not be used for advertising or promotional purposes. Consumer Reports® is an expert, independent nonprofit organization whose mission is to work for a fair, just, and safe marketplace for all consumers and to empower consumers to protect themselves. We accept no advertising and pay for all the products we test. We are not beholden to any commercial interest. Our income is derived from the sale of Consumer Reports®, ConsumerReports.org® and our other publications and information products, services, fees, and noncommercial contributions and grants. Our Ratings and reports are intended solely for the use of our readers. Neither the Ratings nor the reports may be used in advertising or for any other commercial purpose without our permission. Consumer Reports will take all steps open to it to prevent commercial use of its materials, its name, or the name of Consumer Reports®.
Voros S.,State University of New York at Stony Brook |
Elashoff M.R.,CardioDx |
Wingrove J.A.,CardioDx |
Budoff M.J.,University of California at Los Angeles |
And 3 more authors.
Atherosclerosis | Year: 2014
Objective: We previously validated a gene expression score (GES) based on age, sex and peripheral blood cell expression levels of 23 genes measured by quantitative real-time PCR (qRT-PCR) for diagnosis of obstructive coronary artery disease (CAD) (≥50% luminal diameter stenosis). In this study we sought to determine the association between the GES and coronary arterial Plaque Burden and Stenosis by CT-angiography. Methods: A total of 610 patients (mean age: 57±11; 50% male) from the PREDICT and COMPASS studies from 59 centers were analyzed. Coronary artery calcium (CAC) scoring, CT angiography (CTA)-based plaque and stenosis and GES measurements were performed. CAC was expressed as Agatston score and CTA evaluated for stenosis severity: 0. None; 1. Minimal, 2. Mild, 3. Moderate, 4. Severe and 5. Occluded. Correlation analysis, one-way analysis of variance (ANOVA) and receiver operating characteristics (ROC) analyses were performed. Results: GES was significantly associated with plaque burden by CAC (r=0.50; p<0.001) and CTA (segment involvement score index: r=0.37, p<0.001); a low score (≤15) had sensitivity of 0.71 and a high score (≥28) a specificity of 0.97 for the prediction of zero vs. non-zero CAC. Increasing GES was associated with a greater degree of categorical stenosis by ANOVA (p<0.001); GES significantly correlated with maximum luminal stenosis (r=0.41; p<0.01) and segment stenosis score index (r=0.38; p<0.01). A low score had sensitivity of 0.90 and a high score a specificity of 0.87 for ≥70% stenosis. Conclusions: A previously validated GES is significantly associated with Plaque Burden and Stenosis byCT. © 2014 The Authors.
Pevzner L.,University of California at Irvine |
Preslicka C.,Long Beach Memorial Medical Center |
Bush M.C.,Saddleback Memorial Medical Center |
Chan K.,Long Beach Memorial Medical Center
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2011
Objective. To explore women's attitudes and beliefs regarding cesarean delivery and cesarean delivery on maternal request (CDMR). Study design. Anonymous questionnaires assessing patient demographics, knowledge, and attitudes about CDMR were distributed at the time of routine mid-trimester ultrasound appointment. Results. Eight hundred thirty three out of 3929 (21.2%) potential participants completed the questionnaire. About 81.7% of participants indicated that they believed that vaginal delivery was a safer alternative for the mother and 72.8% believed that it was safer for the fetus. While only 6.1% of women thought that CDMR was 'a good idea', most believed that women should have the right to choose their mode of delivery and that the option should be offered to everyone (85.9% and 79.6%, respectively). Socioeconomic and demographic variables did not significantly influence the participants' responses. Conclusion. Majority of women believe that vaginal delivery is safer for the mother and baby and would prefer to have a vaginal delivery if given the option. © 2011 Informa UK, Ltd.
