Marietta, GA, United States
Marietta, GA, United States

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PubMed | Kennesaw State University, WellStar Kennestone Hospital, Center for Nursing Excellence, WellStar Windy Hill Hospital and WellStar Cobb Hospital
Type: | Journal: Evidence-based complementary and alternative medicine : eCAM | Year: 2015

The study purpose was to assess the effects of guided imagery on sedation levels, sedative and analgesic volume consumption, and physiological responses of patients being weaned from mechanical ventilation. Forty-two patients were selected from two community acute care hospitals. One hospital served as the comparison group and provided routine care (no intervention) while the other hospital provided the guided imagery intervention. The intervention included two sessions, each lasting 60 minutes, offered during morning weaning trials from mechanical ventilation. Measurements were recorded in groups at baseline and 30- and 60-minute intervals and included vital signs and Richmond Agitation-Sedation Scale (RASS) score. Sedative and analgesic medication volume consumption were recorded 24 hours prior to and after the intervention. The guided imagery group had significantly improved RASS scores and reduced sedative and analgesic volume consumption. During the second session, oxygen saturation levels significantly improved compared to the comparison group. Guided imagery group had 4.88 less days requiring mechanical ventilation and 1.4 reduction in hospital length of stay compared to the comparison group. Guided imagery may be complementary and alternative medicine (CAM) intervention to provide during mechanical ventilation weaning trials.


PubMed | Northside Hospital, Lebanese American University, Health-U, Emory University and 3 more.
Type: Journal Article | Journal: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association | Year: 2016

There are limited data on which patients not treated with intravenous (IV) tissue-type plasminogen activator (tPA) due to mild and rapidly improving stroke symptoms (MaRISS) have unfavorable outcomes.Acute ischemic stroke (AIS) patients not treated with IV tPA due to MaRISS from January 1, 2009 to December 31, 2013 were identified as part of the Georgia Coverdell Acute Stroke Registry. Multivariable regression analysis was used to identify factors associated with a lower likelihood of favorable outcome, defined as discharge to home.There were 1614 AIS patients who did not receive IV tPA due to MaRISS (median National Institutes of Health stroke scale [NIHSS] 1], of which 305 (19%) did not have a favorable outcome. Factors associated with lower likelihood of favorable outcome included Medicare insurance status (odds ratio [OR]: .53, 95% confidence interval [CI]: .34-.84), arrival by emergency medical services (OR: .46, 95% CI: .29-.73), increasing NIHSS score (per unit OR: .89, 95% CI: .84-.93), weakness as the presenting symptom (OR: .50, 95% CI: .30-.84), and a failed dysphagia screen (OR: .43, 95% CI: .23-.80). During the study period, <1% of patients presenting to participating hospitals with MaRISS within the eligible time window received IV tPA.Baseline characteristics, presenting symptoms, and response to dysphagia screen identify a subgroup of patients who are more likely to have an unfavorable outcome. Whether IV tPA treatment can improve the outcome in this subgroup of patients needs to be evaluated in a randomized placebo-controlled trial.


Brown S.,WellStar Kennestone Hospital | McLaughlin M.,WellStar Kennestone Hospital | Pope D.K.,WellStar Kennestone Hospital | Haile K.,WellStar Kennestone Hospital | And 3 more authors.
Brachytherapy | Year: 2011

