Waterbrook A.L.,University of Arizona |
Adhikari S.,University of Arizona |
Stolz U.,University of Arizona |
Adrion C.,Tucson Medical Center
American Journal of Emergency Medicine | Year: 2013
Objectives: To determine the diagnostic accuracy of emergency physician performed point-of care ultrasound (POCUS) for detecting long bone fractures compared to standard radiography. Methods: This was a single-blinded, prospective observational study of patients presenting to two emergency departments (ED) with trauma to long bones. The study used a convenience sample of patients seen during the study investigators' scheduled clinical shifts. Patients presenting to the ED with complaints of long bone trauma were included in the study when a study investigator was available in the ED. POCUS examinations of injured long bones were performed using a standard protocol. The investigators documented their interpretation prior to radiographs being performed. After standard radiographs were performed, the final radiology reading by a radiology attending physician was obtained from the medical record. Results: One-hundred six patients were enrolled into the study, and 147 long bone POCUS examinations were performed. Forty-two fractures were present by radiographs and the prevalence of fractures was 29%. The sensitivity was 90.2% (4/41, 95% CI: 76.9-97.3) and specificity was 96.1% (4/102, 95% CI: 90.3-98.9). The positive likelihood ratio was 23.0 (95% CI: 8.8-60.5), and the negative likelihood ratio was 0.102 (95% CI: 0.040, 0.258). The positive predictive value was 90.2% (4/41, 95% CI: 76.9-97.3) and the negative predictive value was 96.1% (4/102, 95% CI: 90.3-98.9). Conclusions: Emergency physicians can accurately evaluate long bone fractures in the ED using POCUS. In particular, long bone fractures can be excluded with a high degree of confidence. © 2013 Elsevier Inc. All rights reserved.
Friedman A.C.,University of Arizona |
Downing D.,Fort Defiance Indian Hospital |
Chino J.,Tuba City Regional Health Care Corporation |
Krupinski E.,University of Arizona |
And 2 more authors.
American Journal of Roentgenology | Year: 2010
OBJECTIVE. Fort Defiance Indian Hospital and Tuba City Regional Health Care Center are two rural hospitals with limited availability of optical colonoscopy (OC) and other methods of colorectal cancer screening. Our goals were to determine whether adequate examinations could be obtained with remote supervision after brief onsite instruction and to share lessons learned in our experience with a remote CT colonography (CTC) screening program. MATERIALS AND METHODS. After brief onsite instruction, including performing a CTC examination on a volunteer to train the CT technologists, both sites began performing CTC using standard bowel preparation, fecal tagging, automatic insufflation, and low-dose technique. Studies were transferred to the University of Arizona Hospital for image quality assessment of stool, residual fluid, distention, and interpretation, with reports returned via the teleradiology information system. Clinical follow-up was performed on those patients referred for polypectomy or biopsy. RESULTS. Three hundred twenty-one subjects underwent CTC, including 280 individuals referred for screening examinations (87%). Ninety-two percent of subjects (295/321) had acceptable amounts of residual stool, 91% (293/321) had acceptable levels of fluid, and 92% (294/321) had acceptable distention. Fourteen percent (44/321) of CTC patients had polyps 6 mm or larger in size, with a positive predictive value of 41% for those who subsequently underwent colonoscopy-polypectomy (11/27). CONCLUSIONS. CTC can be introduced to rural underserved communities, performed locally, and interpreted remotely with satisfactory performance, thereby increasing colorectal cancer screening capacity. Important aspects of implementation should include technologist training, referring physician education, careful attention to image transmission, and clearly defined methods of communication with patients and referring providers. © American Roentgen Ray Society.
Garcia L.,Tufts University |
Jaff M.R.,Massachusetts General Hospital |
Metzger C.,Wellmont Holston Valley Medical Center |
Sedillo G.,CardioVascular Solutions Institute |
And 17 more authors.
