News Article | November 21, 2016
In what is considered a victory for patient safety, hospitals across the U.S. have reduced deadly, but highly preventable, central-line bloodstream infections by 50 percent since 2008. In a new investigation of nearly 2,000 hospitals, Consumer Reports looks at the five-year track record of teaching hospitals to see which have successfully reduced these infections, and which have not. The report, available in the January issue of Consumer Reports and online at CR.org, identifies 31 U.S. teaching hospitals on its lowest-performing “zero tolerance” list and 32 on its list of top performers. The story and Ratings are free, in addition to an interactive look-up tool showing hospitals in your area and their five-year track record (go to CR.org/central-line-infections for the tool). “Because teaching hospitals are teaching our next generation of physicians, we think it’s critical to monitor them closely. Our review of their performance on controlling central-line infections is very sobering,” says Doris Peter, Ph.D., director of the Consumer Reports Health Ratings Center. “Central-line infections are highly preventable and there are no excuses for poor performance on this metric. It’s unfortunate to see so many well-known hospitals, some who tout their top rankings and awards, sitting on the sidelines of one of the biggest triumphs in patient safety.” Central-line infections derive from the intravenous lines used to supply medication, nutrients, and fluids to patients who need them the most. When not handled properly, central lines can become host to bacteria, pumping germs straight into the bloodstream of the patient. Once there, the bacteria – including deadly strains such as MRSA that aren’t easily managed with antibiotics – can spread to the heart and other organs. About 650,000 people develop infections after they are admitted to hospitals each year, and 75,000 patients die, according to the latest data from the Centers for Disease Control and Prevention. That makes hospital acquired infections the eighth leading cause of death, just behind diabetes. Central-line infections account for roughly 5 percent of all hospital infections, but are considered a critical subset because: While other hospital infections have stayed steady or declined only slightly in recent years, those linked to central lines were cut in half between 2008 and 2014, according to the CDC. “It’s one of the nation’s greatest patient safety success stories ever,” says Arjun Srinivasan, M.D., associate director for Healthcare Associated Infection Prevention Programs at the CDC. “Hospitals are moving in the right direction, but progress is slowing and too many hospitals have not adequately addressed the problem over the past five years,” says Consumer Reports’ Peter. What Can Be Done Consumer Reports’ nine-page investigation outlines the Pronovost principles developed 15 years ago to prevent central-line infections. It also includes profiles of two hospitals, Shore Medical Center in New Jersey and Mount Sinai St. Luke’s-Roosevelt in New York, that give insight into how they successfully battled this infection, and how they continue to be vigilant and improve. The story also includes 15 steps that consumers can take to stay safe in the hospital (see sidebar). From a policy standpoint, CR has worked successfully at the state level to get laws passed that require hospitals to publicly report hospital infections for more than a decade. And while President Barack Obama’s Affordable Care Act included a provision that lowered Medicare payments to hospitals that had too many infections, more can be done at the federal government to give the public more timely and actionable information, says Lisa McGiffert, director of Consumer Reports’ Safe Patient Project (SafePatientProject.org). “We think there are many requirements that could keep patients safe. For example, the federal government should require hospitals to immediately report infection outbreaks or infection-control breaches to patients, healthcare providers, state and federal agencies, and the public. In essence, we’re saying that when there is an outbreak, if the hospital knows, then everyone should know,” says McGiffert. Complete hospital lists and Ratings are available in the magazine story and online. The list below reveals the 31 lowest scoring U.S. teaching hospitals at preventing central-line infections in intensive care units from January 1, 2011 to December 31, 2015. Hospitals appear in alphabetical order. Atlanta Medical Center (Atlanta, GA) Banner- University Medical Center Tucson (Tucson, AZ) Brooklyn Hospital Center (Brooklyn, NY) Community Regional Medical Center (Fresno, CA) Cooper University Health Care (Camden, NJ) Dartmouth – Hitchcock Medical Center (Lebanon, NH) Emory University Hospital Midtown (Atlanta, GA) Eskenazi Health (Indianapolis, IN) George Washington University Hospital (Washington, DC) Grady Memorial Hospital (Atlanta, GA) Holy Cross Hospital (Silver Spring, MD) Howard University Hospital (Washington, D.C.) Hurley Medical Center (Flint, MI) Indiana University Health University Hospital (Indianapolis, IN) Interim LSU Public Hospital (New Orleans, LA) Long Beach Memorial Medical Center (Long Beach, CA) MacNeal Hospital (Berwyn, IL) Maine Medical Center (Portland, ME) Maricopa Integrated Health System (Phoenix, AZ) Nebraska Medicine - Nebraska Medical Center (Omaha, NE) Palmetto Health Richland (Columbia, SC) Robert Wood Johnson University Hospital (New Brunswick, NJ) Ronald Reagan UCLA Medical Center (Los Angeles, CA) SUNY Downstate Medical Center University Hospital (Brooklyn, NY) Truman Medical Center - Hospital Hill (Kansas City, MO) Tulane Medical Center (New Orleans, LA) UC San Diego Health (San Diego, CA) UF Health Jacksonville (Jacksonville, FL) University Hospital (Newark, NJ) University Medical Center of El Paso (El Paso, TX) University of Iowa Hospitals and Clinics (Iowa City, IA) About Consumer Reports Consumer Reports is the world’s largest and most trusted nonprofit consumer organization, working to improve the lives of consumers by driving marketplace change. Founded in 1936, Consumer Reports has achieved substantial gains for consumers on food and product safety, financial reform, health reform, and many other issues. The organization has advanced important policies to prohibit predatory lending practices, combat dangerous toxins in food, and cut hospital-acquired infections. Consumer Reports tests and rates thousands of products and services in its 50-plus labs, state-of-the-art auto test center, and consumer research center. It also works to enact pro-consumer laws and regulations in Washington, D.C., in statehouses, and in the marketplace. An independent nonprofit, Consumer Reports accepts no advertising, payment, or other support from the companies that create the products it evaluates. _______________ JANUARY 2017 © 2016 Consumer Reports. The material above is intended for legitimate news entities only; it may not be used for advertising or promotional purposes. Consumer Reports® is an expert, independent nonprofit organization whose mission is to work for a fair, just, and safe marketplace for all consumers and to empower consumers to protect themselves. We accept no advertising and pay for all the products we test. We are not beholden to any commercial interest. Our income is derived from the sale of Consumer Reports®, ConsumerReports.org® and our other publications and information products, services, fees, and noncommercial contributions and grants. Our Ratings and reports are intended solely for the use of our readers. Neither the Ratings nor the reports may be used in advertising or for any other commercial purpose without our permission. Consumer Reports will take all steps open to it to prevent commercial use of its materials, its name, or the name of Consumer Reports®.
Singh G.,Truman Medical Center |
Singh G.,Heritage Laboratories International Inc. |
Bonham A.J.,University of Missouri - Kansas City
Journal of the American Board of Family Medicine | Year: 2014
Background: Vitamin D is essential for bone health and probably the health of most nonskeletal tissues. Vitamin D deficiency is widespread, and recommended doses are usually inadequate to maintain healthy levels. We conducted a retrospective observational study to determine whether the recommended doses of vitamin D are adequate to correct deficiency and maintain normal levels in a population seeking health care. We also sought to develop a predictive equation for replacement doses of vitamin D. Methods: We reviewed the response to vitamin D supplementation in 1327 patients and 3885 episodes of vitamin D replacement and attempted to discern factors affecting the response to vitamin D replacement by conducting multiple regression analyses. Results: For the whole population, average daily dose resulting in any increase in serum 25-hydroxyvitamin D level was 4707 IU/day; corresponding values for ambulatory and nursing home patients were 4229 and 6103 IU/day, respectively. Significant factors affecting the change in serum concentrations of 25-hydroxyvitamin D, in addition to the dose administered, are (1) starting serum concentration of 25-hydroxyvitamin D, (2) body mass index (BMI), (3) age, and (f) serum albumin concentration. The following equation predicts the dose of vitamin D needed (in international units per day) to affect a given change in serum concentrations of 25-hydroxyvitamin D: Dose = [(8.52 - Desired change in serum 25-hydroxyvitamin D level) + (0.074 x Age) - (0.20 x BMI) + (1.74 x Albumin concentration) - (0.62 x Starting serum 25-hydroxyvitamin D concentration)]/(-0.002). Analysis of the dose responses among 3 racial groups - white, black, and others - did not reveal clinically meaningful differences between the races. The main limitation of the study is its retrospective observational nature; however, that is also its strength in that we assessed the circumstances seen in usual health care setting. Conclusions: The recommended daily allowance for vitamin D is grossly inadequate for correcting low serum concentrations of 25-hydroxyvitamin D in many adult patients. About 5000 IU vitamin D3/day is usually needed to correct deficiency, and the maintenance dose should be ≥2000 IU/day. The required dose may be calculated from the predictive equations specific for ambulatory and nursing home patients.
Griffith C.,Truman Medical Center
Missouri medicine | Year: 2012
Alcohol has been reported to be beneficial in reducing the risk and complications of cardiovascular disease (CVD). This benefit must be balanced with the known risks of alcohol. This review examines the evidence that there is a favorable effect on CVD and attempts to evaluate if the positive effects outweigh the potential pernicious sequellae.
