How N.Y.’S Biggest For-Profit Nursing Home Group Flourishes Despite A Record Of Patient Harm, Jennifer Lehman

Capstones

How N.Y.'s Biggest For-Profit Nursing Home Group Flourishes Despite a Record of Patient Harm

The state’s “character-and-competence” reviews are supposed to weed out operators with histories of violations and fines— but regulators don’t always act on the full story.

The Effect Of Body Mass Index On Graft Function And Kidney Transplant Outcomes, Morgan Galle

Theses & Dissertations

Background: When determining eligibility for kidney transplantation, body mass index (BMI) is often a debatable criterion for transplant due to the clinical indication, an elevated BMI has adverse effects on kidney transplant outcomes. There is a current gap in research on the effect BMI has on kidney transplant outcomes.

Purpose: The purpose of this study was to determine the role BMI plays in post-kidney transplant clinical outcomes including delayed graft function, new onset diabetes after transplant, wound complications, hospital length of stay, albumin, and readmissions to the hospital from initial hospitalization and at six months following kidney transplantation. The primary …

Kyphotic Progression After Thoracolumbar Burst Fractures Treated Conservatively, With Mis, Or Via Open Approach, Mark Rivkin, Howard Eisenbrock

Mark Rivkin

Management of thoracolumbar burst fractures (AO A3) without neurological deficit is subject to debate in the literature. While TLICS provides guidance for injuries necessitating intervention, it makes little mention of best surgical approaches. Furthermore, intact patients with suspected posterior ligamentous complex injury (TLICS 4) compose an additional level of management uncertainty. Present study examined outcomes for TL burst fractures in neurologically intact patients with suspected disruption of the PLC treated with bracing, MIS, or open fixation and fusion.

Mortality, Mauling, And Maiming By Vicious Dogs, John Bini, Stephen Cohn, Shirley Acosta, Marilyn Mcfarland, Mark Muir, Joel Michalek

John K. Bini

Objective: Maiming and death due to dog bites are uncommon but preventable tragedies. We postulated that patients admitted to a level I trauma center with dog bites would have severe injuries and that the gravest injuries would be those caused by pit bulls. Design: We reviewed the medical records of patients admitted to our level I trauma center with dog bites during a 15-year period. We determined the demographic characteristics of the patients, their outcomes, and the breed and characteristics of the dogs that caused the injuries. Results: Our Trauma and Emergency Surgery Services treated 228 patients with dog bite …

Choosing A Fellow Or Fellowship: A Survey Of Pediatric Otolaryngologists, Robert Chun, Diego Preciado, David Brown, Ravindra Elluru, Stacey Ishman, Joseph Kerschner, Gresham Richter, Cecille Sulman

David C. Brown

No abstract provided.

Perforated Esophageal Intervention Focus (Perf) Study: A Multi Center Study Of Contemporary Treatment, Rob Rice, Joseph Dubose, Kamal Khalil, Jonathon Spicer, Luigi Bonavina, Stefano Siboni, Xian Luo-Owen, Sebron Harrison, Chad Ball, John Bini, Dan Fortes, Gary Vercruysse, David Skarupa, Charles Miller

John K. Bini

No abstract provided.

Perioperative Nonopioid Agents For Pain Control In Spinal Surgery., Anna Rivkin, Mark Rivkin

Mark Rivkin

PURPOSE: Commonly used nonopioid analgesic agents that are incorporated into multimodal perioperative pain management protocols in spinal surgery are reviewed. SUMMARY: Spinal procedures constitute perhaps some of most painful surgical interventions, as they often encompass extensive muscle dissection, tissue retraction, and surgical implants, as well as prolonged operative duration. Perioperative nonopioid analgesics frequently used in multimodal protocols include gabapentin, pregabalin, acetaminophen, dexamethasone, ketamine, and nonsteroidal antiinflammatory drugs (NSAIDs). There is evidence to suggest that gabapentin is safe and effective in reducing opioid consumption and pain scores at optimal doses of 600-900 mg orally administered preoperatively. Pregabalin 150-300 mg orally perioperatively …

Middle-Aged Man With Penetrating Trauma To The Pancreaticoduodenal Complex, Thomas Bening, John Bini, Brian Perry, Melanie Richards

John K. Bini

No abstract provided.