Circulation: Cardiovascular Interventions | Year: 2015
Background - Stent-based therapy in the superficial femoral and popliteal arteries in patients with peripheral artery disease is compromised by restenosis and risk of stent fracture or distortion. A novel self-expanding nitinol stent was developed that incorporates an interwoven-wire design (Supera stent, IDEV Technologies, Inc, Webster, TX) to confer greater radial strength, flexibility, and fracture resistance. Methods and Results - This prospective, multicenter, investigational device exemption, single-arm trial enrolled 264 patients with symptomatic peripheral artery disease undergoing percutaneous treatment of de novo or restenotic lesions of the superficial femoral or proximal popliteal (femoropopliteal) artery. Freedom from death, target lesion revascularization, or any amputation of the index limb at 30 days (+7 days) postprocedure was achieved in 99.2% (258/260) of patients (P<0.001). Primary patency at 12 months (360±30 days) was achieved in 78.9% (180/228) of the population (P<0.001). Primary patency by Kaplan-Meier analysis at 12 months (360 days) was 86.3%. No stent fracture was observed by independent core laboratory analysis in the 243 stents (228 patients) evaluated at 12 months. Clinical assessment at 12 months demonstrated improvement by at least 1 Rutherford-Becker category in 88.7% of patients. Conclusions - The SUPERB Trial, an investigational device exemption study using an interwoven nitinol wire stent in the femoropopliteal artery, achieved the efficacy and safety performance goals predesignated by the Food and Drug Administration. On the basis of the high primary patency rate, absence of stent fracture, and significant improvements in functional and quality-of-life measures, the Supera stent provides safe and effective treatment of femoropopliteal lesions in symptomatic patients with peripheral artery disease. © 2015 American Heart Association, Inc.
Leon Jr. L.R.,Tucson Medical Center |
Mills Sr. J.L.,University of Arizona
Vascular and Endovascular Surgery | Year: 2010
We reviewed all papers most recently reported in the literature (January-December 2008) with regard to infected arterial aneurysms (IAAs) affecting the aorta. Most of the recently reported knowledge is limited to case reports and small series of aortic mycotic aneurysms. Most patients are elderly men and have comorbidities at presentation. Aneurysms were most commonly associated to Salmonella and Staphylococcus. However, several cases of aortic IAAs caused by atypical pathogens were also reported, likely due to an increase in immunosuppressive illnesses, increased life expectancy, improved diagnostic methods, and increasing medical awareness. Open surgical therapy of IAAs remains the gold standard. Some have reported successful outcomes with endovascular methodologies for patients medically compromised or for particular challenging clinical or anatomical scenarios. However, at this time, conclusive evidence is lacking and it should be in general considered a bridge to open repair. The latter should be planned at the earliest possible, when medically permissible.
Leon Jr. L.R.,Tucson Medical Center |
Leon Jr. L.R.,University of Arizona |
Dieter R.S.,Loyola University |
Gadd C.L.,University of Arizona |
And 8 more authors.
