Digital Commons Network^™

Outcome After Decompressive Craniectomy For The Treatment Of Severe Traumatic Brain Injury., Jerry Lee Howard, Mark D Cipolle, Meredith Anderson, Victoria Sabella, Daniele Shollenberger, P Mark Li, Michael D. Pasquale Md, Facs, Fccm

Michael D Pasquale MD, FACS, FCCM

BACKGROUND: Using decompressive craniectomy as part of the treatment regimen for severe traumatic brain injury (STBI) has become more common at our Level I trauma center. This study was designed to examine this practice with particular attention to long-term functional outcome.

METHODS: A retrospective review of prospectively collected data was performed for patients with STBI admitted from January 1, 2003 to December 31, 2005. Our institution manages patients using the Brain Trauma Foundation Guidelines. Data collected from patients undergoing decompressive craniectomy included: age, Injury Severity Score, admission and follow-up Glasgow Coma Score, timing of, and indication for decompressive craniectomy, and …

Use Of Greenfield Filters In Renal Transplant Patients--Are They Safe?, Michael D. Pasquale Md, Facs, Fccm, J H Abrams, J S Najarian, F B Cerra

Michael D Pasquale MD, FACS, FCCM

No abstract provided.

Massive Hematochezia Secondary To Graft-Versus-Host Disease And Cytomegalovirus., M Shabahang, Michael D. Pasquale Md, Facs, Fccm, P Bitterman, E Cirenza, T Spitzer, S R Evans

Michael D Pasquale MD, FACS, FCCM

No abstract provided.

Multicenter Study Of Noninvasive Monitoring Systems As Alternatives To Invasive Monitoring Of Acutely Ill Emergency Patients., W C Shoemaker, H Belzberg, C C Wo, D P Milzman, Michael D. Pasquale Md, Facs, Fccm, L Baga, M A Fuss, G J Fulda, K Yarbrough, J P Van Dewater, P J Ferraro, D Thangathurai, P Roffey, G Velmahos, J A Murray, J A Asensio, K Eltawil, W R Dougherty, M J Sullivan, R S Patil, J Adibi, C B James, D Demetriades

Michael D Pasquale MD, FACS, FCCM

BACKGROUND: Recent reports showed lack of effectiveness of pulmonary artery catheterization in critically ill medical patients and relatively late-stage surgical patients with organ failure. Since invasive monitoring requires critical care environments, the early hemodynamic patterns may have been missed. Ideally, early noninvasive hemodynamic monitoring systems, if reliable, could be used as the "front end" of invasive monitoring to supply more complete descriptions of circulatory pathophysiology.

OBJECTIVES: To evaluate the accuracy and reliability of noninvasive hemodynamic monitoring consisting of a new bioimpedance method for estimating cardiac output combined with arterial BP, pulse oximetry, and transcutaneous PO2 and PCO2; we compared this …

Making The Case For A Paradigm Shift In Trauma Surgery., Thomas J Esposito, Michael Rotondo, Philip S Barie, Patrick Reilly, Michael D. Pasquale Md, Facs, Fccm

Michael D Pasquale MD, FACS, FCCM

No abstract provided.

Elective Colostomy Closure In An Aids Patient., Michael D. Pasquale Md, Facs, Fccm, J M Kenkel, R W Holt

Michael D Pasquale MD, FACS, FCCM

This article describes a 27-year-old patient with acquired immunodeficiency syndrome (AIDS) who underwent emergency sigmoid colostomy, Hartmann's pouch, and presacral drainage for rectal perforation. Three months later, he underwent uneventful elective colostomy closure, a procedure previously unreported in an AIDS patient. He remained without gastrointestinal symptoms for 14 months after colostomy closure until he died from central nervous system toxoplasmosis. A diagnosis of AIDS alone should not preclude colostomy closure in AIDS patients.

