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Tucson, AZ, United States

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. Source

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. Source

Matarese L.E.,East Carolina University | Chinn R.N.,Psychometric Services Division | Hertz N.R.,Psychometric Services Division | Callahan P.,Christiana Care Health System | And 2 more authors.
Journal of Parenteral and Enteral Nutrition | Year: 2012

Background: The National Board of Nutrition Support Certification (NBNSC) is an independent credentialing board responsible for administering the multidisciplinary certification examination in nutrition support. For an exam to be legally and practically defensible, it must represent practice. Validation is by practice audit, the highest level of supporting evidence. Objectives: To define the role of the nutrition support professional (NSP) and the current elements (knowledge and functions) required for competent NSP practice. Methods: A survey instrument was constructed using a content validation strategy to establish the link between job tasks and the content of the examination. Internet-based surveys were made available to 5100 NSPs. NSP duties performed and knowledge required for patient safety and welfare were analyzed for the group as a whole and for each profession separately. Results: A total of 765 surveys were completed (return rate of 15%). The results of the practice audit demonstrate a common core of practice across the nutrition support disciplines as well as a universal core of elements believed to be important for competent nutrition support practice. Conclusion: The results of this survey continue to support a common core of practice across nutrition support disciplines as well as a common core of elements believed to be important for competent nutrition support practice. Accordingly, the NBNSC will continue to offer one examination to all disciplines both nationally and internationally and confer the Certified Nutrition Support Clinician (CNSC) credential to all individuals who successfully pass this validated examination. © 2012 American Society for Parenteral and Enteral Nutrition. Source

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. Source

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. Source

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