A True Bloody Emergency: An Unusual Case Of Thrombotic Thrombocytopenic Purpura, 2024 The University of Texas Rio Grande Valley
A True Bloody Emergency: An Unusual Case Of Thrombotic Thrombocytopenic Purpura, Joshua M. Ninan
Research Symposium
Background: Thrombotic thrombocytopenic purpura (TTP) is a primary thrombotic microangiopathy that is classically characterized by thrombocytopenia and microangiopathic hemolytic anemia (MAHA). Although rare with an annual incidence of 3.7 cases per one million adults, it is considered a true hematological emergency due to its fatality rate of almost 100% if appropriate treatment is not initiated immediately. This makes it vitally important to identify and treat patients with TTP, a task that becomes unusually challenging in the absence of the disorder’s other characteristically diagnostic clinical features such as mucosal bleeding, fever, or presence of schistocytes.
Case Presentation: A 30-year-old gentleman with …
Painting A Landscape Of Acute Care Nurse Scientist Work, 2024 Providence Health Care, Professional Development Department, Spokane, Washington
Painting A Landscape Of Acute Care Nurse Scientist Work, Teresa Rangel
Providence Nursing Research Conference 2023 – Present
Background: Hospitals are increasingly hiring nurse scientists, motivated in part by nursing excellence designations such as Magnet. Magnet designation requires at least three, nurse-led, Institutional Review Board-approved research studies to be conducted in the hospital every four years and for nurses to be actively implementing evidence-based practice (EBP) projects using research evidence. However, clinical nurses often lack the specialized knowledge and training necessary to engage in well-designed research or EBP. Nurse scientists are PhD-prepared individuals with expertise to mentor clinical nurses to navigate the rigor and complexity of creating, implementing, analyzing, and disseminating research and EBP projects. Yet, due …
Acute Care Staff Interactions With Chaplains To Discuss Team Or Personal, Non-Work-Related Stressors, 2024 Providence
Acute Care Staff Interactions With Chaplains To Discuss Team Or Personal, Non-Work-Related Stressors, Gary Weisbrich, Sarah Sumner, Teresa Rangel
Providence Nursing Research Conference 2023 – Present
Background: Healthcare staff experience stress from the workplace when providing complex patient care and often may lean on specially trained spiritual support caregivers, or chaplains, for support navigating patient-related stressors. Yet, healthcare staff can also suffer from team-related or personal stressors that, if unresolved, could negatively impact care delivery. Little is known about whether, how often, and which staff may interact with chaplains for emotional support when experiencing non-patient-related stressors originating from work or personal lives.
Purpose: To describe the proportion of individuals who report discussing team-related or personal stressors with chaplains in the past 12 months, and to …
The Long-Term Economic Implications Of Burn Injury For Burn Survivors, 2024 Wayne State University
The Long-Term Economic Implications Of Burn Injury For Burn Survivors, Jacob M. Dougherty Bs, Hannan A. Maqsood Mbbs, Zhaohui Fan Md Mph, Stewart C. Wang Md Phd, Mark R. Hemmila Md, Naveen F. Sangji Md Mph
Medical Student Research Symposium
Introduction: The long-term economic implications of burn injury on patients and payors has not been well described. Burn injury can be costly due to prolonged intensive care, wound care, rehabilitation, psychological care, and reconstructive surgery that may be required well after the initial injury. We investigated index and post-acute payor and out-of-pocket (OOP) costs related to burn injury for in-patient care at 30 days, and up to 36 months post-discharge to understand the long-term economic implications for burn survivors.
Methods: An observational cohort study was conducted using a commercial claims database from IBM Watson Health® Marketscan. Patients age ≤ …
Racial Disparities In Palliative Care Utilization In The Covid-19 Pandemic, 2024 Wayne State University
Racial Disparities In Palliative Care Utilization In The Covid-19 Pandemic, Margaret S. Bove, Benjamin Huber, Myles Hardeman, Daniel Harris, Areeba Jawed, Amber Comer
Medical Student Research Symposium
BACKGROUND
Palliative care is a vital resource for the critically or terminally ill. It has myriad benefits such as improved quality of life, reduced depressive symptoms, and decreased scarce resource utilization. Self-identified Black/African patients, however, are less likely to utilize advanced care directives or engage in hospice/comfort care measures and are more likely to prefer intensive treatment at the end of life. There is no research, however, on how the COVID-19 pandemic may have affected these trends.