Journal of Vascular Surgery | Year: 2013
Background: Popliteal artery stenting is not routinely performed due to concerns related to the high mobility of the knee joint and the potential for external stent compression, fractures, and occlusion. Open bypass is traditionally considered the gold standard for popliteal artery atherosclerotic lesions. The Supera stent (IDEV Technologies Inc, Webster, Tex) was developed to provide superior radial strength, fracture resistance, and flexibility compared with laser-cut nitinol stents. This study represents the initial United States experience in the management of popliteal artery atherosclerotic disease with the Supera interwoven wire stent. Methods: Patients undergoing stent implantation in the 20-month period after the 2008 Food and Drug Administration clearance were included. Medical records, radiographic imaging, and procedural data were examined. Procedural angiograms were classified according to Trans-Atlantic Inter-Society Consensus criteria. Patency and limb loss rates were calculated using Kaplan-Meier analysis. Results: A total of 39 stents were placed in 34 patients due to isolated popliteal artery occlusive disease. Clinical follow-up was a mean of 12.7 months (range, 0.2-33.7 months), and radiologic follow-up was a mean of 8.4 months (range, 0-26.8 months). Most patients had critical limb ischemia (CLI), with tissue loss (38.2%) or rest pain (35.3%) as the indication for intervention. In 20 patients (58.8%), the most distal end of the stent(s) landed in the below-the-knee popliteal segment, 12 (35.3%) landed in the above-the-knee segment, and two (5.9%) landed precisely at the knee. Other than angioplasty and stenting, 47% of patients did not receive any adjuvant concomitant therapy in the treated leg. Two patients underwent concomitant atherectomy of the popliteal segment. Primary, primary assisted, and secondary patency rates by duplex ultrasound imaging were 79.2%, 88.1% and 93%, respectively, by Kaplan-Meier estimates, with a mean stented length of 12 cm. Six instances of stent occlusion were noted, and six patients were identified with hemodynamically significant in-stent stenosis. Three patients sustained limb loss (8.8%), two related to uncontrolled infections, and one due to perioperative ischemic complications (both with patent stents at the time of limb loss). The overall mortality was 8.8% during the study period. Knee roentgenography was performed in all but one patient, and no stent fractures were identified. Conclusions: Stenting of the popliteal artery using the Supera stent system appears to be safe and effective. The interwoven stent design may better serve areas under extreme mechanical stress. Our results with this highly diseased patient population justify a prospective trial in this subject.
Burgin L.B.,Tennessee Valley Healthcare System |
Gamboa A.M.,Tucson Medical Center |
Tierney D.M.,U.S. Air force |
Lee J.K.,University of Arizona
Consultant Pharmacist | Year: 2013
Objectives: The objective of this study was to evaluate a pharmacy student-led interactive educational program for older adults on the safe use of over-the-counter (OTC) medications. Methods: This was a prospective, interventional study evaluating an educational program covering 12 common OTC topics. Doctor of pharmacy students and a geriatric specialist faculty advisor developed and delivered a 30-minute presentation tailored to older adults, accompanied by various interactive learning methods, including a questionand- answer session. Following the program, participants completed a questionnaire to address the helpfulness and report intentions of behavior change. Results: A total of 88 individuals attended the presentations, and 64 participants voluntarily completed the anonymous post-program survey; 91.8% of the participants indicated the intervention was either "very helpful" or "moderately helpful." The majority of subjects stated they would make changes to the way they use OTCs (79.3%) and discuss OTC use with their providers (88.3%). The three most beneficial topics included vitamins/minerals, reading a drug label, and sleep medications. Conclusion: An interactive educational program on the safe use of OTC medications was helpful and generated positive intentions regarding behavior change in OTC use among older adults.
PubMed | Tucson Medical Center
Type: Journal Article | Journal: Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition | Year: 2016
Parenteral nutrition-associated cholestasis (PNAC) and liver disease have been associated with soybean oil-based intravenous fat emulsions (IVFEs). The benefit of fish oil-based IVFEs in the reversal of parenteral nutrition (PN)-associated liver damage includes allowing for longer PN duration without immediate need for bowel or liver transplantation.The present case involves an infant born with short bowel syndrome (SBS) requiring long-term PN with development of PNAC and subsequent administration of a fish oil-based IVFE.An infant born with SBS was initiated on PN and enteral feeds. After failed enteral progression, bowel lengthening by serial transverse enteroplasty (STEP) resulted in postoperative ileus with delayed enteral feeding for 4 weeks. The administration of long-term PN led to development of PNAC, resulting in initiation of a fish oil-based IVFE. After 4 months, the cholestasis had resolved. Despite the STEP, at 16 months, the child required bowel tapering due to inability to advance enteral feeding.Fish oil-based IVFE was effectively used to reverse PNAC in a child with SBS. Despite early STEP, the patient was not able to tolerate enteral feedings and required bowel tapering. This case illustrates that early surgical intervention did not allow for improved feed tolerance. This resulted in a significant period without enteral nutrition, leading to development of cholestasis. The use of fish oil-based IVFE may permit a longer duration of PN administration without the development of cholestasis or liver disease, allowing for longer time for bowel adaptation prior to the need for surgical intervention.