Smith R.P.,Truman Medical Center
Obstetrics and Gynecology | Year: 2010
Objective: To evaluate resident experience in obstetric and gynecologic procedures after implementation of resident work-hour restrictions. Methods: Median resident experience in core obstetric and gynecologic procedures in the role of "surgeon" for the 3-year period before the implementation of work-hour restrictions were compared with data from a similar 3-year period starting 4 years after the work-hour rules were in effect. Comparisons to national practice changes occurring over the same time period were made with national data. Results: Resident experience in core obstetric procedures has changed in parallel with those occurring nationally, but with little overall effect on total experience (3-year average of median total cases, 513 compared with 510) with a decrease in operative vaginal deliveries (42 compared with 26 cases) and an increase in cesarean deliveries (166 compared with 221 cases). Resident experience with abdominal hysterectomy declined (83.7 compared with 75.4 cases), while experience with vaginal hysterectomy remained steady (31.3 compared with 34.6 cases). In contrast, there was an increase in experience with laparotomy (41.7 compared with 54.6 cases), laparoscopy (56.7 compared with 94 cases), and hysteroscopy (39.7 compared with 62.7 cases). Comparisons to national practice changes occurring over the same time period show similar patterns. Conclusion: The imposition of work-hour restrictions has not had material negative effects on resident technical experience. © 2010 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins.
Singh G.,Truman Medical Center
American journal of clinical pathology | Year: 2014
To evaluate the clinical utility of and demand for the creatine kinase (CK)-MB assay. We examined the number of CK-MB tests from 2007 through 2013 while we progressively deemphasized their use. We first removed CK-MB from the acute coronary syndrome (ACS) panel and then from the main menu and observed the demand for the test. We also reviewed patient medical records to assess the appropriateness of its use. After removing CK-MB from the ACS panel, the test volume dropped from around 12,000 per year to about 150 per year. In reviewing the records of 171 patients who had CK-MB determination done over a 28-month period, we discovered that CK-MB contributed to the diagnosis in only one patient, although it was not essential. Since removing CK-MB from the laboratory menu, two CK-MB tests were ordered in 4 months, and neither added value. CK-MB determinations do not add value to information available from the troponin assay and can be safely removed from the laboratory menu.
Jacobsen R.C.,Truman Medical Center |
Gratton M.C.,Truman Medical Center
Prehospital Emergency Care | Year: 2010
A case of prehospital anaphylactic shock that presented atypically, without a known exposure, is discussed. Anaphylaxis is a potentially life-threatening allergic reaction that requires prompt recognition and aggressive treatment. While there is little diagnostic dilemma (specifically used in the conclusion section of this paper) in the recognition and management of "classic" presentations of anaphylaxis there is likely a need for further education of prehospital providers, as well as emergency physicians, on how to recognize atypical cases of anaphylaxis. These cases can be equally severe, with potentially fatal consequences if missed. The diagnosis and management of anaphylaxis are reviewed, as well as barriers that providers encounter in diagnosing uncommon presentations. © 2011 National Association of EMS Physicians.
Musselman M.E.,North Kansas City Hospital |
Hampton J.P.,University of Missouri - Kansas City |
Hampton J.P.,Truman Medical Center
Pharmacotherapy | Year: 2014
Synthetic, or "designer" drugs, are created by manipulating the chemical structures of other psychoactive drugs so that the resulting product is structurally similar but not identical to illegal psychoactive drugs. Originally developed in the 1960s as a way to evade existing drug laws, the use of designer drugs has increased dramatically over the past few years. These drugs are deceptively packaged as "research chemicals," "incense," "bath salts," or "plant food," among other names, with labels that may contain warnings such as "not for human consumption" or "not for sale to minors." The clinical effects of most new designer drugs can be described as either hallucinogenic, stimulant, or opioid-like. They may also have a combination of these effects due to designer side-chain substitutions. The easy accessibility and rapid emergence of new designer drugs have created challenges for health care providers when treating patients presenting with acute toxicity from these substances, many of which can produce significant and/or life-threatening adverse effects. Moreover, the health care provider has no way to verify the contents and/or potency of the agent ingested because it can vary between packages and distributors. Therefore, a thorough knowledge of the available designer drugs, common signs and symptoms of toxicity associated with these agents, and potential effective treatment modalities are essential to appropriately manage these patients. © 2014 Pharmacotherapy Publications, Inc.