Multicenter, Randomized, Prospective Trial Of Early Tracheostomy., H J Sugerman, L Wolfe, Michael D. Pasquale Md, Facs, Fccm, F B Rogers, K F O'Malley, M Knudson, L Dinardo, M Gordon, S Schaffer

Michael D Pasquale MD, FACS, FCCM

OBJECTIVES: Determine the effect of early (days 3-5) or late (days 10-14) tracheostomy on intensive care unit length of stay (ICU LOS), frequency of pneumonia, and mortality, and evidence of short-term or long-term pharyngeal, laryngeal, or tracheal injury in head trauma, non-head trauma, and critically ill nontrauma patients.

STUDY DESIGN: Randomized, prospective.

SETTING: Five Level I trauma centers.

METHODS: Data were obtained prospectively and included Acute Physiology and Chronic Health Evaluation III score (AIII), Glasgow Coma Scale score, Emergency Room Trauma Score, Injury Severity Score, Acute Injury Score, type of endotracheal tube or tracheostomy, level of positive end-expiratory pressure, and …

Impact Of Cirrhosis On Outcomes In Trauma., Dale A Dangleben, Omid Jazaeri, Thomas Wasser, Mark Cipolle, Michael D. Pasquale Md, Facs, Fccm

Michael D Pasquale MD, FACS, FCCM

BACKGROUND: Cirrhosis as an independent predictor of poor outcomes in trauma patients was identified in 1990. We hypothesized that the degree of preinjury hepatic dysfunction is, by itself, an independent predictor of mortality.

STUDY DESIGN: The trauma registry at our Level I trauma center was queried for all ICD-9 codes for liver disease from 1999 to 2003, and patients were categorized as having Child-Turcotte-Pugh (CTP) class A, B, or C cirrhosis. Data analyzed included age, mechanism of injury, Abbreviated Injury Score (AIS), Injury Severity Score (ISS), Glasgow Coma Score (GCS), hospital length of stay, ventilator days, procedures performed, transfusion of …

Defining "Dead On Arrival": Impact On A Level I Trauma Center., Michael D. Pasquale Md, Facs, Fccm, M Rhodes, M D Cipolle, T Hanley, T Wasser

Michael D Pasquale MD, FACS, FCCM

OBJECTIVE: To determine the potential impact of defining criteria for "dead on arrival" (DOA) on a Level I trauma center.

METHODS: From 1990 to 1994, trauma patients having cardiopulmonary resuscitation (CPR) performed by certified prehospital personnel were reviewed for time of CPR, outcome, and costs to determine whether any benefit would have been realized had DOA criteria been followed.

RESULTS: A total of 106 patients had prehospital CPR; 20 did not meet DOA criteria and underwent resuscitation, three survived (15%). Eighty-six patients met DOA criteria; 16 were pronounced dead without further resuscitative efforts (in-hospital costs of $200/patient), while 70 (81%) …

Reflections On The Case Study: James Tuttle Vs. Lakeland Community College, Harlan Stelmach

Harlan Stelmach

As a Chair of a large academic department that supervises over thirty adjunct faculty members, I have sympathy with all the parties in this case. I have sympathy for administrators trying to maintain academic oversight of many adjunct faculty members who are often just on campus to teach their courses. I have sympathy for adjunct faculty who are under paid and often do the bulk of teaching at the general education level with very little guidance on the mission and values of an institution. As long as their student evaluations do not cause alarm, benign neglect often defines their relationship …

Teaching Big History, Richard B. Simon, Mojgan Behmand, Thomas Burke, Esther Quaedackers, Seohyung Kim, Kiowa Bower, Neal Wolfe, James B. Cunningham, Cynthia Taylor, Martin Anderson, J. Daniel May, Philip Novak, Debbie Daunt, Jaime Castner, Ethan Annis, Amy E. Gilbert, Anne Reid, Suzanne Roybal, Alan Schut, Cynthia Brown, Harlan Stelmach

Harlan Stelmach

Latina Adolescent Outreach Project, Susan C. Scwartz, Claudia Guerra, Julianna Deardorff, Janice Barlow

Susan C. Schwartz

• To culturally adapt and translate into Spanish three components of the Breast Cancer and Environment – Peer Education Tool Kit (2006) for Marin County Latina adolescents: Top Twelve Messages, Teen Brochure, and Personal Action Plan

• To disseminate the adapted, translated materials to high school health educators and community organizations

Adolescent Breast Cancer Prevention, Risk Reduction And Education Project, Susan C. Schwartz, Janice Barlow

Susan C. Schwartz

The Adolescent Breast Cancer Prevention, Risk Reduction and Education Project was developed in 2003 in recognition of the growing scientific evidence that early life events play an important role in the development of breast cancer and the onset of puberty is thought to be a key seventy influencing subsequent breast cancer risk.