METHODS
A retrospective cohort study of patients who experienced in hospital mortality or in hospital hospice due to COVID-19 between March 2020 – …
An Educational Intervention Differentiating Pressure Injuries From End-Of-Life Wounds, 2024 Providence
An Educational Intervention Differentiating Pressure Injuries From End-Of-Life Wounds, Alicia Perez Varela, Annette Callis
Providence Nursing Research Conference 2023 – Present
Background
End-of-life (EOL) wounds are identified in the literature as Kennedy Terminal Ulcers (KTU), Skin Failure (SF), Trombley-Brennan Terminal Tissue Injury (TB-TTI), and SCALE (Skin Changes at Life’s End). EOL wounds have a similar appearance to pressure injuries (PIs) with a fundamentally different etiology. The misclassification of EOL wounds as PIs results in increased Hospital Acquired Pressure Injuries (HAPI), hospital fines, and less-than-optimal EOL wound management.
Purpose
To examine the effectiveness of an educational intervention on EOL wounds in increasing nurse confidence in providing End-of-Life Care (EOLC) and differentiating PIs from EOL wounds.
Methods
This quasi-experimental study used the 28-item …
Management Of Sepsis With The Quick Sequential Organ Failure Assessment, 2024 Providence
Management Of Sepsis With The Quick Sequential Organ Failure Assessment, Jeanna Adams
Providence Nursing Research Conference 2023 – Present
Abstract
Background:
Sepsis can be a source of morbidity and mortality particularly when there are delays in treatment. Early identification may improve time to antimicrobial administration. The quick Sequential Organ Failure Assessment (qSOFA) is an evidence-based practice screening tool that, when in used in conjunction with the Systemic Inflammatory Response Syndrome (SIRS) criteria can enhance recognition and treatment of sepsis. On a suburban Southern California hospital Neurological/Telemetry Unit the qSOFA is automatically calculated in the electronic medical record (EMR) but the bedside nurses were unaware of its availability and value. In addition, sepsis was not being identified in a timely …
An Evidence-Based Skin Management Improvement Project In The Intensive Care Unit, 2024 Providence
An Evidence-Based Skin Management Improvement Project In The Intensive Care Unit, Chelsea Lannoo
Providence Nursing Research Conference 2023 – Present
Background:
Pressure injuries have detrimental effects on patients healing and outcomes and are costly to organizations due to payment programs. Pressure injuries are largely preventable if appropriate interventions are implemented early. In our ICU, post-pandemic monitoring showed increases in hospital-acquired pressure injuries (HAPIs) and consults for medical device HAPIs were increasing. Rounds with wound care department indicated lack of staff compliance with recommended preventive practices. Some issues reported were the use of diapers and excessive linens, failure to use scheduled turning for patients, lack of prevention related to medical devices
Purpose:
The goal of this skin-care management project is …
New Onset Positive Autoantibodies Following Covid-19 Infection, 2024 Lake Erie College of Osteopathic Medicine
New Onset Positive Autoantibodies Following Covid-19 Infection, David Hernandez, Adnaan Sheikh, Shakira Laing, Mariana Adieb, Omar Siddiqui, Rohail Baig, Annabel Antonini, James Vienneau, Camden Burns
Advances in Clinical Medical Research and Healthcare Delivery
The World Health Organization (WHO) declared the novel coronavirus (COVID-19) outbreak a global pandemic on March 11, 2020. Since the original outbreak in December 2019, over 100 million people have been confirmed to have been infected by COVID-19 and over two million people have died. The presentation seen in patients may vary widely based on multiple factors. Fever has been reported in up to 99% of patients, while other common symptoms seen are dyspnea, fatigue, anosmia, and myalgia. Around 80% of COVID-19 patients present with a mild respiratory illness that can be managed at home, while around 15% need basic …
Improving Time To Defibrillation, 2024 Providence
Improving Time To Defibrillation, Jonathan Eyestone, Dana Gilbreth, Amanda Maloney, Tina Pham
Articles, Abstracts, and Reports
"ABSTRACT TITLE: Improving Time to Defibrillation
Background: Providence St. Vincent Medical Center (PSVMC) Medical Surgical units are not meeting the American Heart Association requirement of less than 3 minutes to defibrillation. Time to defibrillation in codes with shockable rhythms averages 4.2 minutes. In Mock Codes, only one met the time less than 3 minutes; four Mock Codes had times over 5 minutes. Resuscitation Quality Improvement CPR (RQI) training is required quarterly. Defibrillator practice with overall Code Blue competency is annual.
Purpose: Combine the hands-on practice of the defibrillator with the hands-on training for RQI.
