Hobart, IN, United States
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Chen S.-L.,Nanjing Medical University | Chen S.-L.,Nanjing Heart Center | Zhang F.-F.,Nanjing Medical University | Xu J.,Nanjing Medical University | And 4 more authors.
Journal of the American College of Cardiology | Year: 2013

Objectives This study was designed to test the safety and efficacy of pulmonary artery (PA) denervation (PADN) for patients with idiopathic PA hypertension (IPAH) not responding optimally to medical therapy. Background Baroreceptors and sympathetic nerve fibers are localized in or near the bifurcation area of the main PA. We previously demonstrated that PADN completely abolished the experimentally elevated PA pressure responses to occlusion of the left interlobar PA. Methods Of a total of 21 patients with IPAH, 13 patients received the PADN procedure, and the other 8 patients who refused the PADN procedure were assigned to the control group. PADN was performed at the bifurcation of the main PA, and at the ostial right and left PA. Serial echocardiography, right heart catheterization, and a 6-min walk test (6MWT) were performed. The primary endpoints were the change of PA pressure (PAP), tricuspid excursion (Tei) index, and 6MWT at 3 months follow-up. Results Compared with the control group, at 3 months follow-up, the patients who underwent the PADN procedure showed significant reduction of mean PAP (from 55 ± 5 mm Hg to 36 ± 5 mm Hg, p < 0.01), and significant improvement of the 6MWT (from 324 ± 21 m to 491 ± 38 m, p < 0.006) and of the Tei index (from 0.7 ± 0.04 to 0.50 ± 0.04, p < 0.001). Conclusions We report for the first time the effect of PADN on functional capacity and hemodynamics in patients with IPAH not responding optimally to medical therapy. Further randomized study is required to confirm the efficacy of PADN. (First-in-Man Pulmonary Artery Denervation for Treatment of Pulmonary Artery Hypertension [PADN-1] study; chiCTR-ONC-12002085). © 2013 by the American College of Cardiology Foundation Published by Elsevier Inc.


Manning M.L.,Thomas Jefferson University | Borton D.L.,Einstein Healthcare Network | Rumovitz D.M.,St Mary Medical Center
American Journal of Infection Control | Year: 2012

In the last decade, the scope of practice of infection preventionists has expanded beyond the traditional roles of solo practitioner and expert data collectors to roles of interventionists and crucial leaders in successful patient safety initiatives. We examined the job descriptions of a small group of practicing infection preventionists to determine whether they reflected this expanded scope and responsibilities. Copyright © 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.


Darwish O.S.,University of California at Irvine | Strube S.,St Mary Medical Center | Nguyen H.M.,Western University of Health Sciences | Tanios M.A.,St Mary Medical Center
Annals of Pharmacotherapy | Year: 2013

Background: Although numerous studies have shown that anticoagulation of nonvalvular atrial fibrillation (AF) significantly decreases the risk of stroke, anticoagulating critically ill patients in the intensive care unit (ICU) poses many challenges and the benefits have not been determined. Objective: To assess the safety and efficacy of anticoagulation in AF patients with sepsis. Ascertaining the incidence of complications associated with anticoagulation therapy, such as bleeding, can optimize patient care. Methods: This was a retrospective observational study to assess the incidence of stroke and anticoagulation-related complications (eg, bleeding, heparin-induced thrombocytopenia) in AF patients with severe sepsis. This study was undertaken in a surgical/medical ICU of a teaching, community-based hospital. A total of 115 patients with AF who were admitted with a diagnosis of sepsis were included in the study. Results: Among 115 patients (mean age 81 ± 9.5 years and CHADS2 [congestive heart failure, hypertension, age >75 years, diabetes mellitus, stroke] score 3.17 ± 1.20), 80 (69.6%) did not receive anticoagulation treatment during their hospitalization and none of these patients developed a stroke. Anticoagulation-related complications occurred more often in the group who received anticoagulation (8.6% [3/35] vs 0%, P =.008). In the anticoagulated group, a majority of the patients were within therapeutic range less than 50% of the time during their ICU stay. There was no statistically significant difference in survival rates during their hospitalization (66.2% [53/80] for the non-anticoagulated group vs 74.3% [26/35] in the anticoagulated group, P =.392). Conclusion: Administration of anticoagulation for elderly patients with a CHADS2 score at 2 or more in the setting of sepsis can be associated with an increased risk of anticoagulation-related complications (eg, bleeding, heparin-induced thrombocytopenia). Managing and targeting a therapeutic goal with warfarin therapy in critically ill patients with sepsis is challenging. Further studies are necessary to provide appropriate recommendations in this setting. © The Author(s) 2013.


Raffa R.B.,Temple University | Eltoukhy N.S.,St Mary Medical Center | Raffa K.F.,University of Wisconsin - Madison
Journal of Clinical Pharmacy and Therapeutics | Year: 2012

What is known and Objective: Temperature-sensitive pathogenic species and their vectors and hosts are emerging in previously colder regions as a consequence of several factors, including global warming. As a result, an increasing number of people will be exposed to pathogens against which they have not previously needed defences. We illustrate this with a specific example of recent emergence of Cryptococcus gattii infections in more temperate climates. Comment: The outbreaks in more temperate climates of the highly virulent - but usually tropically restricted - C. gattii is illustrative of an anticipated growing challenge for the healthcare system. There is a need for preparedness by healthcare professionals in anticipation and for management of such outbreaks, including other infections whose recent increased prevalence in temperate climates can be at least partly associated with global warming. What is new and Conclusion: (Re)emergence of temperature-sensitive pathogenic species in more temperate climates will present new challenges for healthcare systems. Preparation for outbreaks should precede their occurrence. © 2012 Blackwell Publishing Ltd.