Does The Use Of A Regional Nerve Block Decrease The Incidence Of Post Operative Nausea And Vomiting, Decrease Pain Scores, Or Decrease Discharge Time Compared To General Anesthesia Alone?, Donald Lane Whitney

Doctoral Projects

Problem Statement: The use of regional anesthesia in orthopedic surgeries has been shown to decrease the rate of postoperative nausea and vomiting (PONV), postoperative pain, and decrease postoperative discharge time. However, some healthcare facilities continue to provide anesthesia for these procedures without the use of regional anesthesia techniques.

Purpose: The purpose of this capstone project was to determine if the addition of a regional anesthetic technique would be beneficial to the patient and cost efficient to the healthcare facility.

Methods: A retrospective chart review was conducted and data collected on the population of interest. Inclusion criteria were patients undergoing orthopedic …

Cerebral Oximetry Readings In The Sitting Position Versus Supine Position For Patients Undergoing General Anesthesia, Christopher Turner

Doctoral Projects

Problem: Inadequate cerebral blood flow is a significant risk for patients undergoing surgery in the sitting position. Placing the patient in a sitting position may cause a drop in pressure at the level of the brain when compounded with induction and maintenance of general anesthesia. These changes may cause a decrease in cerebral blood flow and oxygenation. Inadequate perfusion for a prolonged period of time could produce negative neurological consequences in the short and long term postoperative period.

Purpose: The purpose of this project is to determine if there is a significant drop in cerebral oximetry, from baseline, when patients …

An Intra-Bone Axial Load Transducer: Development And Validation In An In-Vitro Radius Model, Nikolas K. Knowles, Michael Gladwell, Louis M. Ferreira

Surgery Publications

Background

Accurate measurement of forces through the proximal radius can assess the effects of some surgical procedures on radioulnar load sharing, but is difficult to achieve given the redundant loading nature of the musculoskeletal system. Previously reported devices have relied on indirect measurements that may alter articular joint location and function. An axial load transducer interposed in the diaphysis of the radius may accurately quantify unknown axial loads of the proximal radius, and maintain articular location.

Methods

An in-vitro radius model was developed by interposing an axial load transducer in the diaphysis of the proximal radius. Static loads of 20, …

Department Of Surgery Update, December 2015, Wright State University Department Of Surgery

Department of Surgery Updates

A four page newsletter created by the Department of Surgery documenting changes to the department. This issue contains a message from the chair, a list of important dates, committee meetings, scholarly activity and more.

Efficacy And Safety Of Vorapaxar In Non-St-Segment Elevation Acute Coronary Syndrome Patients Undergoing Noncardiac Surgery, Sean Van Diepen, Pierluigi Tricoci, Mohua Podder, Cynthia M. Westerhout, Philip E. Aylward, Claes Held, Frans Van De Werf, John Strony, Lars Wallentin, David J. Moliterno, Harvey D. White, Kenneth W. Mahaffey, Robert A. Harrington, Paul W. Armstrong

Gill Heart & Vascular Institute Faculty Publications

Background—Perioperative antiplatelet agents potentially increase bleeding after non–ST‐segment elevation (NSTE) acute coronary syndromes (ACS). The protease‐activated receptor 1 antagonist vorapaxar reduced cardiovascular events and was associated with increased bleeding versus placebo in NSTE ACS, but its efficacy and safety in noncardiac surgery (NCS) remain unknown. We aimed to evaluate ischemic, bleeding, and long‐term outcomes of vorapaxar in NCS after NSTE ACS.

Methods and Results—In the TRACER trial, 2202 (17.0%) patients underwent major or minor NCS after NSTE ACS over 1.5 years (median); continuing study treatment perioperatively was recommended. The primary ischemic end point for this analysis was cardiovascular …

High Incidence Of Fracture Events In Patients With Long-Gap Esophageal Atresia (Lgea): A Retrospective Review Prompting Implementation Of Standardized Protocol., Sigrid Bairdain, Brenda Dodson, David Zurakowski, Lawrence Rhein, Brian D Snyder, Melissa Putman, Russell W Jennings

Surgery Faculty Publications

PURPOSE: To identify factors associated with an increased risk of fractures in Long-Gap Esophageal Atresia (LGEA) patients. Following implementation of a risk-stratified program, we hypothesized a reduction in fracture incidence within this potentially high-risk population.

