Dangerfield B.,Maricopa Medical Center |
Webb B.,University of Utah
Antimicrobial Agents and Chemotherapy | Year: 2014
Pneumonia due to methicillin-resistant Staphylococcus aureus (MRSA) is associated with poor outcomes and frequently merits empirical antibiotic consideration despite its relatively low incidence. Nasal colonization with MRSA is associated with clinical MRSA infection and can be reliably detected using the nasal swab PCR assay. In this study, we evaluated the performance of the nasal swab MRSA PCR in predicting MRSA pneumonia. A retrospective cohort study was performed in a tertiary care center from January 2009 to July 2011. All patients with confirmed pneumonia who had both a nasal swab MRSA PCR test and a bacterial culture within predefined time intervals were included in the study. These data were used to calculate sensitivity, specificity, positive predictive value, and negative predictive value for clinically confirmed MRSA pneumonia. Four hundred thirty-five patients met inclusion criteria. The majority of cases were classified as either health care-associated (HCAP) (54.7%) or community- acquired (CAP) (34%) pneumonia. MRSA nasal PCR was positive in 62 (14.3%) cases. MRSA pneumonia was confirmed by culture in 25 (5.7%) cases. The MRSA PCR assay demonstrated 88.0% sensitivity and 90.1% specificity, with a positive predictive value of 35.4% and a negative predictive value of 99.2%. In patients with pneumonia, the MRSA PCR nasal swab has a poor positive predictive value but an excellent negative predictive value for MRSA pneumonia in populations with low MRSA pneumonia incidence. In cases of culture-negative pneumonia where initial empirical antibiotics include an MRSA-active agent, a negative MRSA PCR swab can be reasonably used to guide antibiotic de-escalation. Copyright © 2014, American Society for Microbiology. All Rights Reserved.
News Article | February 15, 2017
NJ Spine & Orthopedic announces the arrival of Dr. Douglas Slaughter, who joins the expert minimally invasive spine care team as an orthopedic surgeon. NJ Spine & Orthopedic, a nationwide leader in minimally invasive spine surgery, treats patients with back and neck pain using state-of-the-art techniques. Dr. Slaughter is a board-certified orthopedic surgeon, who has been successfully practicing minimally invasive techniques for over 21 years, with a strong focus in reconstructive surgery for spinal injuries. Dr. Slaughter treats patients who experience conditions that affect muscles, bones, and joints due to sports and high-impact activity injuries, as well as age-related injuries due to degenerative spine conditions. Other areas of expertise include spinal stenosis and osteoarthritis. “Dr. Slaughter offers an invaluable level of orthopedic expertise to our team,” Dr. Scott Katzman, founder of NJ Spine & Orthopedic, said. “His dedication to treating every patient with the least invasive methods possible has allowed him to become a leading U.S. spine surgeon and a true asset to the NJSO team and our patients.” One of the many reasons we hired Dr. Slaughter was due to his vast experience with artificial disc replacement. Since we believe in maintaining motion in the cervical spine, his extensive training was a perfect fit to NJ Spine & Orthopedic. Dr. Slaughter’s bed side manner is top notch and patients love his gentle approach. Dr. Slaughter, a veteran of the United States Army Reserves, received his medical degree from The University of Cincinnati College of Medicine and served his residency in orthopedic surgery at Maricopa Medical Center in Phoenix, Arizona. He further honed his orthopedic expertise in spinal reconstructive surgery in New York City at Beth Israel Spine Institute under the direction of Dr. Michael Neuwirth. Other previous spine care experience includes Sonoran Spine Center in Phoenix, Arizona, where he personally developed spinal reconstructive surgery and minimally invasive surgery practices. For more information about Dr. Slaughter and NJ Spine & Orthopedic, visit NJSpineAndOrtho.com. About NJ Spine & Orthopedic NJ Spine & Orthopedic is a minimally invasive spine treatment center with offices throughout New Jersey, New York and Florida. The award-winning team of orthopedic surgeons and medical staff offer the latest technology and treatments to repair conditions of the spine that lead to back and neck pain. With over 50 years of combined surgery experience, NJ Spine & Orthopedic operates under a comprehensive treatment philosophy ranging from pain management methods to minimally invasive surgery, and is committed to finding the least invasive and most effective treatments for patients suffering from neck and back pain.
Yealy D.M.,University of Pittsburgh |
Kellum J.A.,University of Pittsburgh |
Huang D.T.,University of Pittsburgh |
Barnato A.E.,University of Pittsburgh |
And 9 more authors.