Methods: The Medical Surgical unit 6 …
Whole Blood In Trauma, 2024 University of the Pacific
Whole Blood In Trauma, Jason P. Prevelige
Pacific Journal of Health
Abstract: Hemorrhage is a leading cause of death in trauma patients. Whole blood administration in trauma has gained a renewed interest in recent years, however the concept is not new at all, with its origins spanning over 100 years. Field experience in United States’ military conflicts has provided important data on the efficacy of whole blood in reducing mortality and amount of blood product administration. Civilian trials however have not necessarily shown similar results. The safety of whole blood however does not seem to be in question given the available data, and is an acceptable option for blood replacement in …
Prediction Of Major Adverse Cardiac Events In The Emergency Department Using An Artificial Neural Network With A Systematic Grid Search, 2024 Aga Khan University
Prediction Of Major Adverse Cardiac Events In The Emergency Department Using An Artificial Neural Network With A Systematic Grid Search, Ahmed Raheem Buksh, Nadeem Ullah Khan, Rida Jawed, Shahan Waheed, Musa Karim
Department of Emergency Medicine
Background: The aim of our research was to design and evaluate an Artificial Neural Network (ANN) model using a systemic grid search for the early prediction of major adverse cardiac events (MACE) among patients presenting to the triage of an emergency department.
Methods: This is a single-center, cross-sectional study using electronic health records from January 2017 to December 2020. The research population consists of adults coming to our emergency department triage at Aga Khan University Hospital. The MACE during hospitalization was the main outcome. To enhance the architecture of an ANN using triage data, we used a systematic grid search …
Issue 6: Pulmonary & Critical Care Insider, 2024 Parkview Health
Issue 6: Pulmonary & Critical Care Insider, Bharat Bajantri Md, Sarah Ellsworth-Hoffman Mls
Critical Care & Pulmonary
Pulmonary & Critical Care Insider Issue 6
Compiled by Bharat Bajantri, MD, and librarian Sarah Ellsworth, MLS for the clinicians of the Pulmonary and Critical Care team of Parkview.
The goal of this newsletter is to give a brief summary of the most pertinent articles to everyday practice and an attempt to keep up with literature as best as possible. Newsletters go out every 1-2 months.
Summaries/Topics in this issue:
Wasted Blood in Hospital Setting
Blood Transfusions
MINT Trial
Epinephrine related death
Non-invasive Airway Management of Comatose Poisoned Emergency Patients
Angiotensin II (AT2) and Vasopressors
Angiotensin II for the Treatment …
Improving Nutritional Delivery To Pediatric Patients On Continuous Renal Replacement Therapy, 2024 Children's Mercy Kansas City
Improving Nutritional Delivery To Pediatric Patients On Continuous Renal Replacement Therapy, Jennifer Ruiz-Boada, Sarah Brunner, Tara Benton, Vimal Chadha
Presentations
INTRODUCTION: Continuous renal replacement therapy (CRRT) is used in critically ill children with acute renal failure. CRRT can lead to malnutrition by removing essential proteins and micronutrients. Malnutrition is associated with worse outcomes, including increased length of stay and mortality. CRRT guidelines suggest the importance of early nutrition and ensuring high protein intake. After evaluating our CRRT patients, we found sub-optimal adherence to the guidelines. This Quality Improvement project aimed to increase the percentage of patients achieving 75% of their goal protein and caloric intake by day 5 of CRRT initiation by 15% by August 2023. METHODS: A multidisciplinary group …
Lazarus Syndrome After Aortic Aneurysm Repair, 2023 HCA Florida Blake Hospital
Lazarus Syndrome After Aortic Aneurysm Repair, Kevyn Niu, Jamie Lee Aldakkour, Charles Huyghues-Despointes, Yizhi Lin
HCA Healthcare Journal of Medicine
Introduction
Lazarus syndrome is defined as the spontaneous return of circulation after cessation of cardiopulmonary resuscitation (CPR). Though there have been multiple cases of Lazarus syndrome documented in the literature, it is a significantly underreported phenomenon with less than 100 cases reported in the literature since the first case in 1982.
