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Bloomington, IN, United States

Pedersen C.A.,Monroe Hospital | Schneider P.J.,University of Arizona | Scheckelhoff D.J.,Professional Development
American Journal of Health-System Pharmacy | Year: 2012

Purpose. Results of the 2011 ASHP national survey of pharmacy practice in hospital settings that pertain to dispensing and administration are presented. Methods. A stratified random sample of pharmacy directors at 1401 general and children's medical-surgical hospitals in the United States were surveyed by mail. Results. In this national probability sample survey, the response rate was 40.1%. Decentralization of the medication-use system continues, with 40% of hospitals using a decentralized system and 58% of hospitals planning to use a decentralized model in the future. Automated dispensing cabinets were used by 89% of hospitals, robots were used by 11%, carousels were used in 18%, and machine-readable coding was used in 34% of hospitals to verify doses before dispensing. Overall, 65% of hospitals had a United States Pharmacopeia chapter 797 compliant cleanroom for compounding sterile preparations. Medication administration records (MARs) have become increasingly computerized, with 67% of hospitals using electronic MARs. Bar-code-assisted medication administration was used in 50% of hospitals, and 68% of hospitals had smart infusion pumps. Health information is becoming more electronic, with 67% of hospitals having partially or completely implemented an electronic health record and 34% of hospitals having computerized prescriber order entry. The use of these technologies has substantially increased over the past year. The average number of full-time equivalent staff per 100 occupied beds averaged 17.5 for pharmacists and 15.0 for technicians. Directors of pharmacy reported declining vacancy rates for pharmacists. Conclusion. Pharmacists continue to improve medication use at the dispensing and administration steps of the medication-use system. The adoption of new technology is changing the philosophy of medication distribution, and health information is rapidly becoming electronic. Copyright © 2012, American Society of Health-System Pharmacists, Inc. All rights reserved.

Martus J.E.,Monroe Hospital
Journal of Pediatric Orthopaedics | Year: 2016

Femoral shaft fractures are common injuries in the pediatric and adolescent age groups. Rigid intramedullary nailing is an excellent treatment option for older children and adolescents, particularly for length-unstable fractures and larger patients (>49 kg). Appropriate indications, contraindications, and preoperative assessment are described. The rigid nailing surgical technique is detailed including positioning, operative steps, pearls, and pitfalls. Complications and the reported outcomes of lateral trochanteric entry nailing are reviewed from the published series. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

Hall R.T.,Monroe Hospital | Domenico H.J.,Vanderbilt University | Self W.H.,Vanderbilt University | Hain P.D.,University of Texas Southwestern Medical Center
Pediatrics | Year: 2013

BACKGROUND AND OBJECTIVE: Blood culture contamination in the pediatric population remains a significant quality and safety issue because false-positive blood cultures lead to unnecessary use of resources and testing. In addition, few studies describe interventions to reduce peripheral blood culture contamination rates in this population. We hypothesized that the introduction of a standardized sterile collection process would reduce the pediatric emergency department's peripheral blood culture contamination rate and unnecessary use of resources. METHODS: A sterile blood culture collection process was designed by analyzing current practice and identifying areas in which sterile technique could be introduced. To spread the new technique, a web-based educational model was developed and disseminated. Subsequently, all nursing staff members were expected to perform peripheral blood cultures by using the modified sterile technique. RESULTS: The peripheral blood culture contamination rate was reduced from 3.9% during the baseline period to 1.6% during the intervention period (P <0001), with yearly estimated savings of ~s250 000 in hospital charges. CONCLUSIONS: Subsequent to our intervention, there was a significant reduction of the peripheral blood culture contamination rate as well as considerable cost savings to the institution. When performed in a standardized fashion by using sterile technique, blood culture collection with low contamination rates can be performed via the insertion of an intravenous catheter. Copyright © 2013 by the American Academy of Pediatrics.

Staebler S.,Monroe Hospital
Advances in Neonatal Care | Year: 2011

Over the past 2 decades, perinatal and neonatal health care has become less coordinated and more competitive in the United States. The impact at the state level has been the evolution of a fragmented, perinatal system with limited access and poorer outcomes. The evidence demonstrates lower mortality risk for very low-birth-weight infants born in designated tertiary centers. Regionalized systems of perinatal care are recommended to ensure that each mother and newborn achieve optimal outcomes. This article discusses the factors impacting implementation of this model at either the state or federal level as well as the incorporation of perinatal regionalization as part of the national agenda of health care reform. Copyright © 2011 by the National Association of Neonatal Nurses.

Grohar P.J.,Monroe Hospital | Helman L.J.,U.S. National Cancer Institute
Pharmacology and Therapeutics | Year: 2013

The Ewing sarcoma family of tumors or Ewing sarcoma (ES) is the second most common malignant bone tumor of childhood. The prognosis for localized Ewing sarcoma has improved through the development of intense multimodal therapy over the past several decades. Unfortunately, patients with recurrent or metastatic disease continue to have a poor prognosis. Therefore, a number of complementary approaches are being developed in both the preclinical and clinical arenas to improve these outcomes. In this review, we will discuss efforts to directly target the biologic drivers of this disease and relate these efforts to the experience with several different agents both in the clinic and under development. We will review the data for compounds that have shown excellent activity in the clinic, such as the camptothecins, and summarize the biological data that supports this activity. In addition, we will review the clinical experience with IGF1 targeted agents, ET-743 and epigenetically targeted therapies, the substantial amount of literature that supports their activity in Ewing sarcoma and the challenges remaining translating these therapies to the clinic. Finally, we will highlight recent work aimed at directly targeting the EWS-FLI1 transcription factor with small molecules in Ewing tumors. © 2012 Elsevier Inc. All rights reserved.

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