News Article | December 7, 2016
Apfel C.C.,University of California at San Francisco |
Heidrich F.M.,TU Dresden |
Jukar-Rao S.,University of California at San Francisco |
Jalota L.,Reading Hospital |
And 4 more authors.
British Journal of Anaesthesia | Year: 2012
Background: In assessing a patient's risk for postoperative nausea and vomiting (PONV), it is important to know which risk factors are independent predictors, and which factors are not relevant for predicting PONV. Methods: We conducted a systematic review of prospective studies (n>500 patients) that applied multivariate logistic regression analyses to identify independent predictors of PONV. Odds ratios (ORs) of individual studies were pooled to calculate a more accurate overall point estimate for each predictor. Results: We identified 22 studies (n=95 154). Female gender was the strongest patient-specific predictor (OR 2.57, 95% confidence interval 2.32-2.84), followed by the history of PONV/motion sickness (2.09, 1.90-2.29), non-smoking status (1.82, 1.68-1.98), history of motion sickness (1.77, 1.55-2.04), and age (0.88 per decade, 0.84-0.92). The use of volatile anaesthetics was the strongest anaesthesia-related predictor (1.82, 1.56-2.13), followed by the duration of anaesthesia (1.46 h-1, 1.30-1.63), postoperative opioid use (1.39, 1.20-1.60), and nitrous oxide (1.45, 1.06-1.98). Evidence for the effect of type of surgery is conflicting as reference groups differed widely and funnel plots suggested significant publication bias. Evidence for other potential risk factors was insufficient (e.g. preoperative fasting) or negative (e.g. menstrual cycle). Conclusions: The most reliable independent predictors of PONV were female gender, history of PONV or motion sickness, non-smoker, younger age, duration of anaesthesia with volatile anaesthetics, and postoperative opioids. There is no or insufficient evidence for a number of commonly held factors, such as preoperative fasting, menstrual cycle, and surgery type, and using these factors may be counterproductive in assessing a patient's risk for PONV. © 2012 The Author .
Davis T.,University of Pennsylvania |
Jones P.,Reading Hospital
Dimensions of Critical Care Nursing | Year: 2012
Increased anxiety levels are a common problem for mechanically ventilated patients. Heightened anxiety and lack of effective treatment options result in negative patient outcomes. Music therapy has been documented as an effective nursing intervention to manage anxiety in ventilator-dependent patients. Seven studies examining the effectiveness of music therapy in ventilator-dependent patients are reviewed in this literature review. Copyright © 2012 Lippincott Williams & Wilkins.
Slotkin E.M.,Reading Hospital |
Patel P.D.,Cleveland Clinic |
Suarez J.C.,Cleveland Clinic
Journal of Arthroplasty | Year: 2015
Acetabular component malposition contributes to increased complications and early revision. Supine positioning during direct anterior approach (DAA) THA facilitates the use of fluoroscopy to improve component positioning. This study evaluated the accuracy of acetabular component orientation using intraoperative fluoroscopy in DAA THA. A total of 780 surgeries by two surgeons were retrospectively reviewed over a 3-year period. Ranges for abduction (30°-50°) and version (5°-250) were employed. Overall, 92% fell within the targeted abduction range, 93% fell within the targeted anteversion range, and 88% met both criteria. The accuracy of component positioning for combined abduction and anteversion improved yearly (79.2%, 2011; 90.9%, 2012; and 95.6%, 2013). Fluoroscopy in DAA THA is a useful tool to improve acetabular component orientation, though a learning curve exists with its interpretation. © 2015 Elsevier Inc..
Cheatle M.D.,University of Pennsylvania |
Cheatle M.D.,Reading Hospital |
Savage S.R.,Dartmouth College |
Savage S.R.,Dartmouth Center on Addiction Recovery and Education |
Savage S.R.,Manchester Veterans Administration Medical Center
Journal of Pain and Symptom Management | Year: 2012
Most patients receiving opioids for the spectrum of pain disorders tolerate opioids well without major complications. However, a subset of this population encounters significant difficulties with opioid therapy (OT). These problems include protracted adverse effects, as well as misuse, abuse, and addiction, which can result in significant morbidity and mortality and make informed consent an important consideration. Opioid treatment agreements (OTAs), which may include documentation of informed consent, have been used to promote the safe use of opioids for pain. There is a debate regarding the effectiveness of OTAs in reducing the risk of opioid misuse; however, most practitioners recognize that OTAs provide an opportunity to discuss the potential risks and benefits of OT and establish mutually agreed-on treatment goals, a clear plan of treatment, and circumstances for continuation and discontinuation of opioids. Informed consent is an important component of an OTA but not often the focus of consideration in discussions of OTAs. This article examines the principles, process, and content of informed consent for OT of pain in the context of OTAs. © 2012 U.S. Cancer Pain Relief Committee Published by Elsevier Inc. All rights reserved.
Le B.H.,Reading Hospital |
Sandusky M.,Brown University
Brain Pathology | Year: 2010
Glioblastoma, the most common primary brain tumor, is a highly infiltrative, malignant astrocytic neoplasm that demonstrates a wide spectrum of morphologic heterogeneity. Cases with a primitive neuroectodermal tumor (PNET)-like component are rare, but are being increasingly recognized and studied. The primitive component typically shows immunohistochemical features that are indicative of potential for divergent differentiation along glial and neuronal pathways; when present, the entire neuraxis may be at risk for involvement, portending a particularly poor prognosis. Recently, data from the largest case series studying malignant gliomas with a PNET-like component suggest that the primitive component likely arises from the malignant glial component. This report presents an example of glioblastoma with a prominent primitive neuroectodermal-like component in an 81 year-old male who, during the course of concurrent chemotherapy and radiation therapy, died five weeks following initial diagnosis. © 2009 International Society of Neuropathology.