METHODS: A retrospective review of LGEA-patients admitted between 2005 and 2014 was conducted. Symptomatic fractures with radiographic confirmation were defined as events. Univariate and multivariable analysis evaluated factors including admission weight-for-age z-score, primary versus secondary Foker process (FP), weight at Foker Stage I, days and episodes of paralysis, number of parenteral nutrition (PN) days, cumulative dose of loop diuretics adjusted for body weight and days …

Background Differences In Baseline And Stimulated Mmp Levels Influence Abdominal Aortic Aneurysm Susceptibility, Matthew A. Dale, Melissa K. Suh, Shijia Zhao, Trevor Meisinger, Linxia Gu, Vicki J. Swier, Devendra K. Agrawal, Timothy Greiner, Jeffrey S. Carson, B. Timothy Baxter, Wanfen Xiong

Department of Mechanical and Materials Engineering: Faculty Publications

Objective: Evidence has demonstrated profound influence of genetic background on cardiovascular phenotypes. Murine models in Marfan syndrome (MFS) have shown that genetic background-related variations affect thoracic aortic aneurysm formation, rupture, and lifespan of mice. MFS mice with C57Bl/6 genetic background are less susceptible to aneurysm formation compared to the 129/SvEv genetic background. In this study, we hypothesize that susceptibility to abdominal aortic aneurysm (AAA) will be increased in 129/SvEv mice versus C57Bl/6 mice. We tested this hypothesis by assessing differences in aneurysm size, tissue properties, immune response, and MMP expression.

Methods: Mice of C57Bl/6 or 129/SvEv background underwent AAA induction …

Pneumoperitoneum, Pneumoretroperitoneum, Pneumomediastinum And Extensive Subcutaneous Emphysema In A Patient With Ulcerative Colitis: A Case Report., Usman T Siddiqui, Hira Shahzad, Asad Raja

Department of Surgery

Abstract

INTRODUCTION:

Pneumo-mediastinum and subcutaneous emphysema are rare presentations of lower gastrointestinal tract perforation.

PRESENTATION OF CASE:

We are presenting the case of a middle aged man diagnosed with UC who presented with dyspnea and subcutaneous emphysema, attributed to multiple perforations including the stomach and colon.

CASE DISCUSSION:

Patients with ulcerative colitis (UC) are at an increased risk of perforations due to friability of colonic mucosa given the chronic inflammation and relapsing flares. Chronic use of steroids further predisposes to stress ulcers. These pathologies sometimes coexist and identification of each is crucial for the appropriate treatment plan.

CONCLUSION:

The case …

Prevalence And Antimicrobial Susceptibility Pattern Of Coagulase-Negative Staphylococci (Cons) Isolated From Clinical Specimens In Northern Of Jordan, Ibrahim Ali Al Tayyar, Mazhar Salim Al-Zoubi, Emad Hussein, Salih Khudairat, Konrad Sarosiek

Department of Surgery Faculty Papers

No abstract provided.

Improved Sensitivity To Fluorescence For Cancer Detection In Wide-Field Image-Guided Neurosurgery, Michael Jermyn, Yoann Gosselin, Pablo A. Valdes, Mira Sibai, Kolbein Kolste

Dartmouth Scholarship

In glioma surgery, Protoporphyrin IX (PpIX) fluorescence may identify residual tumor that could be resected while minimizing damage to normal brain. We demonstrate that improved sensitivity for wide-field spectroscopic fluorescence imaging is achieved with minimal disruption to the neurosurgical workflow using an electron-multiplying charge-coupled device (EMCCD) relative to a state-of-the-art CMOS system. In phantom experiments the EMCCD system can detect at least two orders-of-magnitude lower PpIX. Ex vivo tissue imaging on a rat glioma model demonstrates improved fluorescence contrast compared with neurosurgical fluorescence microscope technology, and the fluorescence detection is confirmed with measurements from a clinically-validated spectroscopic probe. Greater PpIX …

Operating Room First Start Efficiency Throughout A Large Urban Hospital System, Callie Cox Bauer, Kiley A. Bernhard, Danielle M. Greer, Scott Kamelle

Journal of Patient-Centered Research and Reviews

Background: Operating room delays decrease health care system efficiency and increase hospital costs. Data on delays in a multihospital system are sparse.

Purpose: In an effort to improve our operating room efficiency, we investigated operating room delays, the causes and the impending financial impact.