A comparison of dosimetric findings in 33 patients treated with the Contura multilumen balloon (SenoRx Inc., Irvine, CA) (C-MLB) breast brachytherapy catheter vs. 33 patients treated with the MammoSite (Hologic Inc., Bedford, MA) (MS) at a single institution to deliver accelerated partial breast irradiation (APBI) was performed. Methods and Materials: CT-based 3-dimensional planning with dose optimization was completed. APBI treatment of 34. Gy in 3.4. Gy fractions was delivered. Endpoints analyzed included: (1) The percentage of the prescribed dose (PD) covering the planning target volume (PTV), (2) the maximum skin dose as a percentage of the PD, (3) the maximum rib dose as a percentage of the PD, and (4) the V150 and V200. Results: The C-MLB was placed more frequently in patients with closer skin spacing (<7 mm) and rib spacing (<7 mm) than in MS patients (45.5% vs. 12.1%, p= 0.0057 and 57.6 vs. 33.3, p= 0.0131, respectively). Despite closer skin spacing, the overall median skin dose was significantly lower in C-MLB patients (112% of the PD vs. 134%, p= 0.0282). No statistically significant differences in the V150 or V200 were observed. In patients with very limited rib spacing (<4 mm), the C-MLB delivered significantly lower rib doses than the MS (144% of the PD vs. 191%, p= 0.0107). In all clinical scenarios, coverage of the PTV with the C-MLB was either equal to or significantly better than with the MS (p= 0.0024). Conclusion: The C-MLB catheter produced clinically significant improvements in dosimetric endpoints (e.g., reduced skin and rib doses and improved PTV coverage) in most clinical scenarios. © 2011 American Brachytherapy Society.


Khan A.J.,Johnson University | Vicini F.A.,Michigan HealthCare Professionals 21st Century Oncology | Brown S.,Wellstar Kennestone Hospital | Haffty B.G.,Johnson University | And 4 more authors.
Annals of Surgical Oncology | Year: 2013

Background: Shorter courses of APBI, including single-fraction intraoperative therapy, are under active investigation. We designed a prospective trial to identify and address the potential radiobiological and logistical shortcomings of single-fraction APBI. Methods: We designed a single-arm, multi-institutional, prospective phase II trial that sequentially treats 3 cohorts of women (each n = 30) with 3 progressively hypofractionated schedules. Eligible women were age ≥50 years with unifocal invasive or in situ tumors ≤3.0 cm, excised with negative margins, and with negative lymph nodes and positive hormone receptors. We defined strict dosimetric criteria for appropriateness. Results: A total of 30 patients were enrolled at the 7 Gy × 4 fractions dose-level and followed for 6 months. The median skin dose as a percent of prescription dose (PD) was 84 % (40-100), and the median rib dose was 71 % (16-119). Also, 95 % of the PTV-eval received a median of 95 % of PD (range 85-103). The V150 (range 14-48 cc) and V200 (range 0-29 cc) criteria were met in all cases. One breast infection occurred and was treated; 2 cases of symptomatic fat necrosis and 2 cases of symptomatic seromas occurred. Conclusion: Short-course APBI is dosimetrically feasible using the Contura MLB and appears to be tolerable in terms of acute toxicities. Our approach is based on well-defined radiobiological parameters and allows for an abbreviated course of treatment that is guided by full pathological review and the ability to objectively achieve and validate acceptable dosimetric criteria in each case. We have opened enrollment to the next schedule of 8.25 Gy for 3 fractions. © 2012 Society of Surgical Oncology.


Israel P.Z.,Breast Center | Vicini F.,William Beaumont Hospital | Robbins A.B.,Breast Center | Shroff P.,Breast Center | And 3 more authors.
Annals of Surgical Oncology | Year: 2010

Background: We reviewed our institution's experience treating patients with ductal carcinoma in situ (DCIS) of the breast with balloon-based accelerated partial breast irradiation (APBI) to determine the efficacy of this treatment approach in this group of patients. Materials and Methods: A total of 126 cases of DCIS seen and treated with APBI using balloon-based brachytherapy constitute the study population. The median age at diagnosis was 59 years (range, 37-82) with 21% younger than age 50. Nuclear grade distribution was 52.5, 41.4, and 6.1% high, intermediate and low, respectively. Of these patients, 86% had estrogen receptor positive DCIS. The median tumor size was 6 mm (range, 1-26). Margins of excision were negative in 98.4% of patients. All patients were treated with 34 Gy in 10 fractions using either the MammoSite™ or Contura™ breast brachytherapy catheter. A total of 87 patients (73.1%) were placed on adjuvant tamoxifen or arimedex. Results: With a median follow-up of 24 months (range, 0.7-73.9), three (2.4%) ipsilateral breast tumor recurrences (IBTRs) developed for a 2-year actuarial rate of 0.81%. Recurrences developed 4.8, 24.7, and 24.9 months after treatment. On univariate analysis, no variable was associated with IBTR. A subset analysis of the first 50 consecutive patients treated was also performed. With a median follow-up of 40 months (range, 15.6-73.9), one IBTR developed for a 3-year actuarial rate of 2.15%. Conclusions: Early results in patients with DCIS treated with APBI using balloon-based brachytherapy produced results similar to those with invasive cancer treated with APBI or DCIS treated with whole breast irradiation. © 2010 Society of Surgical Oncology.