New England Journal of Medicine | Year: 2014
BACKGROUND: In a single-center study published more than a decade ago involving patients presenting to the emergency department with severe sepsis and septic shock, mortality was markedly lower among those who were treated according to a 6-hour protocol of early goal-directed therapy (EGDT), in which intravenous fluids, vasopressors, inotropes, and blood transfusions were adjusted to reach central hemodynamic targets, than among those receiving usual care. We conducted a trial to determine whether these findings were generalizable and whether all aspects of the protocol were necessary. METHODS: In 31 emergency departments in the United States, we randomly assigned patients with septic shock to one of three groups for 6 hours of resuscitation: protocol-based EGDT; protocol-based standard therapy that did not require the placement of a central venous catheter, administration of inotropes, or blood transfusions; or usual care. The primary end point was 60-day in-hospital mortality. We tested sequentially whether protocol-based care (EGDT and standard-therapy groups combined) was superior to usual care and whether protocol-based EGDT was superior to pro-tocol- based standard therapy. Secondary outcomes included longer-term mortality and the need for organ support. RESULTS: We enrolled 1341 patients, of whom 439 were randomly assigned to protocol-based EGDT, 446 to protocol-based standard therapy, and 456 to usual care. Resuscitation strategies differed significantly with respect to the monitoring of central venous pressure and oxygen and the use of intravenous fluids, vasopressors, inotropes, and blood transfusions. By 60 days, there were 92 deaths in the protocol-based EGDT group (21.0%), 81 in the protocol-based standard-therapy group (18.2%), and 86 in the usual-care group (18.9%) (relative risk with protocol-based therapy vs. usual care, 1.04; 95% confidence interval [CI], 0.82 to 1.31; P = 0.83; relative risk with protocol-based EGDT vs. protocol-based standard therapy, 1.15; 95% CI, 0.88 to 1.51; P = 0.31). There were no significant differences in 90-day mortality, 1-year mortality, or the need for organ support. CONCLUSIONS: In a multicenter trial conducted in the tertiary care setting, protocol-based resuscitation of patients in whom septic shock was diagnosed in the emergency department did not improve outcomes. (Funded by the National Institute of General Medical Sciences; ProCESS ClinicalTrials.gov number, NCT00510835.) Copyright © 2014 Massachusetts Medical Society.
Kelly T.E.,Maricopa Medical Center |
Hackett P.H.,University of Colorado at Denver
High Altitude Medicine and Biology | Year: 2010
Allergies and adverse reactions to sulfonamide medications are quite common. Two distinct categories of drugs are classified as sulfonamides: antibiotics and nonantibiotics. The two groups differ in their chemical structure, use, and the rate at which adverse reactions occur. Cross-reactivity between the two groups has been implied in the past, but is suspect. Acetazolamide, from the nonantibiotic group, is routinely used in the prevention and treatment of high altitude issues and may not need to be avoided in individuals with a history of sulfonamide allergy. This review addresses the differences between the groups and the propensity for intergroup and intragroup adverse reactions based on the available literature. We also examine the different clinical presentations of allergy and adverse reactions, from simple cutaneous reactions with no sequelae through Stevens-Johnson syndrome and anaphylaxis, with risk for significant morbidity and mortality. We offer a systematic approach to determine whether acetazolamide is a safe option for those with a history of allergy to sulfonamides. © Copyright 2010, Mary Ann Liebert, Inc.
Shirah G.R.,Maricopa Medical Center |
O'Neill P.J.,West Valley Hospital
Surgical Clinics of North America | Year: 2014
Intra-abdominal infections are multifactorial, but all require prompt identification, diagnosis, and treatment. Resuscitation, early antibiotic administration, and source control are crucial. Antibiotic administration should initially be broad spectrum and target the most likely pathogens. When cultures are available, antibiotics should be narrowed and limited in duration. The method of source control depends on the anatomic site, site accessibility, and the patient's clinical condition. Patient-specific factors (advanced age and chronic medical conditions) as well as disease-specific factors (health care-associated infections and inability to obtain source control) combine to affect patient morbidity and mortality. © 2014 Elsevier Inc.
Donohue J.F.,University of North Carolina at Chapel Hill |
Jain N.,Maricopa Medical Center
Respiratory Medicine | Year: 2013
Until recently, no point-of-care tool was available for assessing the underlying airway inflammation associated with asthma. Fractional exhaled nitric oxide (FeNO) emerged in the last decade as an important biomarker for asthma assessment and management. Evidence also indicates that FeNO is most accurately classified as a marker of T-helper cell type 2 (Th2)-mediated airway inflammation with a high positive and negative predictive value for identifying corticosteroid-responsive airway inflammation. This manuscript evaluates the evidence for FeNO as a predictor of Th2-mediated corticosteroid-responsive airway inflammation and presents the results of a meta-analysis of three adult studies comparing asthma exacerbation rates with FeNO-based versus clinically-based asthma management algorithms, one of which was not included in a 2012 Cochrane meta-analysis. The primary purpose of the updated meta-analysis was to evaluate asthma exacerbation rates. The results demonstrate that the rate of exacerbations was significantly reduced in favor of FeNO-based asthma management (mean treatment difference = -0.27; 95% CI [-0.42, -0.12] as was the relative rate of asthma exacerbations (relative rate = 0.57; 95% CI [0.41, 0.80]). In summary, FeNO has value for identifying patients with airway inflammation who will and will not respond to corticosteroids. Importantly, the use of FeNO in conjunction with clinical parameters is associated with significantly lower asthma exacerbation rates compared with asthma managed using clinical parameters alone. Together these data indicate that FeNO testing has an important role in the assessment and management of adult asthma. Further studies will continue to define the exact role of FeNO testing in adult asthma. © 2013 Elsevier Ltd. All rights reserved.
