Turning A Blind Eye: How Lack Of Communication With Er Nurses Nearly Cost A Patient Permanent Vision Loss, 2017 North Carolina State University
Turning A Blind Eye: How Lack Of Communication With Er Nurses Nearly Cost A Patient Permanent Vision Loss, Kenneth Royal, April Kedrowicz
Patient Experience Journal
This narrative presents a case in which a patient was treated for conjunctivitis, but a breakdown in several layers of communication (between the hospital and the patient, and between hospital personnel) resulted in multiple medical errors that nearly costs the patient permanent vision loss. This real-life case underscores how simple communication errors may lead to life-altering consequences. Recommendations for improving communication to ensure similar errors do not happen to others are provided.
Decreasing Time To Broad Spectrum Antibiotics For Septic Patients In The Emergency Department, 2017 Department of Pharmacy, Aurora St. Luke’s Medical Center
Decreasing Time To Broad Spectrum Antibiotics For Septic Patients In The Emergency Department, Joseph J. Zieminski, Emily E. Bryant
Journal of Patient-Centered Research and Reviews
Background: Timely administration of broad spectrum antibiotics has been shown to be directly correlated with decreased mortality for patients with severe sepsis and septic shock. As such, both the Surviving Sepsis Campaign and the SEP-1 CMS measure recognize timely antibiotic administration as a cornerstone of therapy for patients with severe sepsis or septic shock.
Purpose: Decrease time to broad spectrum antibiotic administration for septic patients in the emergency department (ED) of Aurora St. Luke’s Medical Center.
Methods: An alert within the electronic medical record was created to more rapidly identify potentially septic patients in the ED. After receiving the ...
New Approaches To The Trauma Patient With Life-Threatening Bleeding With Notes.Pptx, 2017 The University of Texas Health Science Center at Houston
New Approaches To The Trauma Patient With Life-Threatening Bleeding With Notes.Pptx, Richard N. Bradley
Richard N Bradley
Medical Response Times And Their Effect On Prehospital Care, 2017 Murray State University
Medical Response Times And Their Effect On Prehospital Care, Storm Santos
Medical Response Times and Their Effect on Prehospital Care
Storm J. Santos, Rural Health Scholar
Dr. Naber, Faculty Advisor
Department of Health Sciences
Medical emergencies happen in a variety of different environments. Each environment comes with unique challenges that emergency medical responders must work through to safely alleviate any given medical emergency. This study examines the effect of medical team response times on the overall care of the patient as well as if population density (rural vs urban) further affects the overall care of the patient. This study was inspired by works that compared various environmental factors and their ...
The Effects Of Obesity On Outcomes In Trauma Injury: Overview Of The Current Literature, 2017 Marshall University Joan C. Edwards School of Medicine
The Effects Of Obesity On Outcomes In Trauma Injury: Overview Of The Current Literature, Milad Modarresi, Brad Gillon, Javad Najjar Mojarrab, Rodrigo Aguilar, Zackary Dylan Hunter, Matthew Steven Schade, Jackie Sanabria, Rebecca Klug, Seth Adkins, Juan R. Sanabria
Marshall Journal of Medicine
Obesity has reached epidemic proportions and is now considered a chronic disease by the National Institute of Health (NIH) in the West. Its impact on trauma outcomes is of particular interest with several studies presenting conflicting information. The present overview suggests a strong association between obesity and injury severity, hospital length of stay (LOS), intensive care unit (ICU) admission, pattern of injury, rate of complications and mortality. The nature of the observations may relate to an underlying physiological state of the obese patient and its associated comorbidities with a constant heightened inflammatory state aggravated by the second hit on an ...
Examining The Role Of Diagnosis In The Emergency Department Experience, 2017 Thomas Jefferson University
Examining The Role Of Diagnosis In The Emergency Department Experience, Danielle Kovalsky, Bs, Angela Gerolamo, Phd, Aprn, Bcps, Amanda Doty, Ms, Alexzandra Gentsch, Lsw, Annemarie Jutel, Rn, Bphed (Hons), Phd, Kristin L. Rising, Md, Ms
To explore the social, functional, and emotional needs that patients want addressed when seeking a diagnosis at their ED visit.
