Eggenberger J.C.,St Joseph Mercy Hospital |
Eggenberger J.C.,Michigan Heart and Vascular Institute
Clinics in Colon and Rectal Surgery | Year: 2011
Neuroendocrine tumors (NETs) are found throughout the intestinal tract and arise from the Kulchitsky cells located in the crypts of Lieberkhn. They are classified by site of origin and by degree of differentiation, with well-differentiated lesions representing those tumors formerly referred to as carcinoid tumors. The focus of this review is NETs of the appendix, colon, and rectum. The clinical presentation of these tumors is dependent on the primary site and many are discovered incidentally, either during screening or during the investigation of nonspecific abdominal complaints. Treatment is primarily via surgical removal as the response to chemotherapy has been traditionally poor. A noted exception to this has been with treatment of the carcinoid syndrome, which occurs almost exclusively in patients with liver metastases and is due to the release of bioactive peptides and amines directly into the systemic circulation. The use of somatostatin congeners to block the release of these substances has greatly ameliorated the devastating symptoms of this condition. Postresection follow-up is advocated, but specific recommendations are lacking an evidentiary basis. NETS, particularly those of the small bowel, colon, and appendix, are seen in association with other synchronous or metachronous malignancies, often of the gastrointestinal tract. However, the utility of subsequent screening and surveillance is unproven. © 2011 by Thieme Medical Publishers, Inc.
Weaver M.F.,University of Texas Health Science Center at Houston |
Hopper J.A.,St Joseph Mercy Hospital |
Gunderson E.W.,University of Virginia
Addiction science & clinical practice | Year: 2015
Recent designer drugs, also known as "legal highs," include substituted cathinones (e.g., mephedrone, methylone, and methylenedioxypyrovalerone, often referred to as "bath salts"); synthetic cannabinoids (SCs; e.g., Spice); and synthetic hallucinogens (25I-NBOMe, or N-bomb). Compound availability has evolved rapidly to evade legal regulation and detection by routine drug testing. Young adults are the primary users, but trends are changing rapidly; use has become popular among members of the military. Acute toxicity is common and often manifests with a constellation of psychiatric and medical effects, which may be severe (e.g., anxiety, agitation, psychosis, and tachycardia), and multiple deaths have been reported with each of these types of designer drugs. Clinicians should keep designer drugs in mind when evaluating substance use in young adults or in anyone presenting with acute neuropsychiatric complaints. Treatment of acute intoxication involves supportive care targeting manifesting signs and symptoms. Long-term treatment of designer drug use disorder can be challenging and is complicated by a lack of evidence to guide treatment.
EMS spinal precautions and the use of the long backboard-resource document to the position statement of the national association of EMS physicians and the american college of surgeons committee on trauma
White Iv C.C.,University of New Mexico |
Domeier R.M.,St Joseph Mercy Hospital |
Millin M.G.,Johns Hopkins University
Prehospital Emergency Care | Year: 2014
Field spinal immobilization using a backboard and cervical collar has been standard practice for patients with suspected spine injury since the 1960s. The backboard has been a component of field spinal immobilization despite lack of efficacy evidence. While the backboard is a useful spinal protection tool during extrication, use of backboards is not without risk, as they have been shown to cause respiratory compromise, pain, and pressure sores. Backboards also alter a patient's physical exam, resulting in unnecessary radiographs. Because backboards present known risks, and their value in protecting the spinal cord of an injured patient remains unsubstantiated, they should only be used judiciously. The following provides a discussion of the elements of the National Association of EMS Physicians (NAEMSP) and American College of Surgeons Committee on Trauma (ACS-COT) position statement on EMS spinal precautions and the use of the long backboard. This discussion includes items where there is supporting literature and items where additional science is needed. © 2014 National Association of EMS Physicians.
Moudgal V.,St Joseph Mercy Hospital
Hospital practice (1995) | Year: 2012
Clostridium difficile has become an increasingly important nosocomial pathogen and is one of the most common causes of hospital-acquired diarrhea. The incidence of C difficile infection (CDI) is increasing worldwide. Overuse of antibiotics is felt to be a major contributing factor leading to the increased incidence of CDI. The clinical manifestations of CDI vary from a mild form of the disease to fulminant diarrhea, leading to significant patient morbidity and mortality. The increasing incidence of CDI has a major impact on increasing health care costs. This article will summarize the epidemiology, pathogenesis, clinical manifestations, laboratory diagnosis, and treatment options for CDI, as well as infection-control measures for the prevention of CDI.
