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Marietta, GA, United States

Bloom H.L.,Emory University | Constantin L.,New Mexico Institute of Mining and Technology | Dan D.,Piedmont Hospital | De Lurgio D.B.,Emory University | And 9 more authors.
PACE - Pacing and Clinical Electrophysiology | Year: 2011

Background: Cardiovascular implantable electronic device (CIED) infection rates are increasing faster than implantation rates. More effective antimicrobial prophylaxis may help reduce CIED infections and improve clinical outcomes. The AIGISRx® antibacterial envelope is a polymer mesh implanted in the generator pocket with the CIED. After implantation it releases two antibiotics, minocycline and rifampin, that have been shown to reduce infections associated with other medical devices. The purpose of this retrospective cohort study is to determine the rate of CIED implantation success and CIED infection in procedures utilizing the antibacterial envelope. Methods: This study enrolled consecutive CIED procedures utilizing the antibacterial envelope at 10 US academic, community, and Veterans Affairs medical centers. Procedures following an explantation for a prior CIED infection or off-label use of the antibacterial envelope were excluded. Results: The 624 eligible procedures (age 70 ± 13 years, 68.1% men, 27.2% renal insufficiency, 35.4% oral anticoagulant use, 67.8% replacement/revision procedures) utilized pacemakers (35%), implantable cardioverter-defibrillators (ICD)(29%), and cardiac resynchronization therapy with defibrillator devices (CRT-D)(36%). Nearly half of the patients (49%) had at least three predefined risk factors for CIED infection. CIED implantation was successful in 621 procedures (99.5%[95% confidence interval (CI) 98.8-99.9]). There were three major infections (0.48%[95%CI 0.17-1.40]) after 1.9 ± 2.4 months follow-up. The infections followed one ICD revision and two CRT-D replacements. There were seven deaths; none was a result of the antibacterial envelope or the CIED procedure. Conclusions: CIED procedures that utilized an antibacterial envelope had a high rate of CIED implantation success (>99%). Although the follow-up to date is short, there was also a low rate of infection (<0.50%) in this population at high risk for CIED infection. © 2010 Wiley Periodicals, Inc.

Nuyttens J.J.,Netherlands Cancer Institute | Moiseenko V.,University of California at San Diego | McLaughlin M.,WellStar Kennestone Hospital | Jain S.,Bott Cancer Center | And 2 more authors.
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%, D5 cc, D1 cc, 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 45-60 Gy 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, D1 cc at a dose of 32.9 Gy and Dmax dose of 43.4 Gy 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. © 2016 Elsevier Inc.

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.

Fraser D.,WellStar Kennestone Hospital | Spiva L.,Center for Nursing Excellence | Forman W.,ICU | Hallen C.,Childrens Healthcare Of Atlanta
American Journal of Nursing | Year: 2015

Objective: Research is needed to determine the feasibility of implementing a dedicated ICU mobility team in community hospital settings. The purpose of this study was to assess, in one such hospital, four nurse-sensitive quality-of-care outcomes (falls, ventilator-associated events, pressure ulcers, and catheter-associated urinary tract infections [CAUTIs]), as well as hospital costs, sedation and delirium measures, and functional outcomes by comparing ICU patients who received physical therapy from a dedicated mobility team with ICU patients who received routine care. Methods: We conducted a retrospective longitudinal study at a community acute care hospital; patients were randomly assigned to intervention or routine care groups. The mobility team screened patients Monday through Friday using a mobility algorithm to determine eligibility for participation in each early mobility session. Based on their strength, balance, hemodynamic stability, and ability to participate in early mobility activities, patients advanced through four progressively difficult phases of mobility. Data were collected and analyzed after patients were discharged from the hospital. Results: The 66 patients who received the mobility intervention had significantly fewer falls, ventilator-associated events, pressure ulcers, and CAUTIs than the 66 patients in the routine care group. The mobility group also had lower hospital costs, fewer delirium days, lower sedation levels, and improved functional independence compared with the routine care group. Patients in the mobility group got out of bed on 2.5 more days than patients in the routine care group. There were also no adverse events in the mobility group. Conclusions: It is feasible for a community hospital to create and implement a dedicated ICU mobility team. Early mobilization of ICU patients contributed to fewer delirium days and improved patient outcomes, sedation levels, and functional status.

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.

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