News Article | February 16, 2017
SUNNYVALE, Calif., Feb. 16, 2017 (GLOBE NEWSWIRE) -- Digital technologies that improve the patient experience and reduce IT cost of ownership are top of mind for healthcare organizations. At the 2017 HIMSS conference, NetApp (NASDAQ:NTAP) will share its vision for simplifying healthcare IT and how its cloud-connected data management offerings dramatically improve data center economics. The conference runs from February 19 to 23 in Orlando, Florida. “More than 4,000 healthcare customers trust NetApp with their most important asset – their data,” says Dave Nesvisky, senior director, NetApp Healthcare. “NetApp’s innovation positions the company to unify, standardize, and simplify infrastructure — streamlining IT management and maximizing savings while still providing rapid, reliable access to the clinical data that improves patient care.” Booth #1771: Meet Experts, Explore Topics, and Experience the TCO Calculator With NetApp’s presence at HIMSS17, visitors can: How Customers Adapt to Healthcare Demands with NetApp At HIMSS17, NetApp will showcase how its customers adapt to healthcare challenges with confidence, leveraging data management solutions to simplify healthcare IT and reduce total cost of ownership. Tucson Medical: Providing Always-On Access for Digital Hospitals Faced with rapidly growing data volumes from its core Epic software and from retention of data for HIPAA guidelines, Tucson Medical Center (TMC) partnered with NetApp on a solution. Clinicians require constant access to life-saving data, so TMC has no tolerance for outages. “With NetApp, we have not had downtime, which gets overlooked because it’s unheard of. But it’s a phenomenal statistic,” says Drew Burnett, systems and network manager of TMC. “It makes my job easier; it keeps my hair from going as gray.” NetApp technology has been an instrumental tool in virtualizing 98% of TMC’s more than 700 applications. It also allows the healthcare organization to support its 1,300 users concurrently, a competitive advantage that improves the patient experience and quality of outcomes. Engage: Securely Backing Up Records to the Cloud Sophisticated healthcare applications, data-intensive technologies such as MRIs, new Internet of Things (IoT) sensors, and personal devices are generating patient data faster than ever. Healthcare providers feel challenged to meet requirements while containing costs and improving patient care. Engage, the technology division of nonprofit Inland Northwest Health Services (INHS), helps medical centers leverage IT to enhance both operational efficiencies and quality of care. When the cost and time of maintaining its tape-based backup service began to soar, Engage worked with NetApp to provide off-site replication. That technology laid the groundwork for a new backup-to-cloud service. “NetApp technology is helping us help our customers direct more time and money into patient care,” says Frank Tollefson, assistant director of network services, INHS/Engage. “And that is what our business is all about.” About NetApp Leading organizations worldwide count on NetApp for software, systems and services to manage and store data. We help customers capitalize on the value of their data in the hybrid cloud through our Data Fabric strategy, data management expertise, portfolio and ecosystem. To learn more, visit www.netapp.com. © 2017 NetApp, Inc. All Rights Reserved. NETAPP, the NETAPP logo, and the marks listed at http://www.netapp.com/TM are trademarks of NetApp, Inc. Other company and product names may be trademarks of their respective owners.