Tworek J.A.,St Joseph Mercy Hospital |
Henry M.R.,Mayo Medical School |
Blond B.,The American College |
Jones B.A.,Ford Motor Company
Archives of Pathology and Laboratory Medicine | Year: 2013
Context. - Gynecologic cytopathology is a heavily regulated field, with Clinical Laboratory Improvement Amendments of 1988 mandating the collection of many quality metrics. There is a lack of consensus regarding methods to collect, monitor, and benchmark these data and how these data should be used in a quality assurance program. Furthermore, the introduction of human papilloma virus testing and proficiency testing has provided more data to monitor. Objective. - To determine good laboratory practices in quality assurance of gynecologic cytopathology. Data Sources. - Data were collected through a written survey consisting of 98 questions submitted to 1245 Clinical Laboratory Improvement Amendments-licensed or Department of Defense laboratories. There were 541 usable responses. Additional input was sought through a Web posting of results and questions on the College of American Pathologists Web site. Four senior authors who authored the survey and 28 cytopathologists and cytotechnologists were assigned to 5 working groups to analyze data and present statements on good laboratory practices in gynecologic cytopathology at the College of American Pathologists Gynecologic Cytopathology Quality Consensus Conference. Ninety-eight attendees at the College of American Pathologists Gynecologic Cytopathology Quality Consensus Conference discussed and voted on good laboratory practice statements to obtain consensus. Conclusions. - This paper describes the rationale, background, process, and strengths and limitations of a series of papers that summarize good laboratory practice statements in quality assurance in gynecologic cytopathology.
Patel M.R.,University of Michigan |
Leo H.L.,University of Michigan |
Leo H.L.,St Joseph Mercy Hospital |
Baptist A.P.,University of Michigan |
And 2 more authors.
Journal of Allergy and Clinical Immunology | Year: 2015
Background More Americans are managing multiple chronic conditions (MCCs), and trends are particularly alarming in youth. Objective The purpose of this study was to examine the prevalence and distribution of 9 chronic conditions in children and adolescents with and without asthma, and adverse asthma outcomes associated with having MCCs. Methods Cross-sectional interview data from the National Health Interview Survey were analyzed (N = 66,790) between 2007 and 2012 in youth 0 to 17 years of age. Bivariate analysis methods and multivariate generalized linear regression were used to examine associations. Results Five percent of children with asthma had 1 or more coexisting health conditions. The prevalence of 1 or more comorbidities was greater among those with asthma than those without (5.07% [95% CI: 4.5-5.6] vs 2.73% [95% CI: 2.6-2.9]). Those with asthma were twice as likely to have co-occurring hypertension (prevalence ratio [PR] = 2.2 [95% CI: 1.5-3.2]) and arthritis (PR = 2.7 [95% CI: 1.8-4.0]) compared with those without asthma. Every additional chronic condition with asthma was associated with a greater likelihood of an asthma attack (PR = 1.1 [95% CI: 1.0-1.2]), all-cause emergency department visits (PR = 1.3 [95% CI: 1.1-1.5]), and missed school days (PR = 2.3 [95% CI: 1.7-3.2]). Conclusions Children and adolescents with asthma in the US who suffer from MCCs have increased asthma symptoms, missed school days, and all-cause emergency department visits. Further research on optimal management strategies for this group is needed. © 2014 American Academy of Allergy, Asthma & Immunology.
Upadhyay N.,St Joseph Mercy Hospital |
Moudgal V.,St Joseph Mercy Hospital
Journal of Clinical Outcomes Management | Year: 2012
• Objective: To review the current evidence on the health benefits and adverse effects of probiotics. • Methods: Review of the literature. • Results: The efficacy of probiotics is strain-dependent. There is good evidence to support probiotic use in the treatment of acute diarrheal diseases, prevention of antibiotic-associated diarrhea, and prevention of pouchitis. However, there is insufficient evidence to recommend probiotics for use in other clinical conditions. Most of the studies have been marked by clinical and methodological differences, pointing to the need for well-designed clinical trials to properly assess the efficacy of probiotics. The side effects of probiotics are generally mild, but serious infections have been reported, especially in the elderly, patients with intravenous catheters, and the immunocompromised. • Conclusion: While probiotics are beneficial in few clinical conditions, there is a need for additional investigations to better define their proper use in clinical practice. Copyright 2012 by Turner White Communications Inc. All rights reserved.
