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Gilbert, AZ, United States

Qumseya B.,Mayo Clinic Florida | Panossian A.M.,Mayo Clinic Florida | Panossian A.M.,Mercy Gilbert Medical Center | Rizk C.,Mayo Clinic Florida | And 7 more authors.
Clinical Endoscopy | Year: 2014

Background/Aims: Stricture formation is a common complication after endoscopic mucosal resection. Predictors of stricture formation have not been well studied. Methods: We conducted a retrospective, observational, descriptive study by using a prospective endoscopic mucosal resection database in a tertiary referral center. For each patient, we extracted the age, sex, lesion size, use of ablative therapy, and detection of esophageal strictures. The primary outcome was the presence of esophageal stricture at follow-up. Multivariate logistic regression was used to analyze the association between the primary outcome and predictors. Results: Of 136 patients, 27% (n=37)had esophageal strictures. Thirty-two percent (n=44)needed endoscopic dilation to relieve dysphagia (median, 2; range, 1 to 8). Multivariate logistic regression analysis showed that the size of the lesion excised is associated with increased odds of having a stricture (odds ratio, 1.6; 95% confidence interval, 1.1 to 2.3; p=0.01), when controlling for age, sex, and ablative modalities. Similarly, the number of lesions removed in the index procedure was associated with increased odds of developing a stricture (odds ratio, 2.3; 95% confidence interval, 1.3 to 4.2; p=0.007). Conclusions: Stricture formation after esophageal endoscopic mucosal resection is common. Risk factors for stricture formation include large mucosal resections and the resection of multiple lesions on the initial procedure. © 2014 Korean Society of Gastrointestinal Endoscopy.


Rose S.R.,National Institute of Allergy and Infectious Diseases | Lindsley M.D.,Centers for Disease Control and Prevention | Hurst S.F.,Centers for Disease Control and Prevention | Paddock C.D.,Centers for Disease Control and Prevention | And 2 more authors.
Medical Mycology Case Reports | Year: 2013

A 67 year-old Caucasian male from Arizona presented with indolent symptoms of intestinal obstruction and hydronephrosis, found at surgery to be caused by a mass involving the terminal ileum and cecum, extending into the posterior abdominal wall and obstructing the right ureter. Histopathology was diagnostic of basidiobolomycosis. PCR of tissue and sequencing identified the fungus as, Basidiobolus ranarum. During one year of posaconazole treatment, the residual mass shrank, hydronephrosis was relieved and peripheral eosinophilia resolved.


Diedrich A.,Mercy Gilbert Medical Center | Munroe D.J.,Northern Illinois University | Romano M.,Kishwaukee Community Hospital
Diabetes Educator | Year: 2010

Purpose The purpose of this study was to evaluate the effectiveness of a self-help physical activity program for persons with type 2 diabetes. Effectiveness was measured by cardiovascular indicators, hemoglobin A1C, anthropometric indicators, and activity levels. Methods This intervention study included 53 individuals with type 2 diabetes. Participants were randomly assigned. Participants in the intervention group attended the usual Diabetes Self-Management Education Program (DSMEP) and received a copy of the book, Manpo-kei; a concise handout summarizing the key points of Manpo-kei; and a pedometer. Participants not assigned to the intervention attended the usual DSMEP only. Data collection was completed at the beginning of the study and 3 months later using a lifestyle and diabetes questionnaire, a physical activity questionnaire, and cardiovascular and anthropometric measures. Results Those who participated in the intervention demonstrated a significant decrease in hemoglobin A1C, weight, and body fat. In addition, they increased their number of daily steps as measured by the pedometer. The control group also demonstrated a significant decrease in hemoglobin A1C and weight. Both groups demonstrated increases in their regular weekly activity. At the end of the study period, the intervention group had a significantly lower diastolic blood pressure than the control group. Conclusions Pedometers can be a helpful strategy to motivate persons with diabetes to increase physical activity. However, it appears that attendance at DSMEP alone may be enough to increase physical activity for persons with type 2 diabetes. © 2010 The Author(s).


Wilson B.L.,University of Utah | Wilson B.L.,Mercy Gilbert Medical Center | Phelps C.,University of Utah | Phelps C.,Mercy Gilbert Medical Center
JONA's Healthcare Law, Ethics, and Regulation | Year: 2013

OBJECTIVE:: The objective of this study was to determine the perceived level of horizontal hostility (HH) in a 220-bed acute care community hospital and whether the threat of or experience with HH influenced nurse behaviors directly related to patient safety. BACKGROUND:: While the acknowledgement and presence of HH in nursing are gaining prominence, little is known about how a nurse's experience with HH directly influences his/her actions with patients under their care, even when the nurse realizes these actions may not be in the patient's best interest. METHODS:: We used a 28-item survey tool aimed at determining the level of perceived HH in an acute care Magnet-aspiring hospital in the Southwest and then asked about nurses' actions as a result of that experience. Almost 500 nurses were surveyed over a 2-month period in 2011. RESULTS:: Of the nurses who had personally experienced HH, a high number reported performing interventions or actions that could compromise patient care and/or safety, including (a) failing to clarify an unreadable order, (b) lifting or ambulating heavy or debilitated patients without assistance rather than asking for help, (c) using an unfamiliar piece of equipment without asking for clarification, and (d) carrying out an order that the nurse did not believe was in the best interest of the patient, among other behaviors. CONCLUSION:: The presence of HH has clear implications for patient safety. Recommendations for addressing and managing HH are provided and geared to the hospital leadership level. Copyright © 2013 Lippincott Williams & Wilkins.

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