There is a lack of evidence from randomized clinical trials (RCT) supporting percutaneous coronary intervention (PCI) in patients with high bleeding risk or active bleeding. The management decisions are based on extrapolation of subgroups data in RCTs or experts' opinions. Bleeding in the peri-PCI period also increases mortality. In general, PCI can be performed if bleeding can be stopped by mechanical means (compressing or ligating the artery) and the patient can tolerate 4 hours of anticoagulant without further bleeding. For patient with acquired or inherited high risk of bleeding, anecdotal reports showed that either unfractionated heparin or bivalirudin would be acceptable for PCI. For patients on chronic oral anticoagulants, PCI could be performed without new antithrombotic therapy if the international ratio (INR) is between 2 and 3. Antiplatelet therapy would be needed if new thrombi are detected at the index artery. Ultimately, the decision to perform PCI or treat the patient conservatively must be managed on a case-by-case basis. If the benefits outweigh the risk, then the patient can undergo PCI. © Telif Hakki̇ 2013 AVES Yayi̇nci̇li̇k Ltd.


Shea S.S.,St Mary Medical Center | Hoyt K.S.,St Mary Medical Center
Advanced Emergency Nursing Journal | Year: 2012

Patients who present to the emergency department want definitive care by a health care provider who can perform an initial assessment, initiate treatment, and implement a disposition plan. The traditional "nurse triage" model often creates barriers to the process of rapidly evaluating patients. Therefore, innovative strategies must be explored to improve the time of patient arrival to the time seen by a qualified provider in order to complete a thorough medical screening examination. One such approach is a rapid team triage system that provides a patient-centered process. This article describes the implementation of a rapid team triage model in an urban community hospital. Copyright © 2012 Wolters Kluwer Health.


Ramirez E.G.,University of Texas Health Science Center at Houston | Hoyt K.S.,St Mary Medical Center
Advanced Emergency Nursing Journal | Year: 2014

More than 140,000 hand injuries occur yearly, and an estimated 5 days of loss of work per patient occurs (). Advanced practice registered nurses (APRNs) are responsible for managing many of these injuries in primary and emergency care settings. Hand injuries are responsible for approximately 10% of all emergency department visits annually (). This article reviews approaches to the assessment of the patient with a hand injury and establishes a process for basic identification of the hand structures and function. Approaches to history taking and specific evaluations for the hand will be discussed and examples of the assessments will be provided. Diagnostic approaches to support physical findings will be discussed, and methods of radiologic assessment will support the audience in making appropriate diagnosis in relation to hand injuries. This is Part I of a three-part series that will validate the approaches to hand assessment for adults and children and identify specific injuries and their management for the APRN. © 2014 Lippincott Williams & Wilkins.


Darwish O.S.,St Mary Medical Center | Criley J.,St Mary Medical Center
Chest | Year: 2011

Hydrochlorothiazide (HCTZ)-induced pulmonary disease has been described as either an allergic interstitial pneumonitis or a cause of noncardiogenic pulmonary edema. The mechanism of this rare life-threatening side effect is largely unknown. Many patients show peripheral leukopenia and extensive immunologic studies reveal decreased levels of serum immunoglobulins. However, evaluation of the peripheral blood may not reflect local lung changes. Literature reports of bronchoalveolar differentials on such patients are scarce. Bronchoscopy was performed on our patient, and the lavage revealed a significant percentage of neutrophils (70%) and no eosinophils. © 2011 American College of Chest Physicians.


Cocks M.,St Mary Medical Center | Moulton C.-A.,University of Toronto | Luu S.,University of Toronto | Cil T.,University of Toronto | Cil T.,Womens College Hospital
Journal of Surgical Education | Year: 2014

Background Mental practice has been successfully applied in professional sports for skills acquisition and performance enhancement. The goals of this review are to describe the literature on mental practice within sport psychology and surgery and to explore how the specific principles of mental practice can be applied to the improvement of surgical performance - both in novice and expert surgeons. Method The authors reviewed the sports psychology, education, and surgery literatures through Medline, PubMed, PsycINFO, and Embase. Results In sports, mental practice is a valuable tool for optimizing existing motor skill sets once core competencies have been mastered. These techniques have been shown to be more advantageous when used by elite athletes. Within surgery, mental practice studies have focused on skill acquisition among novices with little study of how expert surgeons use it to optimize surgical preparation. Conclusions We propose that performance optimization and skills acquisition should be viewed as 2 separate domains of mental practice. Further understanding of this phenomenon has implications for changing how we teach and train not only novice surgeons but also how experienced surgeons continue to maintain their skills, acquire new ones, and excel in surgery. © 2014 Association of Program Directors in Surgery.


Seckington M.,St Mary Medical Center
Advanced Emergency Nursing Journal | Year: 2014

This case study highlights a unique presentation of an 8-year-old girl with a globe rupture. The recognition of globe rupture is a challenge for all providers. If left untreated or unrecognized, the sequelae are devastating. The assessment and management of this patient are discussed herein. Maintaining a high level of suspicion is the best approach to ensure a positive outcome. © 2014 Wolters Kluwer Health | LippincottWilliams & Wilkins.

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