Breast Cancer And Environment Peer Education Tool Kit -- Community Action Panel, Susan C. Schwartz

Susan C. Schwartz

The Breast Cancer and Environment Peer Education Tool Kit culminates three years of dedicated effort by the Zero Breast Cancer leadership and staff, community partners and advisors, and peer education specialists in the San Francisco Bay Area. The teen breast cancer risk awareness curriculum tools that Zero Breast Cancer is making available to the broader community evolved from a formative community assessment to address the need for ageappropriate teen breast cancer outreach education in a community known for high breast cancer incidence.

The impetus to develop this program has been threefold: 1) to disseminate knowledge back to the community that …

Delirium Days As A Quality Indicator For Medical Surgical Units In Six Hospitals.: A141, Jonny Macias Tejada, Ariba Khan, Michael L. Malone

Ariba Khan, MD, MPH

No abstract provided.

Electronic Data Modeling To Predict 30-Day Hospital Readmission For Older Adults: A127, Ariba Khan, Mary L. Hook, Patti Pagel, Marsha Vollbrecht, Kanwardeep Singh, Aaron Malsch, Michael L. Malone

Ariba Khan, MD, MPH

No abstract provided.

Determining Patients And Their Care Givers' Perspective On Discharge Planning: A110, R Hydari, Ariba Khan, Michael L. Malone

Ariba Khan, MD, MPH

No abstract provided.

Delirium Among Older Adults With Acute Myocardial Infarction.:B58, Ariba Khan, A Meyer, E Chapman, J Bergstrom, J Halm, James Marx, Michael L. Malone

Ariba Khan, MD, MPH

No abstract provided.

Delirium Recognition In Hospitalized Older Patients: A Quality Improvement Project: C97, Jodi Punke, Ariba Khan, Michael Malone

Ariba Khan, MD, MPH

No abstract provided.

Hospital Readmission Of Skilled Nursing Facility Residents: A Systematic Review, Ji Won Yoo, Sanjeeda Jabeen, Tanvir Bajwa, Sun J Kim, David Leander, Laila Hasan, Jodi Punke, Soryal Soryal, Ariba Khan

Ariba Khan, MD, MPH

Hospital readmission of patients discharged to skilled nursing facilities (SNFs) is common and costly with increasing public attention over the past decade, particularly in light of the new health care environment surrounding the advent of the Affordable Care Act. The purpose of the current systematic review is to critically examine prevalence, predictors, and costs of hospital readmission of SNF residents found in the medical literature. Individual resident, facility, and intervention factors predicting hospital readmission of SNF residents were studied. Despite the heterogeneity of the reviewed articles' data sources and study designs, the existing literature asserts that hospital readmission of SNF …

Low-Vision Education For The Health Care Workforce: Strategy To Create A Vision-Friendly Hospital, Ariba Khan, Susan Simon

Ariba Khan, MD, MPH

BACKGROUND: Aging of the baby boomers presents a unique set of challenges for health care workers. Low vision among patients may be a barrier to providing appropriate patient care, may impede communication, and may decrease patients' satisfaction with health care. It is important to train the medical workforce to understand the unique challenges of the aging population.

OBJECTIVE: To test an interactive educational learning model targeting health care workers to improve knowledge and awareness of low vision.