Israel P.Z.,The Breast Center | Robbins A.,The Breast Center | Shroff P.,The Breast Center | Brown S.,WellStar Kennestone Hospital | And 2 more authors.
Brachytherapy | Year: 2012

Purpose: We reviewed our institution's 3-year clinical experience in treating patients with the Contura multilumen balloon (SenoRx, Inc., Aliso Viejo, CA) breast brachytherapy catheter to deliver accelerated partial breast irradiation (APBI). Methods and Materials: Forty-six patients treated with breast-conserving therapy received adjuvant radiation using the Contura catheter (34. Gy in 3.4. Gy fractions). Fourteen patients had Stage 0, 24 had Stage I, and 8 had Stage II breast cancer. Median follow-up was 36 months (range, 1-44 months). Results: Only one local recurrence developed (2%). The rate of persistent seroma formation at latest reported follow-up was 4.3% (2 patients) and the incidence of any clinically detectable telengiectasias was 2.2%. No major toxicities (0% Grade III) have occurred. The median skin dose (% of the prescribed dose) was 99.7. The median dose to 95% of the planning target volume for evaluation was 98.8%. The percentage of patients with excellent/good cosmetic results at 24 (n=23) and 36 (n=22) months was 100% and 97%, respectively. Conclusion: Adjuvant APBI using the Contura multilumen balloon catheter exhibited similar locoregional control, cosmesis, and toxicities to other forms of APBI with similar lengths of follow-up. In addition, improved radiation standards for the delivery of APBI were demonstrated. © 2012 American Brachytherapy Society.


Ray S.M.,Alcoa | Clark S.,Wellstar Kennestone Hospital | Jeter J.W.,University of South Alabama | Treadway S.A.,University of South Alabama | Treadway S.A.,Auburn University
American Journal of Health-System Pharmacy | Year: 2013

Purpose. Pharmacists' use of mobile technology (MT) to verify medication orders placed during their participation in medical rounds is investigated. Methods. A retrospective observational study was conducted at a large academic medical center to assess the impact of MT on the average time to pharmacist verification of medication orders written by general medicine staff during pharmacist participation in patient rounds. A total of 260 medication orders for 129 patients were evaluated: 146 orders processed over a one-month period during which rounding pharmacists verified orders using stationary computer terminals on patient care units and 114 orders processed using an MT device. The primary endpoint was the average time to pharmacist verification for all medication orders; average verification times for orders for specific medication classes (analgesics, antibiotics, antidiabetes drugs, and antihypertensives) were also evaluated. Results. Overall, the average time to order verification was significantly lower with the use of the MT device compared with non-MTassisted order verification (7.5 minutes versus 38.9 minutes, p < 0.001), with significant (p < 0.001) time benefits favoring MT-assisted verification for all order subsets within the evaluated medication classes. Challenges posed by the use of MT-assisted order verification included the selected device's relatively small keyboard and the frequent loss of network connections as the pharmacist moved from floor to floor within the hospital. Conclusion. Clinical pharmacists' use of an MT device to verify medication orders written during patient care rounds can significantly decrease the average time required for order verification relative to the use of stationary computer terminals. Copyright © 2013, American Society of Health-System Pharmacists, Inc.


