Hospital of Saint Raphael

Hartford, CT, United States

Hospital of Saint Raphael

Hartford, CT, United States
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Oyasiji T.,Hospital of Saint Raphael | Helton S.W.,Hospital of Saint Raphael
Surgical Endoscopy and Other Interventional Techniques | Year: 2011

Background: This study sought to know the opinions of general surgeons registered in the state of Connecticut about their use of laparoscopic lysis of adhesions (LLA) to manage adhesive small bowel obstruction (SBO) compared with open lysis of adhesions (OLA) in terms of safety, contraindications, and outcomes. Methods: A questionnaire was designed to gather the opinions of general surgeons registered in Connecticut on this topic. The questionnaire was administered electronically and through the mail. Results: Of the 205 general surgeons to whom the questionnaire was sent, 87 completed it (42% response). The respondents were evenly distributed throughout Connecticut. Of these respondents, 9% were university teaching hospital faculty, 55% were community teaching hospital based, and 36% were community nonteaching hospital based. The answers to the questions were expressed as percentages and differences between groups tested using Fisher's exact test, with the significance level set at a P value less than 0.05. According to their self-reports, 60% of the respondents used LLA in their practice, with 38% of this group using LLA for less than 15% of their adhesive SBO cases. Compared with surgeons out of training less than 15 years, a greater number of surgeons out of training more than 15 years considered LLA to be safer (P = 0.03) and to have better outcomes (P = 0.04) than OLA. More surgeons in academic/teaching settings considered LLA to be safe than did surgeons in nonacademic/nonteaching settings (P = 0.04), and more members of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)/Society of Laparoendoscopic Surgeons (SLS) considered LLA to be safe than nonmembers (P = 0.001). Conclusions: Many surgeons do not perform LLA for reasons that differ from those in the surgical literature, which supports LLA. Surgeons recently trained or with membership in minimally invasive surgery (MIS) societies are more likely to use LLA. These data suggest that recent training and interest or membership in MIS associations influence surgeons' choice for LLA. This survey demonstrated that an opportunity exists to improve patient outcomes with education about the merits of LLA in the state of Connecticut. © 2011 Springer Science+Business Media, LLC.

Havill N.L.,Hospital of Saint Raphael | Havill H.L.,Hospital of Saint Raphael | Mangione E.,Hospital of Saint Raphael | Dumigan D.G.,Hospital of Saint Raphael | Boyce J.M.,Hospital of Saint Raphael
American Journal of Infection Control | Year: 2011

Increased attention has been focused on disinfection by housekeepers, but few data are available on disinfection of equipment by nurses. We used adenosine triphosphate bioluminescence assays and aerobic cultures to assess the cleanliness of portable medical equipment disinfected by nurses between each patient use. We found that the equipment was not being disinfected as per protocol and that education and feedback to nursing are warranted to improve disinfection of medical equipment. Copyright © 2011 by the Association for Professionals in Infection. Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Boyce J.M.,Hospital of Saint Raphael | Boyce J.M.,Yale University | Havill N.L.,Hospital of Saint Raphael | Havill H.L.,Hospital of Saint Raphael | And 3 more authors.
Infection Control and Hospital Epidemiology | Year: 2011

Objective. To compare fluorescent markers with aerobic colony counts(ACCs)and anadenosine triphosphate(ATP)bioluminescence assay system for assessing terminal cleaning practices. Design. A prospective observational survey. Setting. A 500-bed university-affiliated community teaching hospital. Methods. Inaconvenience sample of 100 hospital rooms,5 high-touch surfaces were marked with fluorescent markers before terminal cleaning and checked after cleaning to see whether the marker had been entirely or partially removed. ACC and ATP readings were performed on the same surfaces before and after terminal cleaning. Results. Overall, 378 (76%) of 500 surfaces were classified as having been cleaned according to fluorescent markers, compared with 384 (77%) according to ACC criteria and 225 (45%) according to ATP criteria. Of 382 surfaces classified as not clean according to ATP criteria before terminal cleaning, those with the marker removed were significantly more likely than those with the marker partially removed to be classified as clean according to ATP criteria (P =.003). Conclusions. Fluorescent markers are useful in determining how frequently high-touch surfaces arewiped duringterminalcleaning. However, contaminated surfaces classified as clean according to fluorescent marker criteria after terminal cleaning were significantly less likely to be classified as clean according to ACC and ATP assays. © 2011 by The Society for Healthcare Epidemiology of America.