Ulin K.,Review Centre |
Urie M.M.,Review Centre |
Cherlow J.M.,Long Beach Memorial Medical Center
International Journal of Radiation Oncology Biology Physics | Year: 2010
Purpose: Variability in computed tomography/magnetic resonance imaging (CT/MR) cranial image registration was assessed using a benchmark case developed by the Quality Assurance Review Center to credential institutions for participation in Children's Oncology Group Protocol ACNS0221 for treatment of pediatric low-grade glioma. Methods and Materials: Two DICOM image sets, an MR and a CT of the same patient, were provided to each institution. A small target in the posterior occipital lobe was readily visible on two slices of the MR scan and not visible on the CT scan. Each institution registered the two scans using whatever software system and method it ordinarily uses for such a case. The target volume was then contoured on the two MR slices, and the coordinates of the center of the corresponding target in the CT coordinate system were reported. The average of all submissions was used to determine the true center of the target. Results: Results are reported from 51 submissions representing 45 institutions and 11 software systems. The average error in the position of the center of the target was 1.8 mm (1 standard deviation = 2.2 mm). The least variation in position was in the lateral direction. Manual registration gave significantly better results than did automatic registration (p = 0.02). Conclusion: When MR and CT scans of the head are registered with currently available software, there is inherent uncertainty of approximately 2 mm (1 standard deviation), which should be considered when defining planning target volumes and PRVs for organs at risk on registered image sets. Copyright © 2010 Elsevier Inc.
Jordan Y.J.,Providence Little Company of Mary Medical Center Torrance |
Jordan J.E.,Providence Little Company of Mary Medical Center Torrance |
Lightfoote J.B.,Pomona Valley Hospital Medical Center |
Ragland K.D.,Pomona Valley Hospital Medical Center |
Ragland K.D.,Long Beach Memorial Medical Center
American Journal of Roentgenology | Year: 2012
OBJECTIVE. The purposes of this study were to determine the clinical importance and relative value of reinterpretation of brain CT studies by subspecialty experts by assessing the accuracy of interpretation by general radiologists at primary stroke centers and to assess interpretive quality outcomes as a function of change in the treatment of patients with stroke diagnoses or acute presentations of suspected stroke. MATERIALS AND METHODS. Computerized medical records for the years 2009-2010 at four major community hospitals were queried for primary interpretation of brain CT studies of stroke patients with an acute presentation of either stroke or suspected stroke as diagnosed by board-certified general radiologists (nonneuroradiologists). A central database was queried that allowed one to query by clinical history or symptoms. Secondary interpretation of images of the identified patient sample was then performed by three experienced neuroradiologists. Each case was initially interpreted as an emergency or urgent study by a general radiologist. The reinterpretations performed by a neuroradiologist were scored as concordant or discordant. The discordant studies were categorized as a major discordance if there was a change in clinical management or as a minor discordance if there was no effect on or change in clinical management. The assessment was limited to brain CT studies without contrast administration. CT angiography and perfusion CT studies were not included in the analysis. Patients with hemorrhagic stroke, brain tumors, abscesses, and AIDS or HIV infection were excluded to limit the assessment to ischemic nonhemorrhagic disease. RESULTS. Of the 560 studies reviewed, 14 studies (2.5%) were identified as discordant. Of those discordant studies, four (0.7% of the original 560) were categorized as major discrepancies necessitating a change in clinical management. Ten (1.78%) were categorized as minor discrepancies, for which there was no change in management. There were no permanent adverse outcomes with respect to morbidity and mortality as a result of a discrepant interpretation, as determined by chart review or communication with the attending or referring physician by the secondary reader. CONCLUSION. Most of the interpreted head CT cases read by board-certified general radiologists for patients presenting with stroke or stroke symptoms did not result in discordant interpretations as verified by subspecialty experts. Discordant interpretations did not result in changes in clinical management in most cases. Double reading of head CT scans for these patients by subspecialty experts appears to be an inefficient method of substantially improving imaging health quality outcomes in stroke. © American Roentgen Ray Society.
Song J.,Long Beach Memorial Medical Center
Clinical Ophthalmology | Year: 2016
Selective laser trabeculoplasty is a laser treatment to treat glaucoma. It was initially indicated for open-angle glaucoma but has been proven to be efficacious for various types of glaucoma. This review article summarizes the few rare complications that can be seen with selective laser trabeculoplasty. It also makes recommendations on how to avoid these problems and how to treat patients when these rare complications arise. © 2016 Song.
