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Winter M.A.,Medical Center Blvd | Berg G.M.,Trauma Research | Berg G.M.,University of Kansas
Pharmacotherapy | Year: 2012

Study Objective. To evaluate the impact of various body weights and serum creatinine (Scr) concentrations on the bias and accuracy of the Cockcroft- Gault creatinine clearance (C-G Clcr) equation compared with measured 24-hour Clcr. Design. Retrospective analysis. Setting. Tertiary care hospital. Patients. A total of 3678 patients with stable renal function and who underwent a 24-hour urine collection between July 1, 1996, and June 30, 2010. Measurements and Main Results. For each patient, C-G Cl cr was calculated and compared with a measured 24-hour Cl cr. Body weight adjustments to the calculation were performed based on the following weight classifications: underweight, normal weight, overweight, obese, and morbidly obese. In addition, C-G Clcr was calculated by using rounded Scr values based on two Scr thresholds-0.8 mg/dl and 1 mg/dl-for patients with measured Scr values below those thresholds. Those patients were then evaluated after stratification into two age groups: all ages and a subgroup of patients aged 65 years or older. The Scr-rounded C-G Clcr values were compared with the C-G Clcr values using actual Scr values. Mean differences were calculated, and accuracy was evaluated. Use of actual body weight in the calculations for underweight patients resulted in an unbiased Clcr of -0.22 ml/minute (p=0.898). Use of ideal body weight in the calculations of patients of normal weight returned an unbiased Clcr of -1.3 ml/ minute (p=0.544). An unbiased C-G Cl cr could not be calculated for other weight categories. In those patients, adjusted body weight using a factor of 0.4 (ABW0.4) was the least biased and most accurate. In patients aged 65 years or older with an Scr less than 0.8 mg/dl and less than 1 mg/dl, actual Scr was unbiased (-3 ml/min [p=1] and -9 ml/min [p=0.279], respectively) and more accurate than rounded Scr. In patients of all ages with an Scr less than 0.8 mg/dl and less than 1 mg/dl, actual Scr proved less biased (-4.5 ml/min [p=0.038] and -5.5 ml/min [p<0.001], respectively) and more accurate than rounded Scr. Conclusion. An unbiased C-G Clcr can be calculated using actual body weight in underweight patients and ideal body weight in patients of normal weight. Using ABW0.4 for overweight, obese, and morbidly obese patients appears to be the least biased and most accurate method for calculating their C-G Clcr. Rounding S cr in patients with low Scr did not improve accuracy or bias of the Clcr calculations. Copyright © 2012 Pharmacotherapy Publications, Inc.


The International Association of HealthCare Professionals is pleased to welcome Sherene Shalhub, MD, MPH, FACS, Vascular Surgeon, to their prestigious organization with her upcoming publication in The Leading Physicians of the World. Dr. Sherene Shalhub is a highly trained and qualified surgeon with extensive expertise in all facets of her work. Dr. Shalhub is currently serving patients within Valley Medical Center in Renton, Washington, and a Multidisciplinary Vascular Genetics Clinic within Harborview Medical Center in Seattle, Washington. She is also an Assistant Professor of Surgery in the Division of Vascular Surgery at the University of Washington with a research program at the University Medical Center in Seattle, Washington. Dr. Sherene Shalhub graduated with her Medical Degree with honors from the Morsani College of Medicine at the University of South Florida in Tampa, where she also gained her Master of Public Health Degree. She then relocated to Seattle, Washington, where she completed training as a General Surgery resident and Vascular Surgery fellow at the University of Washington, where she also completed her postdoctoral Trauma Research fellowship. Dr. Shalhub is double board certified in both Vascular and General Surgery, and has earned the coveted title of Fellow of the American College of Surgeons. To keep up to date with the latest advances and developments in her field, she maintains a professional membership with the Society for Vascular Surgery. Dr. Shalhub has authored and coauthored multiple research manuscripts and textbook chapters, and teaches in both clinical and research settings. For her hard work and dedication to her patients, she was awarded the 2014 and 2016 UW Medicine PRAISE Award. In her free time, Dr. Shalhub enjoys traveling to other countries, learning new skills unrelated to medicine, and spending time with her family and friends. Learn more about Dr. Shalhub here: http://www.valleymed.org/ and be sure to read her upcoming publication in The Leading Physicians of the World. FindaTopDoc.com is a hub for all things medicine, featuring detailed descriptions of medical professionals across all areas of expertise, and information on thousands of healthcare topics. Each month, millions of patients use FindaTopDoc to find a doctor nearby and instantly book an appointment online or create a review.  FindaTopDoc.com features each doctor’s full professional biography highlighting their achievements, experience, patient reviews and areas of expertise.  A leading provider of valuable health information that helps empower patient and doctor alike, FindaTopDoc enables readers to live a happier and healthier life.  For more information about FindaTopDoc, visit http://www.findatopdoc.com