Preskorn S.H.,University of Kansas |
Kane C.P.,Pfizer |
Kane C.P.,Reading Hospital |
Lobello K.,Pfizer |
And 5 more authors.
Journal of Clinical Psychiatry | Year: 2013
Objective: Determine the point prevalence of phenoconversion to cytochrome P450 2D6 (CYP2D6) poor metabolizer status in clinical practice. Method: This multicenter, open-label, single-visit naturalistic study was conducted from October 2008 to July 2009 in adult patients (≥ 18 years) who had been receiving venlafaxine extended-release (ER) (37.5-225 mg/d) treatment for up to 8 weeks. A 15-mL blood sample was drawn 4 to 12 hours after patients' last venlafaxine ER dose. Plasma O-desmethylvenlafaxine and venlafaxine concentrations were determined for each patient. CYP2D6 poor metabolizer phenotype was defined as O-desmethylvenlafaxine to venlafaxine ratio < 1 based on published data. CYP2D6 genotype was determined for each patient; patients were classified as poor metabolizer, intermediate metabolizer, extensive metabolizer, and ultrarapid metabolizer. Agreement between poor metabolizer phenotype and genotype classifications was assessed using the McNemar test. Results: Phenoconversion to CYP2D6 poor metabolizer status occurred in 209 of 865 individuals (24%) with a CYP2D6 non-poor metabolizer genotype. The incidence of CYP2D6 poor metabolizer status based on phenotype was almost 7 times higher than that expected based on genotype: only 4% (35/900) of patients were genotypic CYP2D6 poor metabolizers, but 27% (243/900) were phenotypic CYP2D6 poor metabolizers (McNemar test, P < .0001). Conclusions: CYP2D6 phenotype conversion is common in patients being treated for depression. These results are important because differences in CYP2D6 drug metabolic capacity, whether genetically determined or due to phenoconversion, can affect clinical outcomes in patients treated with drugs substantially metabolized by CYP2D6. These results demonstrate that personalized medicine based solely on genetics can be misleading and support the need to consider drug-induced variability as well. © 2013 Copyright Physicians Postgraduate Press, Inc.
Strauss S.,Reading Hospital |
Bourbeau P.P.,BD Diagnostics
Journal of Clinical Microbiology | Year: 2015
This study compared results from plating urine specimens with the BD InoqulA instrument using a 10-μl inoculum with results from cultures plated manually with a 1-μl loop for comparable 2-month periods. The positivity rates, turnaround times for positive cultures, and BD Phoenix identification and antimicrobial susceptibility test results were comparable for both time periods. We experienced no problems with culture interpretation as the result of moving to the 10-μl inoculum. Copyright © 2015, American Society for Microbiology. All Rights Reserved.
News Article | December 9, 2016
With an upcoming publication in the Worldwide Leaders in Healthcare, Joy K. Darkes, RN, BSN, joins the prestigious ranks of the International Nurses Association. Joy is a Registered Nurse with 46 years of experience in her field and an extensive expertise in all facets of nursing, especially pediatric nursing and school nursing. Joy is currently working at King’s Academy in Mohrsville, Pennsylvania. Joy received her hospital-based Nursing Degree in 1970 from Reading Hospital. An advocate for continuing education, she graduated with her Bachelor of Science Degree in Nursing at Kutztown University of Pennsylvania in 1990. Joy is a National Certified School Nurse, as well as an inductee of Sigma Theta Tau International Honor Society of Nursing, and keeps up to date in her field through her professional membership with the National Association of School Nurses. Joy attributes her great success to always wanting to be a nurse, feeling that nursing was her calling in life. When she is not working, Joy dedicates her free time to swimming. Learn more about Joy K. Darkes here: http://inanurse.org/network/index.php?do=/4133323/info/ and be sure to read her upcoming publication in the Worldwide Leaders in Healthcare.
News Article | November 29, 2016
With an upcoming publication in the Worldwide Leaders in Healthcare, Joy K. Darkes, RN, BSN, joins the prestigious ranks of the International Nurses Association. Joy is a Registered Nurse with 46 years of experience in her field and an extensive expertise in all facets of nursing, especially pediatric nursing and school nursing. Joy is currently serving patients at King’s Academy in Mohrsville, Pennsylvania, and is also Elementary Principal at Ephrata Area School District. Joy received her hospital-based Nursing Degree in 1970 from Reading Hospital. An advocate for continuing education, she graduated with her Bachelor of Science Degree in Nursing at Kutztown University of Pennsylvania in 1990. Joy is a National Certified School Nurse, as well as an inductee of Sigma Theta Tau International Honor Society of Nursing, and keeps up to date in her field through her professional membership with the National Association of School Nurses. Joy attributes her great success to always wanting to be a nurse, feeling that nursing was her calling in life. When she is not working, Joy dedicates her free time to swimming. Learn more about Joy K. Darkes here and be sure to read her upcoming publication in the Worldwide Leaders in Healthcare.