News Article | December 26, 2016
On December 7, 2016, Santé of Tucson held its Grand Opening celebration. Santé of Tucson had a festive day of greeting new guests, visitors, local business people and neighbors to their grand opening event. Everyone was impressed by the design of the floor plans and the quality of the details provided to future residents. Santé Partners and Summerplace Management worked together to deliver this grand facility to Tucson. The senior care expertise of Santé Partners combined with the exceptional professionalism of Summerplace Management resulted in a remarkable addition to the senior community of Tucson. By 2040, the number of Americans 75 and older will surpass 45.7 million, according to U.S. Census Bureau projections. The market demand for senior housing is on the rise and the nation is already experiencing a shortage of resources. "The presence of Santé of Tucson will deepen our healthcare assets," said Joe Snell, president and CEO of Tucson Regional Economic Opportunities. Santé Partners and Summerplace Management expect a high demand for the first year of operations of Santé of Tucson facility. Santé Transitional Rehabilitation Centers (TRCs) are reshaping the after-hospitalization care industry and revolutionizing the way guests and patients receive care. Santé TRCs provide assisted living, short-term rehabilitation and senior care centers focused on the mind, body and spirit. The Santé of Tucson TRC facility is a one of a kind facility in Tucson. It consists of a two-story facility nestled in a 68,000-square-foot building with 103 patient beds. The new facility also includes a short-term memory care (dementia) wing, which is privately secured and includes its own private dining and physical rehabilitation gym. The facility operations include both inpatient and outpatient rehabilitation services and an in-house pharmacy. The comforts of home are important during the rehabilitation process, which is why the personal suites at Santé of Tucson have all the same, high-quality amenities as other Santé properties: kitchenettes, personal bathrooms with granite countertops, and ample room for overnight family members. The property is in close proximity to Tucson Medical Center, St. Joseph’s Hospital and surrounding medical districts. Additional hospitals served are the University of Arizona Medical Center and Northwest Medical Centers. The Transitional Rehabilitation Center is located at 2040 N. Wilmot Road near Grant, just south of Costco, and is the first Tucson location for Santé. Santé and Summerplace Management are also developing another senior facility in Glendale, Arizona. Santé at Westgate operations will include assisted living, memory care, inpatient and outpatient rehabilitation services and an in house pharmacy. Santé at Westgate will be a four story, 172 unit/189 bed, 232,369 square foot building which includes an underground parking garage. Santé and Summerplace Management anticipate having this project fully financed, permitted and under construction in the first quarter of 2017. Santé, a senior and post-acute healthcare company, was founded in 2008 by C. Mark Hansen, Sterling Short and Jim Tellatin with a focus on providing a compassionate continuum of care. Since its inception, Santé has opened five care facilities in Arizona—Santé of Mesa, Santé of Surprise, Santé of Chandler, Santé of North Scottsdale and Santé of Tucson. Santé also owns Santé Home Health and Rehabilitation Services to provide guests with the same exceptional care in the comfort of their own home. Santé’s project management department has more than 40 years of construction and project management experience, and has completed more than $200 million in senior living development projects in 15 states. With years of experience in acquiring, financing and managing commercial, industrial and residential real estate, Summerplace Management has built a reputation of growth and success. A group of real estate development and finance executives have come together and created Summerplace Management and its affiliated companies, to manage the financing and development of real estate across the United States. The project diversity includes Office, Hotels, Apartments, Condominiums and residential subdivisions, Land development and entitlement, Entertainment, Senior Living, Assisted Living, Memory Care and Skilled Nursing facilities. Statements contained in this press release that are not historical facts may be forward-looking statements within the meaning of federal law. Such statements can be identified by the use of forward-looking terminology, such as "believes," "expects," "plans," "intends," "anticipates" and variations of such words or similar expressions, but their absence does not mean that the statement is not forward-looking. Such forward-looking statements reflect management's beliefs and assumptions and are based upon information currently available to management and involve known and unknown risks, results, performance or achievements, which may differ materially from those expressed or implied in such statements. Such statements include, but are not limited to: adverse economic conditions and the impact on the real estate industry, including healthcare real estate; our ability to finance our assets on terms that are acceptable to us, if at all, including our ability to complete securitization financing transactions; understanding of our competition and our ability to compete effectively; market and industry trends; our financing needs; and, our expected leverage and the effects of our current strategies. Our ability to predict results or the actual effect of plans or strategies is inherently uncertain, particularly given the economic environment. Although we believe that the expectations reflected in such forward-looking statements are based on reasonable assumptions, our actual results and performance could differ materially from those set forth in the forward-looking statements. These forward-looking statements involve risks, uncertainties and other factors that may cause our actual results in future periods to differ materially from those forward-looking statement. Except where required by law, Summerplace Management undertakes no obligation to revise or update any forward-looking statements to reflect events or circumstances after the date of this press release.