Case Presentation
After elective aortic aneurysm repair, an 88-year-old with a do-not-resuscitate directive had cardiac arrest, briefly showing post-mortem respiration and pulse. Despite resuscitation efforts including pharmacological intervention and CPR, he passed away within an hour. This case highlights complexities in end-of-life care and warrants exploration of post-mortem physiological …
Beyond The Basics: Unraveling The Complexity Of Coronary Artery Calcification, 2023 Aga Khan University
Beyond The Basics: Unraveling The Complexity Of Coronary Artery Calcification, Satwat Hashmi, Pashmina Wiqar Shah, Zouhair Aherrahrou, Elena Aikawa, Rédouane Aherrahrou
Department of Biological & Biomedical Sciences
Coronary artery calcification (CAC) is mainly associated with coronary atherosclerosis, which is an indicator of coronary artery disease (CAD). CAC refers to the accumulation of calcium phosphate deposits, classified as micro- or macrocalcifications, that lead to the hardening and narrowing of the coronary arteries. CAC is a strong predictor of future cardiovascular events, such as myocardial infarction and sudden death. Our narrative review focuses on the pathophysiology of CAC, exploring its link to plaque vulnerability, genetic factors, and how race and sex can affect the condition. We also examined the connection between the gut microbiome and CAC, and the impact …
Myocardial Protection In High-Risk Cardiopulmonary Bypass Support, 2023 Baylor College of Medicine, Houston, TX
Myocardial Protection In High-Risk Cardiopulmonary Bypass Support, Subhasis Chatterjee, Marc R. Moon
Journal of Shock and Hemodynamics
The development of cardioplegia has facilitated complex cardiac surgery and allowed high-risk patients to safely tolerate life-saving procedures. By following the principles of electromechanical arrest, inducing hypothermia, and using adjunctive agents to help mitigate the effects of hypothermia and ischemia reperfusion injury, cardioplegia can be safely induced with various commercially available compositions, which can be delivered by several different surgical techniques. Although many studies have compared these methods, there is little consensus on whether any one method is superior to another. Just as a surgeon may need to modify technique according to individual patient factors, so too must a surgeon …
Allergic Bronchopulmonary Aspergillosis: Radiological And Microbiological Profile Of Patients Presented In An Outpatient Pulmonary Clinic In A Developing Country, 2023 Aga Khan University
Allergic Bronchopulmonary Aspergillosis: Radiological And Microbiological Profile Of Patients Presented In An Outpatient Pulmonary Clinic In A Developing Country, Nousheen Iqbal, Muhammad Irfan, Mustafa Bin Ali Zubairi, Maaha Ayub, Safia Awan, Kauser Jabeen, Ali Bin Sarwar Zubairi
Section of Pulmonary & Critical Care
There is limited data available about allergic bronchopulmonary aspergillosis (ABPA) in Pakistan. The aim of the study was to describe the radiological and microbiological profile of ABPA patients presenting to the outpatient pulmonary clinic of a tertiary care hospital in Karachi, Pakistan. A retrospective study was conducted on ABPA patients who presented to the pulmonary outpatient clinic at Aga Khan University Hospital, Karachi, Pakistan, from January 2017 to December 2019. Data was collected on microbiology and radiology features on predesigned proforma. A total of 7759 asthmatic patients presented at the outpatient pulmonology clinic during the study period. Of the 245 …
Variability In Provider Assessment Of Sepsis And Potential Of Host Response Technology To Address This Dilemma—Results Of An Online Delphi Study, 2023 University of South Florida (USF) Morsani College of Medicine, Tampa
Variability In Provider Assessment Of Sepsis And Potential Of Host Response Technology To Address This Dilemma—Results Of An Online Delphi Study, Chadd K. Kraus, Hollis R. O’Neal, Nathan A. Ledeboer, Todd W. Rice, Wesley H. Self, Richard E. Rothman
School of Medicine Faculty Publications
Potentially septic patients have a huge clinical and economic impact on hospitals and often present to the emergency department (ED) with undifferentiated symptoms. The triage of these patients is complex and has historically relied heavily upon provider judgment. This study aims to evaluate the consistency of provider judgment and the potential of a new host response sepsis test to aid in the triage process. A modified Delphi study involving 26 participants from multiple specialties was conducted to evaluate provider agreement about sepsis risk and to test proposed actions based on the results of a sepsis test. The participants considered case …
Massive Transfusion And Shock Index, 2023 University of Texas at Tyler
Massive Transfusion And Shock Index, Kasey House
MSN Capstone Projects
Hemorrhagic shock is one of the leading causes of preventable death in military trauma patients. Literature shows that pre-hospital transfusions of blood products within the combat environment have shown to have a greater likelihood of survival. This has produced a challenge in the pre-hospital setting to have a standardized method of predicting the patient’s need for a massive transfusion. In the last few years, the development of a Massive Transfusion Protocol (MTP) has become the standard to quickly deliver blood products to actively bleeding patients. Every minute waiting to administer blood products increases mortality by 5%.
While initiating an MTP …