Methods: A retrospective analysis on first case-of-the-day surgeries at three hospitals during 2013 was conducted. Delays were defined as in-room time being after scheduled surgery start time. Length of delay and causes were recorded. Patient demographics, body mass index, hospital facility, total number of procedures, provider specialty and time of patient arrival were incorporated into a …

Does The Expression Of Ki-67, P16 And Cox-2 At Initial Diagnosis Of Breast Atypia Or Usual Ductal Hyperplasia Predict A Second Clinically Significant Event?, Judy A. Tjoe, Philippe Gascard, Jianxin Zhao, Gary F. Neitzel, Maharaj Singh, Brittany Last, James Marx, Thea Tlsty, Sanjay Kansra

Journal of Patient-Centered Research and Reviews

Background: Women diagnosed with atypical ductal hyperplasia (ADH) or atypical lobular hyperplasia (ALH) have a fivefold increased risk of developing breast cancer. Because ADH/ALH can be precursors or predictive markers of a subsequent clinically significant event (SCSE), i.e. atypia, in situ or invasive carcinoma, the clinical outcome for these patients ranges anywhere from remission to invasive malignancy. Currently we cannot predict which atypical breast lesion is likely to be associated with future cancer, resulting in aggressive management and, possibly, overtreatment. Kerlikowske et al. reported that a combination of three biomarkers (cell cycle regulator p16INK4a, proliferation antigen Ki-67 and stress response …

Treatment Of Ischemia Reperfusion Injury With Rna Interference, Terry M. Zwiep

Electronic Thesis and Dissertation Repository

Ischemia reperfusion injury (IRI) occurs during transplantation and causes apoptosis and inflammation. The purpose of this research was to determine the effect of caspase-3, complement 3, and RelB gene silencing in the reduction of IRI using an in vitro model.

LLC-PK1 cells were used along with antimycin A for the in vitro IRI model. Prior to exposure to antimycin A, cells were transfected with caspase-3, C3, and RelB small interfering RNA (siRNA) alone or in combination and then analyzed.

The relative risk reduction of apoptosis in antimycin A treated cells with caspase-3 siRNA was 46.6% (p=0.019), RelB siRNA 42.8% (p=0.038), …

Ependymal Tumors With Oligodendroglioma Like Clear Cells: Experience From A Tertiary Care Hospital In Pakistan, Fauzan Alam Hashmi, Muhammad Faheem Khan, Saad Akhtar Khan, Muhammad Waqas, Muhammad Ehsan Bari, Arsalan Ahmed

Section of Neurosurgery

Background: Ependymal tumors with oligodendroglioma like clear cells have never been reported from Pakistan. We aimed to see the features and outcomes of this rare entity.
Methods: It was retrospective cohort conducted at the Department of Neurosurgery, Aga Khan University from 2003 to 2013. The medical records and radiology of patients with proven histopathology were reviewed. Analysis was done on SPSS 20.
Results: Eleven cases of ependymal tumors with clear cells were found, which equated to 1.5% of the total tumor burden in 11 years. The median age was 49 years. Most common presenting symptom was headache 54.5%. Out of …

Penetrating Abdominal Trauma, Lauren Dudas Md

Department of Surgery

No abstract provided.

Randomized Clinical Trial Comparing Perioperative Care For Breast Cancer Patients At A Patient Hotel Versus A General Surgical Ward, Madleen Anna Camilla Huzell, Johan Frisack, Kristina Dalberg

Patient Experience Journal

Breast cancer is the most frequent cancer among women in Europe and the US. The aim of this study was to assess whether perioperative care, for breast cancer patients, provided at a patient hotel could be an alternative to the conventional care in an ordinary surgical ward. The study focuses solely on the patients’ experience of the provided care with a primary outcome that perioperative care at the patient hotel would be valued better than care in a general ward. Prospective, randomized single centre study. Between 2010 and 2012 a total of 151 patients < 80 years and without severe comorbidities were included in the trial, whereof 76 patients were randomised to the ward group and 75 patients to the hotel group. Five patients were excluded from each group. The validated IN2005-E questionnaire was used to evaluate the patients’ experiences of the care. The response rate was high with 65 patients answering the IN2005-E in each group. No difference could be found between the two groups regarding patient characteristics, type of surgery or tumour characteristics. The patients generally perceived the quality of the provided care as high. However, in the hotel group there was a better experience of care regarding issues such as coordination, privacy, some aspects of medical information, availability and the courtesy of the nurses. For selected patients, perioperative care at a patient hotel is an appreciated alternative to care at a surgical ward.