News Article | March 2, 2017
PHOENIX--(BUSINESS WIRE)--Jack B. Jewett will retire as Flinn Foundation president and CEO at the end of September, concluding more than eight years of service in which the foundation expanded and enhanced its program areas to better serve Arizona. Russell Reynolds Associates, an international executive search firm, has been hired by the foundation to conduct a national search to replace Jewett. The new CEO is expected to be named this summer. Jewett was hired in 2009 as the second CEO in the history of the Phoenix-based private, nonprofit grantmaking organization after a long career as an Arizona leader in health care, education and public policy, with extensive community involvement. He had previously served on the Arizona Board of Regents from 1998-2006, including a term as president; served five terms in the Arizona House of Representatives, from 1983-1992; held senior public policy and government relations positions with Tucson Medical Center for 13 years; and was president of Territorial Newspapers, a family-owned publishing and printing company in Tucson. As CEO, Jewett saw the need for a new initiative to cultivate civic leadership at a statewide level to assure a strong future for Arizona. The nonpartisan Arizona Center for Civic Leadership and its flagship Flinn-Brown Academy, established in 2010, was the philanthropic response to this need. Today, the Flinn-Brown Network of current and future state-level leaders from all walks of life is 260 members strong. This program joined the foundation’s continued dedication to supporting the biosciences, arts and culture, and the Flinn Scholars Program, a merit-based scholarship awarded to Arizona’s top high-school seniors to attend one of Arizona’s public universities. The biosciences have remained the preeminent target of the foundation’s grantmaking. Under Jewett’s leadership, the foundation started a Bioscience Entrepreneurship Program to benefit promising Arizona startup firms, updated Arizona’s Bioscience Roadmap to continue the long-term strategic plan, launched a new direction in arts giving focused on bringing financial stability to organizations, celebrated the foundation’s 50th anniversary, and enhanced the Scholars Program by offering professional internships to Scholars at leading Arizona businesses and organizations. “Jack has provided tremendous leadership to the foundation and to Arizona over many years,” said Dr. David J. Gullen, chair of the Flinn Foundation board of directors. “Flinn’s new initiatives during his tenure have complemented and strengthened the foundation’s longtime goals and programs.” Jewett was hired in the midst of a deep recession, when the foundation’s endowment, as was the case throughout the philanthropic sector, was suffering. The foundation never canceled or reduced grant awards, or reduced staff, and the endowment has recovered to more than $200 million. Carefully targeted recent grants have supported major collaborative initiatives led by organizations such as Banner Alzheimer's Institute, Critical Path Institute and Translational Genomics Research Institute, as well as the state’s three public universities and a number of Arizona’s largest arts-and-culture organizations. “Today, the Flinn Foundation is in excellent condition financially and programmatically, and opportunities abound for the foundation to play its proven pivotal roles of catalyzing, convening and grantmaking, and have a substantial impact on Arizona under the leadership of the next president and CEO,” Jewett said. The Flinn Foundation was established in 1965 by Dr. Robert Flinn and his wife, Irene, to improve the quality of life in Arizona. Robert Flinn, a leading cardiologist, headed the departments of cardiology and electrocardiography at St. Joseph’s Hospital in Phoenix. He was chief of the medical staff at St. Joseph’s and at Phoenix Memorial Hospital, president of both state and county medical societies, and co-founder and first president of the Arizona affiliate of the American Heart Association. Irene Flinn was a woman of considerable wealth and generous philanthropy. Dr. Flinn died in 1984 at age 87; Mrs. Flinn in 1978 at age 78.