Greenville, NC, United States
Greenville, NC, United States

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Phillips J.K.,Pitt County Memorial Hospital
AANA Journal | Year: 2010

The purpose of this qualitative study was to examine the challenges that recent graduates of nurse anesthesia programs coped with during their anesthesia curriculum from their perspective. The initial research questions for this study were: From the graduates' perspective, what were the stressors that they encountered during their nurse anesthesia program? And how did they successfully negotiate those stressors in order to graduate from their program? This phenomenon was studied using grounded theory methodology. The data were collected by individual, semistructured, in-depth interviews with 12 recent nurse anesthesia program graduates, from 5 different nurse anesthesia programs, who have been out of school for less than 2 years. This exploration into student nurse anesthetist stress and coping articulates 3 phases of development as these students progressed through their program. The phases are transitioning in (first 9 months of program), finding their way (9 to 18 months into program), and transitioning out (18 to 28 months into program). Coping mechanisms employed by the participants were problem focused, emotion focused, and a combination of the 2. Recommendations for action and future research are discussed.


Rappold A.G.,U.S. Environmental Protection Agency | Stone S.L.,U.S. Environmental Protection Agency | Cascio W.E.,U.S. Environmental Protection Agency | Neas L.M.,U.S. Environmental Protection Agency | And 7 more authors.
Environmental Health Perspectives | Year: 2011

Background: In June 2008, burning peat deposits produced haze and air pollution far in excess of National Ambient Air Quality Standards, encroaching on rural communities of eastern North Carolina. Although the association of mortality and morbidity with exposure to urban air pollution is well established, the health effects associated with exposure to wildfire emissions are less well understood. Objective: We investigated the effects of exposure on cardiorespiratory outcomes in the population affected by the fire. Methods: We performed a population-based study using emergency department (ED) visits reported through the syndromic surveillance program NC DETECT (North Carolina Disease Event Tracking and Epidemiologic Collection Tool). We used aerosol optical depth measured by a satellite to determine a high-exposure window and distinguish counties most impacted by the dense smoke plume from surrounding referent counties. Poisson log-linear regression with a 5-day distributed lag was used to estimate changes in the cumulative relative risk (RR).Results: In the exposed counties, significant increases in cumulative RR for asthma [1.65 (95% confidence interval, 1.25-2.1)], chronic obstructive pulmonary disease [1.73 (1.06-2.83)], and pneumonia and acute bronchitis [1.59 (1.07-2.34)] were observed. ED visits associated with cardio-pulmonary symptoms [1.23 (1.06-1.43)] and heart failure [1.37 (1.01-1.85)] were also significantly increased. Conclusions: Satellite data and syndromic surveillance were combined to assess the health impacts of wildfire smoke in rural counties with sparse air-quality monitoring. This is the first study to demonstrate both respiratory and cardiac effects after brief exposure to peat wildfire smoke.


Cook P.P.,East Carolina University | Rizzo S.,University of California at Los Angeles | Gooch M.,Pitt County Memorial Hospital | Jordan M.,Pitt County Memorial Hospital | And 2 more authors.
Journal of Antimicrobial Chemotherapy | Year: 2011

Objectives: We evaluated the effect of implementation of an electronic medical record (EMR) on the use of antimicrobial agents and on the rates of infections with Clostridium difficile and methicillin-resistant Staphylococcus aureus (MRSA). Methods: This was a retrospective, observational study conducted between 1 January 2005 and 31 December 2009. Antimicrobial drug use, rates of nosocomial C. difficile infection (CDI) and MRSA infection, the number of medical charts reviewed and number of antimicrobial recommendations made and accepted were compared before and after implementing the EMR utilizing interrupted time-series analysis. Results: Compared with the 10 quarters prior to implementing the EMR, there was a 36.6% increase in the number of charts reviewed (P<0.0001), a 98.1% increase in the number of antimicrobial recommendations made (P<0.0001) and a 124% increase in the number of recommendations accepted (P<0.0001). There was a 28.8% decrease in the use of 41 commonly used antibacterial agents (P<0.0001). Nosocomial CDI decreased by 18.7% (P=0.07) and nosocomial MRSA infections decreased by 45.2% (P<0.0001) following implementation of the EMR. Conclusions: Adoption of an EMR facilitated a significant increase in chart reviews and antimicrobial recommendations, which resulted in a sustained decrease in antimicrobial use. There were decreased nosocomial infections with MRSA and a trend towards decreasing CDIs following implementation of the EMR. © The Author 2010. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.