METHODS: Participants completed a survey prior to and after an educational intervention that consisted of 4 components: (1) normal aging, (2) eye-disease of …

Prognostic Indices For Hospitalized Older Adults: A Metaanalysis And Systematic Review: A134, Ariba Khan, Ayesha Maria, James Hocker, Maharaj Singh, Michelle R. Simpson, Saima T. Akbar, Ji Won Yoo, Adnan Nazir, S Kim, Michael L. Malone

Ariba Khan, MD, MPH

No abstract provided.

Primary Hyperparathyroidism In An Older Woman With Multiple Comorbidities: A Case Study, Tanvir K. Bajwa, Ariba Khan, Sanjeeda Jabeen, Michael L. Malone

Ariba Khan, MD, MPH

No abstract provided.

Electronic Data Modeling To Predict 30-Day Hospital Readmission For Older Adults, Ariba Khan, Mary L. Hook, Patti Pagel, Marsha A. Vollbrecht, Maharaj Singh

Ariba Khan, MD, MPH

Background/Significance: Approximately 20% of Medicare beneficiaries are readmitted within 30 days, costing $17.4 billion annually. Research predicting readmission (readmit) has focused on administrative and diagnosis data.

Purpose: The aim of this study was to identify electronic health record (EHR)-based clinical factors to predict readmit for older adults.

Methods: This retrospective cohort study used demographic, diagnoses, and clinical EHR data to identify readmit predictors at a large quaternary medical center. The population was limited to adults > 65 years, index length of stay < 30 days and those not discharged to an acute care facility or inpatient rehabilitation. Logistic regression modeling evaluated clinical predictors with diagnoses from two sources: medical history and postdischarge ICD9 coding. Univariate analysis was done for categorical and continuous variables. For multivariate logistic regression, the population was divided into derivation (70%) and validation (30%) cohorts.

Results: The sample (N=4,503; mean age ± standard deviation (SD): 77 ± 8 years; female: 54%) included patients hospitalized …

Neurosyphilis: An Uncommon Cause Of Dementia, Avinash Rao, Ariba Khan, Kanwardeep Singh, Debra L Anderson, Michael L. Malone

Ariba Khan, MD, MPH

No abstract provided.

An Electronic Medical Record-Derived Real-Time Assessment Scale For Hospital Readmission In The Elderly, Ariba Khan, Michael L. Malone, Patti Pagel, Marsha A. Vollbrecht, Dennis Baumgardner

Ariba Khan, MD, MPH

OBJECTIVE: "Readmission risk score", a 20-point, 4-dimensional tool, is generated from the electronic medical record. This study was performed to evaluate the ability of the readmission risk score to predict 30-day readmissions among older hospitalized patients.

METHODS: A retrospective study was conducted utilizing data from the electronic medical record. Using a cutoff value of 7, the readmission score sensitivity was 61%, specificity was 22%, positive predictive value 12%, negative predictive value 77%. The positive and negative likelihood ratios were 0.8 and 1.8, respectively.

CONCLUSION: The readmission risk score was associated with 30-day readmissions (median score of readmitted vs not readmitted …

A Multidimensional Assessment Of The Palliative Care Skills Of A Geriatrics Practice: A70, Ariba Khan, Patti Pagel, Marsha Vollbrecht, Michael L. Malone, E Khalid

Ariba Khan, MD, MPH

No abstract provided.

A Survey Of Concerns In End-Of-Life Care: Perspective From Pakistan, Ariba Khan, Maharaj Singh, Sarah Saeed, Arif Siddiqui, Zeba Aziz, Michael L. Malone

Ariba Khan, MD, MPH

No abstract provided.

Can A Real-Time Checklist, Automatically Generated By The Electronic Medical Record, Predict 30-Day Readmissions In Hospitalized Elderly?: C99, Ariba Khan, Karen Padua, Michael L. Malone, Marsha A. Vollbrecht, Patti Pagel

Ariba Khan, MD, MPH

No abstract provided.

An Electronic Medical Record Marker For Delirium In Hospitalized Elderly: A93, John Lung, Ariba Khan, Maharaj Singh, Laila Hasan, Anna Karst, Kanwardeep Singh, Michael L. Malone

Ariba Khan, MD, MPH

No abstract provided.