Havill N.L.,Hospital of Saint Raphael | Boyce J.M.,Hospital of Saint Raphael | Boyce J.M.,Yale University
Journal of Clinical Microbiology | Year: 2010

We compared the recovery of methicillin-resistant Staphylococcus aureus (MRSA) on a new selective chromogenic agar, BD BBL CHROMagar MRSA II (CMRSAII), to that on traditional culture media with 293 stool specimens. The recovery of MRSA was greater on the CMRSAII agar. Screening of stool samples can identify patients who were previously unknown carriers of MRSA. Copyright © 2010, American Society for Microbiology. All Rights Reserved.

Mayor R.B.,Hospital of Saint Raphael
Connecticut Medicine | Year: 2012

Tendinopathy is a general term that describes any painful condition that occurs in or around a tendon. Historically, treatments have been directed at inflammation, but an improved understanding of the pathophysiology of tendinopathy has led to redirecting the treatment toward methods that address the underlying pathophysiology. Anti-inflammatory treatments such asNSAIDs and corticosteroid injections are still in common use. Novel treatments such as topical nitrates and platelet rich plasma injections aim to address the biological changes seen in tendinopathy, but evidence of clinical benefit is scant. This article reviews the most widely used treatments for tendinopathy and outlines the literature support for their use.

Taveras A.E.,Hospital of Saint Raphael
Advances in peritoneal dialysis. Conference on Peritoneal Dialysis | Year: 2012

The role of peritoneal dialysis (PD) in the treatment of end-stage renal disease in elderly patients remains unclear. In the United States, PD is used only to a limited extent in that population. There are concerns about technique failure, including physical and psychosocial limitations and the risks of peritonitis. Thus, we retrospectively reviewed our 22 years of experience with patients 75 years of age and older who started on PD. Basic demographic data were collected, and mortality, technique failure, and peritonitis rates were determined. Quality of life (QOL) was assessed using the SF-36 questionnaire, a global QOL assessment, and a depression questionnaire. Among the 235 patients identified (mean age: 79 +/- 4 years; 51% white; 49% female; mean time on PD: 15.8 +/- 11.5 months), technique failure rates at 12 months were not significantly different for the patients 75 years of age older compared with the patients less than 75 years of age. Mortality rates were significantly higher in elderly patients. The peritonitis rate in patients 75 years of age and older was 1 episode in 23.6 patient-months compared with 1 episode in 23 patient-months in younger patients. The most common gram-positive organisms isolated were Staphylococcus epidermidis (38%0) and S. aureus (50%); gram-negative organisms accounted for 22%, and yeasts, 5% of peritonitis episodes. Reasons for transfer to hemodialysis included psychosocial problems (42%) and peritonitis (25%). Not surprisingly, physical component scores on the SF-36 were lower in the older than in the younger patients, but mental component scores on the SF-36 were slightly better in older than in younger patients, and global QOL and depression scores were not different between the groups. Our data suggest that PD is a reasonable modality for elderly patients.

Boyce J.M.,Hospital of Saint Raphael | Boyce J.M.,Yale University
Infection Control and Hospital Epidemiology | Year: 2012

An increasing proportion of central line-associated bloodstream infections (CLABSIs) are seen in outpatient settings. Many of such infections are due to hemodialysis catheters (HD-CLABSIs). Such infections are associated with substantial morbidity, mortality, and excess healthcare costs. Patients who receive dialysis through a catheter are 2-3 times more likely to be hospitalized for infection and to die of septic complications than dialysis patients with grafts or fistulas. Prevention measures include minimizing the use of hemodialysis catheters, use of CLABSI prevention bundles for line insertion and maintenance, and application of antimicrobial ointment to the catheter exit site. Instillation into dialysis catheters of antimicrobial solutions that remain in the catheter lumen between dialyses (antimicrobial lock solutions) has been studied, but it is not yet standard practice in some dialysis units. At least 34 studies have evaluated the impact of antimicrobial lock solutions on HD-CLABSI rates. Thirty-two (94%) of the 34 studies demonstrated reductions in HD-CLABSI rates among patients treated with antimicrobial lock solutions. Recent multicenter randomized controlled trials demonstrated that the use of such solutions resulted in significantly lower HD-CLABSI rates, even though such rates were low in control groups. The available evidence supports more routine use of antimicrobial lock solutions as an HD-CLABSI prevention measure in hemodialysis units. © 2012 by The Society for Healthcare Epidemiology of America. All rights reserved.