Brown S.D.,St Joseph Mercy Hospital
Journal of trauma nursing : the official journal of the Society of Trauma Nurses | Year: 2012
Rib fractures pose significant risk to trauma patients. Effective pain control and the ability to take deep breaths are crucial for optimal recovery, and these are key elements in current clinical guidelines. These guidelines use incentive spirometry volumes along with other assessment values to guide patient care. However, despite current guidelines, nurses do not routinely document inspired respiratory volumes. This article provides trauma nurses with the rationale for documenting and tracking incentive spirometry volumes to improve outcomes for patients with rib fractures. This promotes early detection of respiratory decline and early interventions to improve pain control and pulmonary function.
Kenaan M.,University of Michigan |
Seth M.,University of Michigan |
Aronow H.D.,St Joseph Mercy Hospital |
Wohns D.,Meijer |
And 2 more authors.
Journal of the American College of Cardiology | Year: 2013
Objectives The purpose of this study was to examine the incidence and outcomes of percutaneous coronary intervention (PCI) performed in patients who had not received pre-procedural aspirin. Background Aspirin is an essential component of peri-PCI pharmacotherapy. Previous studies suggest that pre-procedural aspirin is not administered to a clinically significant number of patients undergoing PCI. Methods We evaluated the incidence of PCIs performed without pre-procedural aspirin use among patients undergoing PCI from January 2010 through December 2011 at 44 hospitals in Michigan. Propensity-matched multivariate analysis was used to adjust for the nonrandom use of aspirin. Results Our study population comprised 65,175 patients, of whom 4,640 (7.1%) did not receive aspirin within 24 h before undergoing PCI. Aspirin nonreceivers were more likely to have had previous gastrointestinal bleeding or to present with cardiogenic shock or after cardiac arrest. In the propensity-matched analysis, absence of aspirin before PCI was associated with a higher rate of death (3.9% vs. 2.8%; odds ratio: 1.89 [95% confidence interval: 1.32 to 2.71], p < 0.001) and stroke (0.5% vs. 0.1%; odds ratio: 4.24 [95% confidence interval: 1.49 to 12.11], p = 0.007) with no difference in need for transfusions. This association was consistent across multiple pre-specified subgroups. Conclusions A significant number of patients do not receive aspirin before undergoing PCI. Lack of aspirin before PCI was associated with significantly increased in-hospital mortality and stroke. Our study results support the need for quality efforts focused on optimizing aspirin use before PCI. © 2013 by the American College of Cardiology Foundation Published by Elsevier Inc.
Ardati A.K.,University of Michigan |
Kaufman S.R.,University of Michigan |
Aronow H.D.,St Joseph Mercy Hospital |
Nypaver T.J.,Ford Motor Company |
And 3 more authors.
Circulation: Cardiovascular Interventions | Year: 2012
Background-Peripheral arterial disease is a manifestation of systemic atherosclerosis and is predictive of future cardiovascular events. Clinical trial data have demonstrated that medical therapy can attenuate cardiovascular morbidity and mortality in patients with peripheral arterial disease. The utilization and impact of recommended medical therapy in a contemporary population of patients who undergo percutaneous interventions for lifestyle-limiting peripheral arterial disease is unknown. Methods and Results-Using the Blue Cross Blue Shield of Michigan Cardiovascular Consortium Peripheral Vascular Intervention (BMC2 PVI) database, we identified 1357 peripheral vascular intervention encounters between January 2007 and December 2009 for the purpose of treating claudication. Before the intervention, 85% of these patients used aspirin, 76% used statin, 65% abstained from smoking, and 47% did all 3. There was no difference in cardiovascular events among those taking an aspirin and a statin on admission and those who were not. However, in both an unadjusted and a multivariable analysis, the odds of an adverse peripheral vascular outcome (repeat peripheral intervention, amputation, or limb salvage surgery) within 6 months decreased by more than half in patients receiving aspirin and statin therapy before peripheral vascular intervention as compared with those who received neither (odds ratio, 0.45; 95% CI, 0.29-0.71). Conclusions-The fundamental elements of medical therapy in patients with lifestyle-limiting claudication are often underutilized before referral for revascularization. Appropriate medical therapy before percutaneous revascularization is associated with fewer peripheral vascular events at 6 months. © 2012 American Heart Association, Inc.