Hampton J.P.,University of Missouri - Kansas City |
Hampton J.P.,Truman Medical Center
American Journal of Health-System Pharmacy | Year: 2011
Purpose. The pharmacology, pharmacokinetics, safety, and dosing of medications used during the pretreatment and paralysis with induction steps of rapid-sequence intubation (RSI) and the role of the pharmacist in RSI are reviewed. Summary. RSI is a process involving the administration of a sedative induction agent and a paralytic agent to facilitate endotracheal intubation. This is a procedure in which the emergency department (ED) pharmacist can play an integral role, especially in the steps of pretreatment, paralysis with induction, and postintubation management. The pretreatment phase occurs three minutes before administration of induction and neuromuscular blockers. The purpose of pretreatment is to attenuate the pathophysiologic response to laryngoscopy and intubation. Three minutes after the pretreatment agents have been administered, paralysis with induction will begin. The purpose of induction is to produce a state of general anesthesia, allowing for the administration of paralytics and facilitation of ideal intubating conditions. It is advisable for the ED pharmacist to be familiar with the steps and medications involved with RSI so that appropriate interventions may be made, facilitating both the successful intubation and the safety of the patient. The relative chaos that may occur during emergent RSI requires the ED pharmacist to have a clearly defined primary plan as well as contingency plans to deal with potential complications. Commonly used medications during intubation include lidocaine, fentanyl, etomidate, midazolam, thiopental, ketamine, succinylcholine, and rocuronium. Conclusion. The selection of an appropriate sedative and neuromuscular blocker during the pretreatment and paralysis with induction steps of RSI can be facilitated by an ED pharmacist. Copyright © 2011, American Society of Health-System Pharmacists, Inc. All rights reserved.
Enriquez M.,University of Missouri |
Farnan R.,Truman Medical Center |
Neville S.,Kansas City Care Clinic
AIDS Patient Care and STDs | Year: 2013
This qualitative study examined the role of experienced HIV-infected lay individuals who work in HIV medical care settings as educators. Participants in this study had been in the role an average of 4 years, and referred to their work as "peering," a newly coined verb in the vein of nursing. An overarching theme was that the title "peer educator" captured neither the scope of their work, nor the skill set they contribute to patient care. Peers brought unique contributions to the HIV care team that were vital to encouraging patients to stay engaged in care. Peers felt undervalued and expressed the wish to be "professionalized." Results from this study suggest that peers show promise as behavior change agents who can model healthful behaviors, particularly for newly diagnosed patients or those struggling with engagement in HIV care and adherence to treatment. However, peers need and want more formal training in behavior change science, and peer-led services must become more uniform and readily available to patients across HIV care settings. Research is needed to document the positive impact that peers can have on HIV-related health outcomes and to increased knowledge about the attributes of successful peers. © 2013, Mary Ann Liebert, Inc.
News Article | February 15, 2017
When a genetic disorder characterized by high intelligence and homicidal behavior breaks out, the government must act to preserve human fertility. “The Thirty Minute War,” by late author Elwyn M. Grimes, MD, takes readers into a futuristic world where the government is forced to implement gene therapy and sterilization for all citizens after a terrorist-orchestrated nuclear accident results in environmental contamination. Sadee Digmond, chief of operations, becomes accidentally pregnant. In fear of retaliation from the government, she changes her identity and is troubled by the impacts of environmental catastrophe in America. Collette Grimes is honoring her late husband’s legacy by publishing his work in the hopes of illustrating the impact of environmental toxins on fostering the growth of diseases and the psychological and social issues of fertility. “Elwyn was an academician for more than 30 years and observed many human experiences,” Collette said. “With this novel, he wanted to provoke readers to imagine the immense devastating effect of cyber war and environmental contamination and how these issues could impact many people.” Dr. Grimes was one of the first African American reproductive endocrinologists in the country. During his medical career, he served as Chairman at numerous medical centers throughout the United States. Dr. Grimes established the section of reproductive endocrinology and infertility at Truman Medical Center in Kansas City, where he founded the area’s first freestanding sperm bank. “My husband wrote for the joy of putting pen to paper," Collette said. “He passed away prior to editing and publishing. I wanted to assist in sharing his message, a message that he was so passionate about. About the author Elwyn M. Grimes, MD, was born in Woodville, Mississippi. After medical school, he completed a fellowship at Peter Bent Brigham Hospital and Harvard School of Medicine in Boston, Massachusetts. Over his long career, Grimes served as a clinician and educator at several prestigious medical facilities specializing in reproductive endocrinology and infertility. He established the Midwest Fertility Foundation and Laboratory, a sperm bank in Kansas City, Missouri. Working in a specialty that has such a personal impact on people’s lives, he chose to share his creativity and experience with the reading public in this medical suspense novel. He is survived by his wife, Collette, who published and edited his work posthumously.