Enriquez J.L.,Maricopa Medical Center |
Wu T.S.,University of Arizona
Critical Care Clinics | Year: 2014
The use of ultrasonography in medical practice has evolved dramatically over the last few decades and will continue to improve as technological advances are incorporated into daily medical practice. Although ultrasound machine size and equipment have evolved, the basic principles and fundamental functions have remained essentially the same. This article reviews the general ultrasound apparatus design, the most common probe types available, and the system controls used to manipulate the images obtained. Becoming familiar with the machine and the controls used for image generation optimizes the scans being performed and enhances the use of ultrasound in patient care. © 2014 Elsevier Inc.
Tully J.,Phoenix Childrens Hospital |
Dameff C.,Maricopa Medical Center |
Kaib S.,University of Arizona |
Moffitt M.,University of Arizona
Academic Medicine | Year: 2015
Problem Medical education today frequently includes standardized patient (SP) encounters to teach history-taking, physical exam, and communication skills. However, traditional wallmounted cameras, used to record video for faculty and student feedback and evaluation, provide a limited view of key nonverbal communication behaviors during clinical encounters. Approach In 2013, 30 second-year medical students participated in an end-of-life module that included SP encounters in which the SPs used Google Glass to record their first-person perspective. Students reviewed the Google Glass video and traditional videos and then completed a postencounter, self-evaluation survey and a follow-up survey about the experience. Outcomes Google Glass was used successfully to record 30 student/SP encounters. One temporary Google Glass hardware failure was observed. Of the 30 students, 7 (23%) reported a "positive, nondistracting experience"; 11 (37%) a "positive, initially distracting experience"; 5 (17%) a "neutral experience"; and 3 (10%) a "negative experience." Four students (13%) opted to withhold judgment until they reviewed the videos but reported Google Glass as "distracting." According to follow-up survey responses, 16 students (of 23; 70%) found Google Glass "worth including in the [clinical skills program]," whereas 7 (30%) did not. Next Steps Google Glass can be used to video record students during SP encounters and provides a novel perspective for the analysis and evaluation of their interpersonal communication skills and nonverbal behaviors. Next steps include a larger, more rigorous comparison of Google Glass versus traditional videos and expanded use of this technology in other aspects of the clinical skills training program.
Quan D.,Maricopa Medical Center |
Quan D.,University of Arizona
Critical Care Clinics | Year: 2012
Critters and creatures can strike fear into anyone who thinks about dangerous animals. This article focuses on the management of the most common North American scorpion, arachnid, hymenoptera, and snake envenomations that cause clinically significant problems. Water creatures and less common animal envenomations are not covered in this article. Critical care management of envenomed patients can be challenging for unfamiliar clinicians. Although the animals are located in specific geographic areas, patients envenomed on passenger airliners and those who travel to endemic areas may present to health care facilities distant from the exposure. © 2012 Elsevier Inc.
Katz E.D.,Maricopa Medical Center
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine | Year: 2010
Remediation of residents is a common problem and requires organized, goal-directed efforts to solve. The Council of Emergency Medicine Residency Directors (CORD) has created a task force to identify best practices for remediation and to develop guidelines for resident remediation. Faculty members of CORD volunteered to participate in periodic meetings, organized discussions and literature reviews to develop overall guidelines for resident remediation and in a collaborative authorship of this article identifying best practices for remediation. The task force recommends that residency programs: 1. Make efforts to understand the challenges of remediation, and recognize that the goal is successful correction of deficits, but that some deficits are not remediable. 2. Make efforts aimed at early identification of residents requiring remediation. 3. Create objective, achievable goals for remediation and maintain strict adherence to the terms of those plans, including planning for resolution when setting goals for remediation. 4. Involve the institution's Graduate Medical Education Committee (GMEC) early in remediation to assist with planning, obtaining resources, and documentation. 5. Involve appropriate faculty and educate those faculty into the role and terms of the specific remediation plan. 6. Ensure appropriate documentation of all stages of remediation. Resident remediation is frequently necessary and specific steps may be taken to justify, document, facilitate, and objectify the remediation process. Best practices for each step are identified and reported by the task force. © 2010 by the Society for Academic Emergency Medicine.