Moore F.O.,Louisiana State University Health Sciences Center | Duane T.M.,Virginia Commonwealth University | Hu C.K.C.,Scottsdale Healthcare Osborn Medical Center | Fox A.D.,Rutgers University | And 7 more authors.
Journal of Trauma and Acute Care Surgery | Year: 2012

BACKGROUND: Antibiotic use in injured patients requiring tube thoracostomy (TT) to reduce the incidence of empyema and pneumonia remains a controversial practice. In 1998, the Eastern Association for the Surgery of Trauma (EAST) developed and published practice management guidelines for the use of presumptive antibiotics in TT for patients who sustained a traumatic hemopneumothorax. The Practice Management Guidelines Committee of EAST has updated the 1998 guidelines to reflect current literature and practice. METHODS: A systematic literature review was performed to include prospective and retrospective studies from 1997 to 2011, excluding those studies published in the previous guideline. Case reports, letters to the editor, and review articles were excluded. Ten acute care surgeons and one statistician/epidemiologist reviewed the articles under consideration, and the EAST primer was used to grade the evidence. RESULTS: Of the 98 articles identified, seven were selected as meeting criteria for review. Two questions regarding presumptive antibiotic use in TT for traumatic hemopneumothorax were addressed: (1) Do presumptive antibiotics reduce the incidence of empyema or pneumonia? And if true, (2) What is the optimal duration of antibiotic prophylaxis? CONCLUSION: Routine presumptive antibiotic use to reduce the incidence of empyema and pneumonia in TT for traumatic hemopneumothorax is controversial; however, there is insufficient published evidence to support any recommendation either for or against this practice. Copyright © 2012 by Lippincott Williams & Wilkins.


Lamis R.L.,Institute for Safe Medication Practices | Kramer J.S.,Wesley Medical Center | Hale L.S.,Wichita State University | Zackula R.E.,University of Kansas | Berg G.M.,Trauma Research
American Journal of Health-System Pharmacy | Year: 2012

Purpose. The association between fall risk and inpatient medications was evaluated. Methods. A retrospective, case-control study was performed to compare the medication use of patients sustaining at least one fall during hospitalization (case group) with a control group of patients who did not fall. Data were collected from medical records and generated reports. A fall was defined by the hospital as an event in which the patient comes to rest on the floor from a lying, standing, or sitting position. Adult patients (>18 years of age) admitted between January 1 and December 31, 2006, experiencing a fall at least 48 hours after hospital admission were included in the case group. Each case was matched with one control by age (within five years), sex, admission date (within 30 days), patient care unit, and length of stay. Medications administered within 48 hours before the fall for the case group or designated fall date and time for the control group were documented. Results. Of the 414 documented fall events, 209 patients met the inclusion criteria. Of those patients, 96 matched control patients on all criteria. Significantly more case patients received a greater number of central nervous system (CNS) agents compared with matched control patients (p = 0.017). There was no statistically significant difference in the number of medications from all other drug classes or the total number of medications received by the groups. Conclusion. In a sample of hospitalized patients, CNS agents were significantly associated with falls. Copyright © 2012, American Society of Health-System Pharmacists, Inc. All rights reserved.

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