Cook P.P.,East Carolina University | Gooch M.,Pitt County Memorial Hospital | Rizzo S.,University of California at Los Angeles
Antimicrobial Agents and Chemotherapy | Year: 2011

We examined the effect of the addition of ertapenem to our hospital formulary on the resistance of nosocomial Pseudomonas aeruginosa to group 2 carbapenems (imipenem, meropenem, and doripenem). This was a retrospective, observational study conducted between 1 January 2000 and 31 January 2009 at a large, tertiary-care hospital. Autoregressive integrated moving average (ARIMA) regression models were used to evaluate the effect of ertapenem use on the susceptibility of Pseudomonas aeruginosa to group 2 carbapenems as well as on the use of the group 2 carbapenems, ciprofloxacin, and other antipseudomonal drugs (i.e., tobramycin, cefepime, and piperacillin-tazobactam). Resistance was expressed as a percentage of total isolates as well as the number of carbapenem-resistant bacterial isolates per 10,000 patient days. Pearson correlation was used to assess the relationship between antibiotic use and carbapenem resistance. Following the addition of ertapenem to the formulary, there was a statistically significant decrease in the percentage of Pseudomonas aeruginosa isolates resistant to the group 2 carbapenems (P = 0.003). Group 2 carbapenem use and the number of carbapenem-resistant Pseudomonas aeruginosa isolates per 10,000 patient days did not change significantly over the time period. There was a large decrease in the use of ciprofloxacin (P = 0.0033), and there was a correlation of ciprofloxacin use with the percentage of isolates resistant to the group 2 carbapenems (ρ = 0.47, P = 0.002). We suspect that the improvement in susceptibility of Pseudomonas aeruginosa to group 2 carbapenems was related to a decrease in ciprofloxacin use. Copyright © 2011, American Society for Microbiology. All Rights Reserved.


Jonathan Lewis G.,Pitt County Memorial Hospital | Fang X.,East Carolina University | Gooch M.,East Carolina University | Cook P.P.,Pitt County Memorial Hospital
Infection Control and Hospital Epidemiology | Year: 2012

objective. To examine the effect of restricting ciprofloxacin on the resistance of nosocomial gram-negative bacilli, including Pseudomonas aeruginosa, to antipseudomonal carbapenems. design. Interrupted time-series analysis. setting. Tertiary care teaching hospital with 11 intensive care and intermediate care units with a total of 295 beds. patients. All nosocomial isolates of P. aeruginosa. intervention. Restriction of ciprofloxacin. results. There was a significant decreasing trend observed in the percentage (P=0351) and the rate (P=0006) of isolates of P. aeruginosa that were resistant to antipseudomonal carbapenems following the restriction of ciprofloxacin. There was also a significant decreasing trend observed in the percentage (P=0017) and the rate (P=0001) of isolates of ciprofloxacin-resistant P. aeruginosa. The rate of cefepime-resistant P. aeruginosa isolates declined (P=004) but the percentage of cefepime-resistant P. aeruginosa isolates did not change. There were no significant changes observed in the rate or the percentage of piperacillin-tazobactam-resistant P. aeruginosa isolates. There were no significant changes observed in the susceptibilities of nosocomial Enterobacteriaciae or Acinetobacter baumannii isolates that were resistant to carbapenems. Over the study period there was a significant increase in the use of carbapenems (P=0134); the use of ciprofloxacin decreased significantly (P=0027). There were no significant changes in the use of piperacillin-tazobactam or cefepime. conclusion. Restriction of ciprofloxacin was associated with a decreased resistance of P. aeruginosa isolates to antipseudomonal carbapenems and ciprofloxacin in our hospital's intermediate care and intensive care units. There were no changes observed in the susceptibilities of nosocomial Enterobacteriaciae or A. baumannii to carbapenems, despite increased carbapenem use. Reducing ciprofloxacin use may be a means of controlling multidrug-resistant P. aeruginosa. Vidant Medical Center (formerly Pitt County Memorial Hospital), Greenville, North Carolina; 2. East Carolina University, Greenville, North Carolina. © 2012 by The Society for Healthcare Epidemiology of America. All rights reserved.


George A.,Pitt County Memorial Hospital | Figueredo V.M.,Albert Einstein Medical Center
Journal of Cardiovascular Medicine | Year: 2010

The use of alcohol as a social lubricant has been ubiquitous in human societies since ancient times. It has also long been recognized that alcohol produces undesirable cardiovascular effects, especially when imbibed in excess. Numerous investigators have noted a causal relationship between alcohol and arrhythmias, as well as sudden cardiac death. We have undertaken a comprehensive review of the literature on alcohol as a potential trigger for arrhythmias. We have reviewed the major epidemiological studies undertaken on this subject. We have also explored pathophysiological mechanisms that drive the arrythmogenic effects of alcohol. In conclusion, although there is definite proof in the literature to implicate alcohol as a culprit in arrhythmias, the relationship is complex. © 2010 Italian Federation of Cardiology.


Patonay B.C.,Pitt County Memorial Hospital | Patonay B.C.,East Carolina University | Oliver W.R.,East Carolina University
Journal of Forensic Sciences | Year: 2010

An unexpected infant death is usually investigated with a complete autopsy. If evidence of prior trauma is found at autopsy in these cases, suspicion is raised for nonaccidental trauma. In a young infant, the residua of trauma received during birth has the potential to be incorrectly interpreted as nonaccidental trauma. We report a the findings of a 4 1/2-month-old-infant that died unexpectedly with a healing linear skull fracture and a circular lesion over the calvarium found at autopsy. Though this lesion was concerning, the remainder of the autopsy and the histological findings did not support a diagnosis of recent trauma. Review of the literature describing birth injuries made the diagnosis of healing, residual birth trauma more convincing in this case. © 2010 American Academy of Forensic Sciences.