Emergency Surgery And Limitation Of Therapeutic Effort In Relation To Neurologic Deterioration In Elderly Patients – A Survey Of European Surgeons, 2017 Milton Keynes University Hospital NHS Foundation Trust, Emergency Surgery Department, Milton Keynes, UK
Emergency Surgery And Limitation Of Therapeutic Effort In Relation To Neurologic Deterioration In Elderly Patients – A Survey Of European Surgeons, Mihai Paduraru, Luca Ponchietti, Isidro M. Casas, Jorge Pereira, Aitor Landaluce-Olavarria, Diego Mariani
Journal of Mind and Medical Sciences
Background. In emergency surgery, a very heterogeneous approach is required in the decision making process, especially when considering the patient’s postoperative quality of life as well as medical, ethical, and legal factors. In some cases, the presence of an Advance Directive (AD) form may potentially help resolve the surgeon’s dilemma. Objectives. The primary objective of this survey was to investigate the opinions of surgeons across a representative cross-section of European countries regarding the decision making process using a specific case scenario so as to identify similarities and differences in practice. A secondary objective was to identify the possibility ...
Not All Evidence Is Created Equal: Changes In Practice Require The Highest Possible Level Of Statistical Testing, 2017 Eastern Kentucky University
Not All Evidence Is Created Equal: Changes In Practice Require The Highest Possible Level Of Statistical Testing, Sandy Hunter
EKU Faculty and Staff Scholarship
The practice of medicine has come a long way over the past 150 years. For example, routine use of leeches to remove “bad blood” no longer occurs, and everyone involved in healthcare knows to wear personal protective equipment.
Changes to practice have (at times) been slow in coming. However, we simply can no longer routinely rely on providing care without evidence that it works. Investigators conduct rigorous studies to determine the efficacy of treatments. This philosophy of testing clinical practices using research methods to validate their efficacy and safety is known as evidence-based medicine.1
Sex Differences In Rt-Pa Utilization At Hospitals Treating Stroke: The National Inpatient Sample., 2017 Columbia University
Sex Differences In Rt-Pa Utilization At Hospitals Treating Stroke: The National Inpatient Sample., Amelia K. Boehme, Brendan G. Carr, Scott Eric Kasner, Karen C Albright, Michael J. Kallan, Mitchell S V S.V. Elkind, Charles C. Branas, Michael T. Mullen
Department of Emergency Medicine Faculty Papers
BACKGROUND AND PURPOSE: Sex and race disparities in recombinant tissue plasminogen activator (rt-PA) use have been reported. We sought to explore sex and race differences in the utilization of rt-PA at primary stroke centers (PSCs) compared to non-PSCs across the US.
METHODS: Data from the National (Nationwide) Inpatient Sample (NIS) 2004-2010 was utilized to assess sex differences in treatment for ischemic stroke in PSCs compared to non-PSCs.
RESULTS: There were 304,152 hospitalizations with a primary diagnosis of ischemic stroke between 2004 and 2010 in the analysis: 75,160 (24.7%) patients were evaluated at a PSC. A little over ...
Accuracy Of Emergency Medical Services Dispatcher And Crew Diagnosis Of Stroke In Clinical Practice., 2017 University of Pennsylvania
Accuracy Of Emergency Medical Services Dispatcher And Crew Diagnosis Of Stroke In Clinical Practice., Judy Jia, Roger Band, Michael E. Abboud, William Pajerowski, Michelle Guo, Guy David, C. Crawford Mechem, Steven R Messé, Brendan G. Carr, Michael T Mullen
Department of Emergency Medicine Faculty Papers
BACKGROUND: Accurate recognition of stroke symptoms by Emergency Medical Services (EMS) is necessary for timely care of acute stroke patients. We assessed the accuracy of stroke diagnosis by EMS in clinical practice in a major US city.
