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St. Louis, MO, United States

Erbe B.,Mercy Hospital
Tar heel nurse | Year: 2011

In perioperative settings, medications are removed from their original identifying containers; therefore, scrub personnel (RN's and OR Technicians) need to label all medications placed on the sterile field. In this study, medication labeling practices will be evaluated in the operating room of a 187-bed, Charlotte, North Carolina hospital. Subsequently, blank and preprinted labels will be used to test compliance of safe medication practices. The results of the Performance Improvement study indicate that scrub persons are likely to label medications and syringes more often and more accurately when preprinted labels are provided. The data obtained from this project led to supplying preprinted labels for all procedures in order to improve patient safety in the operating room.

Jaffan A.A.A.,Emory University | Prince E.A.,University of Rhode Island | Hampson C.O.,Mercy Hospital | Murphy T.P.,University of Rhode Island
CardioVascular and Interventional Radiology | Year: 2013

Purpose: To establish the efficacy and safety of the preclose technique in total percutaneous endovascular aortic repair (PEVAR). Methods: A systematic literature search of Medline database was conducted for series on PEVAR published between January 1999 and January 2012. Results: Thirty-six articles comprising 2,257 patients and 3,606 arterial accesses were included. Anatomical criteria used to exclude patients from undergoing PEVAR were not uniform across all series. The technical success rate was 94 % per arterial access. Failure was unilateral in the majority (93 %) of the 133 failed PEVAR cases. The groin complication rate in PEVAR was 3.6 %; a minority (1.6 %) of these groin complications required open surgery. The groin complication rate in failed PEVAR cases converted to groin cutdown was 6.1 %. A significantly higher technical success rate was achieved when arterial access was performed via ultrasound guidance. Technical failure rate was significantly higher with larger sheath size (≥20F). Conclusion: The preclose technique in PEVAR has a high technical success rate and a low groin complication rate. Technical success tends to increase with ultrasound-guided arterial access and decrease with larger access. When failure occurs, it is unilateral in the majority of cases, and conversion to surgical cutdown does not appear to increase the operative risk. © 2013 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).

OBJECTIVES: Relatively little is known about the prevalence of and factors associated with the absence of fever, normal white blood cell count (WBC), lack of neutrophilia, and the frequency of elevated serum C-reactive protein (CRP) in adult hospitalized patients with bacteremia. METHODS: Frequencies of fever (temperature ≥100°F), abnormal WBC count (≥10,000/μL or <4500/μL), neutrophilia (neutrophils ≥80%) and potential factors that may be associated with negative results, and frequency of elevated serum CRP were studied retrospectively in 622 bacteremic episodes in adult patients at a community teaching hospital. RESULTS: The frequencies of individual parameters were as follows: fever, 78.4% (95% confidence interval [CI] 74.9%-81.6%); abnormal WBC count, 65.2% (95% CI 61.3%-69.0%); neutrophilia, 67.5% (95% CI 63.7%-71.2%); and elevated CRP (>0.8 mg/dL), 98.4% (95% CI 97%-99.2%). Age 50 years and older, corticosteroid use, and isolation of either Staphylococcus sp not aureus or Enterococcus sp combined were independently associated with the absence of fever (P ≤ 0.01 for all). Isolation of Staphylococcus sp not aureus/Enterococcus and lack of corticosteroid use were independently associated with normal WBC (P < 0.05 for both). Nonwhite race and primary bacteremia were independently associated with lack of neutrophilia (P < 0.05 for both). CONCLUSIONS: Absence of fever, normal WBC, and lack of neutrophilia are common in patients with bacteremia and may be confounded by a variety of factors; however, serum CRP remains elevated in the majority (>98%) of bacteremic episodes. © 2012 by The Southern Medical Association.

Holmes D.R.,Mayo Medical School | Doshi S.K.,St Johns Health Center | Kar S.,Cedars Sinai Medical Center | Price M.J.,Scripps Research Institute | And 4 more authors.
Journal of the American College of Cardiology | Year: 2015

Abstract Background The risk-benefit ratio of left atrial appendage closure (LAAC) versus systemic therapy (warfarin) for prevention of stroke, systemic embolism, and cardiovascular death in nonvalvular atrial fibrillation (NVAF) requires continued evaluation. Objectives This study sought to assess composite data regarding left atrial appendage closure (LAAC) in 2 randomized trials compared to warfarin for prevention of stroke, systemic embolism, and cardiovascular death in patients with nonvalvular AF. Methods Our meta-analysis included 2,406 patients with 5,931 patient-years (PY) of follow-up from the PROTECT AF (Watchman Left Atrial Appendage System for Embolic Protection in Patients with Atrial Fibrillation) and PREVAIL (Prospective Randomized Evaluation of the Watchman LAA Closure Device In Patients With Atrial Fibrillation Versus Long Term Warfarin Therapy) trials, and their respective registries (Continued Access to PROTECT AF registry and Continued Access to PREVAIL registry). Results With mean follow-up of 2.69 years, patients receiving LAAC with the Watchman device had significantly fewer hemorrhagic strokes (0.15 vs. 0.96 events/100 patient-years [PY]; hazard ratio [HR]: 0.22; p = 0.004), cardiovascular/unexplained death (1.1 vs. 2.3 events/100 PY; HR: 0.48; p = 0.006), and nonprocedural bleeding (6.0% vs. 11.3%; HR: 0.51; p = 0.006) compared with warfarin. All-cause stroke or systemic embolism was similar between both strategies (1.75 vs. 1.87 events/100 PY; HR: 1.02; 95% CI: 0.62 to 1.7; p = 0.94). There were more ischemic strokes in the device group (1.6 vs. 0.9 and 0.2 vs. 1.0 events/100 PY; HR: 1.95 and 0.22, respectively; p = 0.05 and 0.004, respectively). Both trials and registries identified similar event rates and consistent device effect in multiple subsets. Conclusions In patients with NVAF at increased risk for stroke or bleeding who are candidates for chronic anticoagulation, LAAC resulted in improved rates of hemorrhagic stroke, cardiovascular/unexplained death, and nonprocedural bleeding compared to warfarin. © 2015 American College of Cardiology Foundation.

Carson H.J.,Mercy Hospital
American Journal of Clinical Pathology | Year: 2014

Objectives: At autopsy, tattoos are recorded as part of the external examination. An investigation was undertaken to determine whether negative messages that are tattooed on a decedent may indicate a predisposition to certain fatal outcomes. Methods: Tattooed and nontattooed persons were classified by demography and forensics. Tattoos with negative or ominous messages were reviewed. Statistical comparisons were made. Results: The mean age of death for tattooed persons was 39 years, compared with 53 years for nontattooed persons (P = .0001). There was a significant contribution of negative messages in tattoos associated with nonnatural death (P = .0088) but not with natural death. However, the presence of any tattoo was more significant than the content of the tattoo. Conclusions: Persons with tattoos appear to die earlier than those without. There may be an epiphenomenon between having tattoos and risk-taking behavior such as drug or alcohol use. A negative tattoo may suggest a predisposition to violent death but is eclipsed by the presence of any tattoo. © American Society for Clinical Pathology.

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