The Utilization Of High Flow Oxygen To Administer Inhaled Pulmonary Vasodilators In Post-Operative Left Ventricular Assist Patient Population To Facilitate Extubation, Kenneth Miller Med, Rrt-Accs, Ae-C;, Timothy S. Misselbeck, Barbara A. Ebert Crnp, Robert Allman Rrt, Linda Cornman Bs, Rrt-Nps, Rrt-Accs, Ae-C

Patient Care Services / Nursing

No abstract provided.

Renal Oncocytosis In A Pediatric Patient: Case Report And Review Of The Literature, Stacey Speer, Daniele Wiseman, Madeleine Moussa, Andreana Bütter

Surgery Publications

Renal oncocytosis is a rare condition in which the kidney develops numerous oncocytomas. We present a case of a 12-year-old female who presented with right-sided flank pain of one-year duration. Imaging revealed several masses in the right kidney. Tissue biopsy confirmed multiple benign oncocytomas. Due to the presence of multiple oncocytomas throughout the kidney, a radical nephrectomy was performed. Given the rarity of this condition, as well as its known association with von Hippel-Lindau disease and Birt-Hogg-Dube syndrome, genetic investigations were pursued but failed to identify any abnormalities. This patient remains well and disease free six years after surgery. A …

Department Of Surgery Update, November 2015, Wright State University Department Of Surgery

Department of Surgery Updates

A four page newsletter created by the Department of Surgery documenting changes to the department. This issue contains a message from the chair, a list of important dates, committee meetings, scholarly activity and more.

A Prospective Analysis Of Factors Associated With Decreased Physical Activity In Patients With Cirrhosis Undergoing Transplant Evaluation, Anna Christina Dela Cruz, Valery Vilchez, Sooyeon Kim, Benjamin Barnes, Abhishek Ravinuthala, Anthony Zanni, Roberto Galuppo, Achuthan Sourianarayanane, Trushar Patel, Erin Colleen Maynard, Malay B. Shah, Michael F. Daily, Timothy L. Uhl, Karyn A. Esser, Roberto Gedaly

Internal Medicine Faculty Publications

BACKGROUND: Physical activity has been associated with improved recovery time after transplantation. Handgrip strength has been related to post-transplant outcomes.

AIM: To evaluate predictors of physical activity and grip strength in cirrhotic patients undergoing liver transplant evaluation.

METHODS: Single center, prospective analysis.

RESULTS: A hundred patients were evaluated (54% male, mean age 53 ± 9). Common etiologies of liver disease were non-alcoholic hepatitis (27%), hepatitis C (22%), and alcoholic liver disease (21%). Mean MELD score was 13.5. Forty one percent had a history of smoking. Ninety-three patients completed the International Physical Activity Questionnaire. The median total physical activity score of …

Toe-Tourniquet Syndrome: A Rare Potentially Devastating Entity, Naveed Baloch, M Atif, Rizwan Hussain Rashid, Pervaiz Mahmood Hashmi

Section of Orthopaedic Surgery

Toe-tourniquet syndrome is a rare and commonly misdiagnosed condition caused by a hair or a fiber wrapped around digits (fingers and toes). A four months baby girl who was crying and presented with redness and swelling at her 2nd and 3rd toes of right foot. Child had red and swollen 2nd and 3rd toes of right foot with hair end protruding through wounds. Constricting hairs were cut and removed. Toetourniquet syndrome is a rare entity which is caused by hair wrapped around a toe or a digit. Diagnosis is mostly clinical. In order to prevent this condition to happen, education …

Surveillance In The Service Of Safety, Rashid Jooma

Section of Neurosurgery

The World Report on Road Traffic Injury Prevention of 2004 recommended that the newly motorizing countries establish road injury surveillance to define the burden, identify highrisk groups, plan intervention and monitor their impact. Despite its stated importance in the literature, very few examples of sustained surveillance systems are reported from low income countries. This presentation shares the results of an urban RTI surveillance program that has been running for the past 8 years since 2007 in the emergency departments of five major hospitals in Karachi, Pakistan. We describe the process of establishing the road injury surveillance system incorporating a multi-institution …