METHODS AND RESULTS: Philadelphia Fire Department data were merged with data from a single comprehensive stroke center to identify patients diagnosed with stroke or TIA from 9/2009 to 10/2012. Sensitivity and positive predictive value (PPV) were calculated. Multivariable logistic regression identified variables associated with correct EMS diagnosis. There were 709 total cases, with 400 having a discharge diagnosis of stroke or ...
Growing Old In The Emergency Department, 2017 Dublin City University
Growing Old In The Emergency Department, Paul Liston, G Conyngham, Malcolm Brady, P J. Byrne, Peadar Gilligan
Emergency Medicine Articles
The research team were concerned that older patients requiring emergency admission seemed to wait longer for a hospital bed, and as such were disproportionately affected by Emergency Department overcrowding. To investigate this theory and explore any changes over time, a ten year dataset (2005-2014 inclusive) was extracted from the information systems at Beaumont Hospital, Dublin. This research examines the changing age profile of ED patients, identifies the relationship between age and the total time spent in the Emergency Department (Patient Experience Time (PET)), and examines the public belief that EDs are busiest in winter when reports of overcrowding and elderly ...
Unforgiving Heat Wave Deaths In The Largest Metropolitan City Of Pakistan: Lessons Learned, 2017 Aga Khan University
Unforgiving Heat Wave Deaths In The Largest Metropolitan City Of Pakistan: Lessons Learned, Muhammad Akbar Baig, Shahan Waheed, Asad Mian, Erfaan Hussain
Heat stroke is a deadly condition that needs astute care and timely management. Recently, the city of Karachi in Pakistan has been the victim of an intense heat wave, which has resulted in an insurmountable loss of life. We observed various deficiencies in dealing with this national threat that provides us with a valuable lesson regarding the measures that can be undertaken to avoid such a disaster from occurring again.
The Pediatric Disease Spectrum In Emergency Departments Across Pakistan: Data From A Pilot Surveillance System, Huba Atiq, Emaduddin Siddiqui, Surraya Bano, Asher Feroze, Sayyeda Ghazala Kazi, Jabeen Fayyaz, Shivam Gupta, J. Razzak, Adnan A Hyder, Asad Mian
Background: There is an increasing number of urgently ill and injured children being seen in emergency departments (ED) of developing countries. The pediatric disease burden in EDs across Pakistan is generally unknown. Our main objective was to determine the spectrum of disease and injury among children seen in EDs in Pakistan through a nationwide ED-based surveillance system. Methods: Through the Pakistan National Emergency Department Surveillance (Pak-NEDS), data were collected from November 2010 to March 2011 in seven major tertiary care centers representing all provinces of Pakistan. These included five public and two private hospitals, with a collective annual census of ...
Urinary Nitrate Might Be An Early Biomarker For Pediatric Acute Kidney Injury In The Emergency Department, Asad Mian, Yue Du, Harsha K Garg, Chantal Caviness, Stuart L Goldstein, Nathan S Bryan
NO is involved in normal kidney function and perturbed in acute kidney injury (AKI). We hypothesized that urinary concentration of NO metabolites, nitrite, and nitrate would be lower in children with early AKI presenting to the emergency department (ED), when serum creatinine (SCr) was uninformative. Patients up to 19 y were recruited if they had a urinalysis and SCr obtained for routine care. Primary outcome, AKI, was defined by pediatric Risk, Injury, Failure, Loss of function, End-stage renal disease (pRIFLE) criteria. Urinary nitrite and nitrate were determined by HPLC. A total of 252 patients were enrolled, the majority (93%) of ...
Nitric Oxide And Its Metabolites In The Critical Phase Of Illness: Rapid Biomarkers In The Making, 2017 Aga Khan University
Nitric Oxide And Its Metabolites In The Critical Phase Of Illness: Rapid Biomarkers In The Making, Asad Mian, Mayank Aranke, Nathan S. Bryan
The potential of nitric oxide (NO) as a rapid assay biomarker, one that could provide a quantum leap in acute care, remains largely untapped. NO plays a crucial role as bronchodilator, vasodilator and inflammatory mediator. The main objective of this review is to demonstrate how NO is a molecule of heavy interest in various acute disease states along the emergency department and critical care spectrum: respiratory infections, central nervous system infections, asthma, acute kidney injury, sepsis, septic shock, and myocardial ischemia, to name just a few. We discuss how NO and its oxidative metabolites, nitrite and nitrate, are readily detectable ...