Gauland C.,Pitt County Memorial Hospital
Advances in skin & wound care | Year: 2011

The objective of the study was to determine if the use of locally implanted, synthetic calcium sulfate tablets, impregnated with antibiotics, can heal lower-extremity osteomyelitis, without the use of oral and/or intravenous antibiotics or wound complications associated with similarly used mined or refined calcium sulfate. Over a 5-year period, 354 patients with clinically confirmed osteomyelitis of the lower extremity were evaluated, and 337 met the inclusion criteria; 14 were lost to follow-up. Devitalized or infected bone was debrided to the level of healthy cancellous and cortical bone. Compromised soft tissue was resected. At the onset of each operative encounter, the synthetic calcium sulfate tablets were mixed with a standard antibiotic mixture: 500 mg of powdered vancomycin mixed into 240 mg of gentamicin (normally supplied as a liquid in a concentration of 80 mg/2 mL). Vancomycin and gentamicin were chosen because they cover a broad spectrum of both gram-positive and gram-negative bacteria. A total of 279 of 323 patents (86.4%) clinically healed without the use of intravenous antibiotics following surgical debridement and tablet implantation. In addition, 24/323 (7.4%) required the use of intravenous antibiotics, but still healed; 20/323 (6.2%) required amputation, of which, 12 (3.7%) were digital amputations, 2 (0.6%) were ray amputations, and 6 (1.9%) were below-knee amputations. The use of locally implanted antibiotic-impregnated, synthetic calcium sulfate tablets in the surgical debridement site for bone infections of the lower extremity, without the concurrent use of intravenous antibiotics, has shown encouraging results.


Mazer M.A.,East Carolina University | Mazer M.A.,Pitt County Memorial Hospital | Alligood C.M.,Pitt County Memorial Hospital | Wu Q.,East Carolina University
Journal of Pain and Symptom Management | Year: 2011

Context: Most deaths in intensive care units occur after limitation or withdrawal of life-sustaining therapies. Often these patients require opioids to assuage suffering; yet, little has been documented concerning their use in the medical intensive care unit. Objectives: To determine the dose and factors influencing the use of opioids in patients undergoing terminal withdrawal of mechanical ventilation in this setting. Methods: Data were prospectively collected from 74 consecutive patients expected to die soon after extubation. The doses of morphine, effect on time to death, and relation of dose to diagnostic categories were analyzed. Results: The mean (±standard deviation) dose of morphine given to patients during the last hour of mechanical ventilation was 5.3 mg/hour. Patients dying after extubation received 10.6 mg/hour just before death. Immediately before extubation, the dose correlated directly with chronic medical opioid use and sepsis with respiratory failure and inversely with coma after cardiopulmonary resuscitation or a primary neurological event. After terminal extubation, the final morphine dose correlated directly with the presence of sepsis with respiratory failure and chronic pulmonary disease. The mean time to death after terminal extubation was 152.7 ± 229.5 minutes without correlation with premorbid diagnoses. After extubation, each 1 mg/hour increment of morphine infused during the last hour of life was associated with a delay of death by 7.9 minutes (P = 0.011). Conclusion: Premorbid conditions may influence the dose of morphine given to patients undergoing terminal withdrawal of mechanical ventilation. Higher doses of morphine are associated with a longer time to death. © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.


Pofahl W.E.,East Carolina University | Ramsey K.M.,East Carolina University | Nobles D.L.,Pitt County Memorial Hospital | Cochran M.K.,Pitt County Memorial Hospital | Goettler C.,East Carolina University
American Surgeon | Year: 2011

Although infrequent, postoperative methicillin-resistant Staphylococcus aureus (MRSA) surgical site infection (SSI) is associated with significant morbidity and cost. Previous studies have identified the importance of MRSA screening to diminish the risk of postoperative MRSA SSI. The current study quantifies the importance of eradication of the MRSA carrier state to prevent MRSA SSI. Beginning February 2007, all admissions to an 800-bed tertiary care hospital were screened for MRSA by nasal swab using rapid polymerase chain reaction-based testing. Patients found to be nasal carriers of MRSA were treated with 2 per cent mupirocin nasal ointment and 4 per cent chlorhexidine soap before surgery. The subset of patients undergoing procedures that are part of the Surgical Care Improvement Project (SCIP) were followed for MRSA SSI (n = 8980). The results of preoperative MRSA screening and eradication of the carrier state were analyzed. Since the initiation of universal MRSA screening, 11 patients undergoing SCIP procedures have developed MRSA SSI (0.12%). Of these, six patients (55%) had negative preoperative screens. Of the five patients with positive preoperative screens, only one received treatment to eradicate the carrier state. In patients who develop MRSA SSI, failure to treat the carrier state before surgery results in MRSA SSI.

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