PubMed | Abington Memorial Hospital, University of California at San Diego, WellStar Kennestone Hospital, Netherlands Cancer Institute and Holy Redeemer Hospital
Type: Journal Article | Journal: Seminars in radiation oncology | Year: 2016

Mediastinal critical structures such as trachea, bronchus, esophagus, and heart are among the dose-limiting factors for stereotactic body radiation therapy (SBRT) to central lung lesions. The purpose of this study was to characterize the risk of esophagitis for patients treated with SBRT and to develop a statistical dose-response model to assess the equivalent uniform dose, D10%, D5cc, D1cc, and Dmax, to the esophagus and the risk of toxicity. Toxicity outcomes of a dose-escalation study of 56 patients who had taken CyberKnife treatment from 45-60Gy in 3-7 fractions at the Erasmus MC-Daniel den Hoed Cancer Center were utilized to create the dose-response model for esophagus. A total of 5 grade 2 esophageal complications were reported (Common Terminology Criteria for Adverse Events version 3.0); 4 complications were early effects and 1 complication was a late effect. All analyses were performed in terms of 5-fraction equivalent dosing. According to our study, D1cc at a dose of 32.9Gy and Dmax dose of 43.4Gy corresponded to a complication probability of 50% for grade 2 toxicity. In this series of 58 CyberKnife mediastinal lung cases, no grade 3 or higher esophageal toxicity occurred. Our estimates of esophageal toxicity are compared with the data in the literature. Further research needs to be performed to establish more reliable dose limits as longer follow-up and toxicity outcomes are reported in patients treated with SBRT for central lung lesions.


Mishra P.,WellStar Kennestone Hospital
Journal of Healthcare Management | Year: 2011

The need for personalized service in healthcare has never been clearer. A patient recognizes the difference between being cared for and merely being processed. Patients are more likely to talk about experiences that were outside of their expectations-whether they exceeded them or fell short. The need to measure patient experience in concert with outcomes and quality data has increased over the years, and healthcare organizations have responded with measures such as voluntarily reporting inpatient patient perspective data to CMS and implementing value-based purchasing. Kennedy, Caselli, and Berry present a seven-prong model for improving service quality. Their valuable work highlights the importance of consistency in a results-oriented environment.


Fine R.E.,WellStar Kennestone Hospital | Vose J.G.,PEAK Surgical
Journal of Medical Case Reports | Year: 2011

Introduction. Although a skin- and nipple-sparing mastectomy technique offers distinct cosmetic and reconstructive advantages over traditional methods, partial skin flap and nipple necrosis remain a significant source of post-operative morbidity. Prior work has suggested that collateral thermal damage resulting from electrocautery use during skin flap development is a potential source of this complication. This report describes the case of a smoker with recurrent ductal carcinoma in situ (DCIS) who experienced significant unilateral skin necrosis following bilateral skin-sparing mastectomy while participating in a clinical trial examining mastectomy outcomes with two different surgical devices. This unexpected complication has implications for the choice of dissection devices in procedures requiring skin flap preservation. Case presentation. The patient was a 61-year-old Caucasian woman who was a smoker with recurrent DCIS of her right breast. As part of the clinical trial, each breast was randomized to either the standard of care treatment group (a scalpel and a traditional electrosurgical device) or treatment with a novel, low thermal injury dissection device, allowing for a direct, internally controlled comparison of surgical outcomes. Post-operative follow-up at six days was unremarkable for both operative sites. At 16 days post-surgery, the patient presented with a significant wound necrosis in the mastectomy site randomized to the control study group. Following debridement and closure, this site progressively healed over 10 weeks. The contralateral mastectomy, randomized to the alternative device, healed normally. Conclusion: We hypothesize that thermal damage to the subcutaneous microvasculature during flap dissection may have contributed to this complication and that the use of a low thermal injury dissection device may be advantageous in select patients undergoing skin- and nipple-sparing mastectomy. © 2011 Fine and Vose; licensee BioMed Central Ltd.

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