Alkhoury F.,Hospital of Saint Raphael | Courtney J.,Hospital of Saint Raphael
American Surgeon | Year: 2011

Severely head-injured patients require significant resources across the continuum of care. The objective of this study is to analyze the impact of the level of trauma center designation on the outcome of the severely head-injured patient. The National Trauma Data Bank between 2001 and 2006 (NTDB 6.2) was queried for all patients with isolated traumatic head injury and Glasgow Coma Score (GCS) less than 9. Comparisons between Level I and Level II trauma centers were made reviewing hospital length of stay (LOS), intensive care unit LOS, ventilator days, major complication rate (pulmonary embolism, pneumonia, lower extremity deep vein thrombosis), mortality, and discharge status. Chi-square and Student t tests were used to determine statistical significance defined as P < 0.05. There were 31,736 patients from 258 facilities who met the inclusion criteria during the study period. Level I trauma centers had approximately twice as many patients admissions as Level II centers. However, the severity of injuries and patients' characteristics identified by the emergency department GCS as well as the probability of survival score showed no difference between Level I and Level II centers. The comparisons between Level I and Level II trauma centers shows that Level II centers are not inferior to Level I in terms of outcomes and complication rate. Level II trauma centers encounter patients with isolated complex head injury less often but with outcomes and complication rates comparable to that of Level I centers. The transport of head-injured patients should not bypass Level II in favor of Level I.

Khatri P.,Hospital of Saint Raphael
Connecticut medicine | Year: 2012

The history and physical examination skills are being replaced by the tools of technology in establishing the actual cause of illness. We present a patient where the history and physical examination were essential in establishing the diagnosis. A 28-year-old female presented to the Emergency Department (ED) with an acute episode of epigastric pain radiating to the back associated with vomiting. Laboratory examinations revealed pancreatitis, imaging showed gallstones and the patient was admitted with the diagnosis of gallstone pancreatitis. A more detailed history and physical examination, however, was notable for a family history of "Mediterranean blood" and abdominal examination demonstrated splenomegaly and laboratory examination showed a microcytic anemia. The recognition of the family history, splenomegaly and microcytic anemia led to the diagnosis of thalassemia as the cause of the gallstone pancreatitis. Clearly, the history was essential in establishing the underlying cause of the problem.

Havill N.L.,Hospital of Saint Raphael | Moore B.A.,Yale University | Boyce J.M.,Hospital of Saint Raphael | Boyce J.M.,Yale University
Infection Control and Hospital Epidemiology | Year: 2012

objective. To compare the microbiological efficacy of hydrogen peroxide vapor (HPV) and ultraviolet radiation (UVC) for room decontamination. design. Prospective observational study. setting. 500-bed teaching hospital. methods. HPV and UVC processes were performed in 15 patient rooms. Five high-touch sites were sampled before and after the processes and aerobic colony counts (ACCs) were determined. Carrier disks with ~ 10 6 Clostridium difficile (CD) spores and biological indicators (BIs) with 10 4 and 10 6 Geobacillus stearothermophilus spores were placed in 5 sites before decontamination. After decontamination, CD log reductions were determined and BIs were recorded as growth or no growth. results. 93% of ACC samples that had growth before HPV did not have growth after HPV, whereas 52% of sites that had growth before UVC did not have growth after UVC (P <.0001) The mean CD log reduction was >6 for HPV and ~ 2 for UVC. After HPV 100% of the 10 4 BIs did not grow, and 22% did not grow after UVC, with a range of 7%-53% for the 5 sites. For the 10 6 BIs, 99% did not grow after HPV and 0% did not grow after UVC. Sites out of direct line of sight were significantly more likely to show growth after UVC than after HPV. Mean cycle time was 153 (range, 140-177) min for HPV and 73 (range, 39-100) min for UVC (P <.0001). conclusion. Both HPV and UVC reduce bacterial contamination, including spores, in patient rooms, but HPV is significantly more effective. UVC is significantly less effective for sites that are out of direct line of sight. © 2012 by The Society for Healthcare Epidemiology of America.

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