Long-Term Correction Of Ornithine Transcarbamylase Deficiency By Wpre-Mediated Overexpression Using A Helper-Dependent Adenovirus, Asad Mian, W.Michael Lmccormack, Viraj Mane, Soledad Kleppe, Philip Ng, Milton Finegold, William E. O'Brien, John R. Rodgers, Arthur L. Beaude, Brendan Lee
The urea cycle disorders (UCDs) are important models for developing gene replacement therapy for liver diseases. Long-term correction of the most common UCD, ornithine transcarbamylase (OTC) deficiency, has yet to be achieved in clinical or preclinical settings. The single human clinical trial using early-generation adenovirus (Ad) failed to show any biochemical correction. In adult OTC-deficient mice, an E1/E2-deleted Ad vector expressing the mouse OTC gene, but not the human, was only transiently therapeutic. By using post-transcriptional overexpression in the context of the less immunogenic helper-dependent adenoviral vector, we achieved metabolic correction of adult OTC-deficient mice for >6 months. Demonstrating ...
Safety Netting Through The Prevention And Detection Of Child Abuse In Low And Middle Income Countries: Lessons From Pakistan, Kanwal Nayani, Muhammad Akbar Baig, Nick Brown, Asad Mian
No abstract provided.
Nitric Oxide Metabolites As Biomarkers For Influenza-Like Acute Respiratory Infections Presenting To The Emergency Room, Asad Mian, Federico R Laham, Andrea T Cruz, Harsha Garg, Charles G Macias, A. Chantal Caviness, Pedro A Piedra
Aims: Nitric oxide (NO) is increased in the respiratory tract in pulmonary infections. The aim was to determine whether nasal wash NO metabolites could serve as biomarkers of viral pathogen and disease severity in children with influenza-like illness (ILI) presenting to the emergency department (ED) during the 2009 influenza A H1N1 pandemic. Methods: Children ≤18 years old presenting to the ED with ILI were eligible. Nasal wash specimens were tested for NO metabolites, nitrate and nitrite, by HPLC and for respiratory viruses by real-time PCR. Results: Eighty-nine patients with ILI were prospectively enrolled during Oct-Dec, 2009. In the entire cohort ...
Late Onset Oesophageal Perforation Due To Gunshot Injury Of Chest: Successful Non-Operative Management In A Young Child, Asad Mian, Saima H. Khan, Naeem -Uz-Zafar Khan
No abstract provided.
Requirement Of Argininosuccinate Lyase For Systemic Nitric Oxide Production, 2017 Baylor College of Medicine, Houston
Requirement Of Argininosuccinate Lyase For Systemic Nitric Oxide Production, Ayelet Erez, Sandesh Cs. Nagamani, Oleg A. Shchelochkov, Muralidhar H. Premkumar, Philippe M. Campeau Campeau, Yuqing Chen, Harsha K. Garg, Li Li, Asad Mian, Terry K. Bertin, Jennifer O. Black, Heng Zeng, Yaoping Tang, Anilkumar K. Reddy, Marshall Summar, William E. O’Brien, David G. Harrison, William E. Mitch, Juan C. Marini, Judy L. Aschner, Nathan S. Bryan, Brendan Lee
Nitric oxide (NO) is crucial in diverse physiological and pathological processes. We show that a hypomorphic mouse model of argininosuccinate lyase (encoded by Asl) deficiency has a distinct phenotype of multiorgan dysfunction and NO deficiency. Loss of Asl in both humans and mice leads to reduced NO synthesis, owing to both decreased endogenous arginine synthesis and an impaired ability to use extracellular arginine for NO production. Administration of nitrite, which can be converted into NO in vivo, rescued the manifestations of NO deficiency in hypomorphic Asl mice, and a nitric oxide synthase (NOS)-independent NO donor restored NO-dependent vascular reactivity ...