Sternschuss G.,Long Beach Memorial Medical Center |
Ostergard D.R.,University of Louisville |
Patel H.,Long Beach Memorial Medical Center
Journal of Urology | Year: 2012
Purpose: We reviewed the mechanisms by which polypropylene mesh changes after implantation in the human body. Materials and Methods: The existing polymer and medical literature was reviewed regarding polypropylene, including its chemical characteristics, and compositional and physical properties, which undergo alteration after implantation at various human body locations. We also reviewed the changes in those physical properties that were demonstrable in explanted specimens. Results: Polypropylene in mesh form is commonly considered inert and without adverse reactions after implantation in humans. The literature suggests otherwise with reports of various degrees of degradation, including depolymerization, cross-linking, oxidative degradation by free radicals, additive leaching, hydrolysis, stress cracking and mesh shrinkage along with infection, chronic inflammation and the stimulation of sclerosis. Many substances added to polypropylene for various purposes during manufacture behave as toxic substances that are released during the degradation process. The material may also absorb various substances. These alterations in the chemical structure of polypropylene are responsible for visibly demonstrable fiber changes, resulting in the loss of structural integrity through material embrittlement. The heat of manufacturing polypropylene fibers begins the degradation process, which is augmented by the post-production heat used to flatten the mesh to prevent curling and attach anchoring appendages. Conclusion: Based on available evidence the polypropylene used for surgical treatment of various structural defects is not inert after implantation in the human body. The quest for the perfect mesh must continue. © 2012 American Urological Association Education and Research, Inc.
Strauss M.B.,Long Beach Memorial Medical Center |
Strauss M.B.,University of California at Irvine
Undersea and Hyperbaric Medicine | Year: 2012
Crush injuries represent a spectrum of injury to body parts as resutt of trauma. Presentations vary from minor contusions to timb-threatening damage. Typicatty, the injury invotves muttipte tissues, from skin and subcutaneous, to muscte and tendons, to bone and joints. In their most severe presentations, predictabte comptications - inctuding osteomyetitis, non-union of fractures, amputations and failed flaps - occur in approximatety 50 percent of the cases with standard of practice surgicat and medicat interventions [1-3]. Sketetat muscte-compartment syndrome (SMCS) is another consequence of trauma, but in this situation the target tissues are musctes and nerve. Edema and/or bleeding within the confines of the fasciat envelope can increase the pressure within the sketetat musctecompartment. When the tissue fluid pressure within the compartment exceeds the capittary perfusion pressure to the musctes and nerves in the compartment, these tissues are rendered ischemic and manifest the signs and symptoms of SMCS. The SMCS, especiatty in its incipient stages before a fasciotomy is required, is a therapeutic chattenge since no means to arrest its progression exist other than hyperbaric oxygen (HBO2). Unfortunatety, HBO2 is woefutty negtected as an adjunct for managing crush injury and SMCS. Strong arguments exist for its use based on evidenced-based information and how HBO2 mitigates the pathotogy of these conditions. Copyright © 2012 Undersea & Hyperbaric Medical Society, Inc.
Nyi P.P.,Long Beach Memorial Medical Center
Journal of psychoactive drugs | Year: 2010
An Internet-based survey of Salvia divinorum ("salvia") users was conducted to identify correlates surrounding its use. Salvia-knowledgeable persons were recruited via "social networking Internet websites" (n = 23) where notices were posted on recreational salvia group message boards (n = 69). Data collection included demographics, use circumstances, experiences, and age (current and at first salvia use). A total of 219 surveys were analyzed. Salvia users who were young adults (< or = 21 yrs) at first use favored salvia for fun (OR = 1.94, CI = 1.08-3.49, p = 0.03) or to relieve boredom (OR = 2.06 CI = 1.09-3.91, p = 0.02), while salvia users who were adults (> or = 22 yrs) at first use favored salvia for spiritual effects (OR = 2.63, CI = 1.02-6.75, p = 0.04). Being an adult at first use was associated with higher odds of concurrent marijuana (OR = 2.68, CI = 1.50-4.78, p = 0.0007) or tobacco use (OR = 1.94, CI = 1.05-3.60, p = 0.03). Over half of all respondents reported use reduction or cessation in the past 12 months (114 of 219, 52%), citing dislike of the high (33.3%) or loss of interest in salvia (28.9%). Reports of cessation suggest salvia use may be more attributed to curiosity than continual abuse.