4107 Limited Echocardiogram Examinations Performed by Intensivists: A Surgeon-Driven Multidisciplinary Program

2017 ◽  
Vol 83 (1) ◽  
pp. 78-81 ◽  
Author(s):  
Paula Ferrada ◽  
David Evans ◽  
Sara Parker ◽  
Sammy Pedram ◽  
Curtis N. Sessler
Keyword(s):  
Intensive Care Unit ◽  
Training Program ◽  
Multidisciplinary Approach ◽  
Institutional Review Board ◽  
Transthoracic Echocardiogram ◽  
Multidisciplinary Program ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
The Mean ◽  
Reimbursement Amount

Limited transthoracic echocardiogram (LTTE) has been introduced as a tool to direct resuscitation. At our institution, a multidisciplinary training program was instituted. Our hypothesis is that in spite all efforts for multidisciplinary training, certification, and credentialing, limited echocardiograms are under billed for. A training program was implemented in August 2010. This was followed by a process of credentialing and adding LTTE to the billing privileges for providers. Institutional Review Board approval was obtained to review all the studies performed from August 2010 to October 2014. About 4107 LTTEs were performed during the study period. Only 685 examinations were billed for (16.6%). The total amount billed for all the studies was $80,819.00. The number of studies billed for and performed in the emergency department (ED) were 342, and 343 studies were billed while performed in the intensive care unit (ICU). Our institution received payment at a higher rate when the studies were performed in the ICU (71.7%) versus ED (49.4%), P < 0.0001. The total actual reimbursement for the ED was $6487.29 and for the ICU was $8213.95 for a total of $14,701.24. The mean reimbursement amount was $35.59. If all of the studies were billed for and reimbursed at the average payment amount, the institution would have received $146,168.13. A multidisciplinary approach is pivotal for the success of intensivist-driven bedside echocardiogram programs. Education regarding credentialing and billing is a necessary addition to ensure sustainability of such efforts.

scholarly journals Contact Hand Burns in Children: Still a Major Prevention Need

2020 ◽  
Vol 41 (5) ◽  
pp. 1000-1003
Author(s):  
Jaclyn M McBride ◽  
Kathleen S Romanowski ◽  
Soman Sen ◽  
Tina L Palmieri ◽  
David G Greenhalgh
Keyword(s):  
Reconstructive Surgery ◽  
Skin Grafting ◽  
The Other ◽  
Institutional Review Board ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Palmar Surface ◽  
The Mean ◽  
Hand Burns ◽  
Palmar Aspect

Abstract Since toddlers explore with their hands, contact burns continue to be a major pediatric problem. The purpose of this report is to review our 8-year experience with contact burns of the hand. After institutional review board approval, a review of pediatric contact hand burns that occurred between 2006 and 2014 was performed. In the 8-year span, 536 children had contact hand burns. The majority suffered burns from an oven or stove (120). The other etiologies included burns from a fireplace (76), clothing iron (65), curling or straightening iron (50), and firepit or campfire (46). The mean age was 2.62 years, with a range of 2 months to 18 years. Male children (339) burned their hands more than females (197). Most children burned the palmar aspect of their hand (384) compared to the dorsum (61). These burns typically cover small TBSAs (mean 1.08% TBSA), with only 2% of burns comprising &gt;5% TBSA. Approximately, 84% of these patients did not need surgery, but 86 (16%) had skin grafting (usually full thickness) and roughly 26% of those needed reconstructive surgery. Contact burns to the hand continue to be a major problem for toddlers. Children are most likely to burn themselves on an oven or stove, fireplace, clothing iron or curling/straightening iron. The palmar surface of the hand is the most likely site. While most children do not require surgery, approximately 16% require grafting. A significant number of those patients need reconstructive surgery. Clearly, current prevention efforts have failed to reduce these injuries.

The Mobile Thriving Respite With and for the Street Community

2021 ◽  
pp. 002216782110467
Author(s):  
Robert McInerney ◽  
Kelsey Long ◽  
Rachel Stough
Keyword(s):  
Lived Experiences ◽  
Institutional Review Board ◽  
Short Term ◽  
Community Based ◽  
Bearing Witness ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Emergent Strategy ◽  
The Creation ◽  
Theoretical Foundations

We report on our work with the street community of Pittsburgh, specifically, a community-based action initiative we call the Mobile Thriving Respite (Institutional Review Board approval was obtained from our university). For 5 years, student advocate ethnographers from Point Park University have gathered data (e.g., long- and short-term interviews, participant-observations generating fieldnotes). The data revealed and supported the need for thriving beyond surviving homelessness. The data endorsed the creation of the mobile thriving respite. In the first part of this work, we will discuss some critical concepts regarding homelessness as a phenomenon and then argue that while surviving as enduring is necessary, there are some for whom survival is a perpetual, lethal state of being. We will discuss the theoretical foundations to the respite and offer researchers’ ethnographic accounts of the respite’s process and progress (We had to temporarily end the respite during the Covid-19 pandemic. To date, the respite has returned with “pop up” events outside at various locations). We will outline how the mobile thriving respite is a praxis as site of resistance as well as an emergent strategy, and an instantiation of communitas. We will then revisit surviving as collectively bearing witness and testifying to the lived experiences of those living outside.

scholarly journals Bone Mineral Density in Gravida: Effect of Pregnancies and Breast-Feeding in Women of Differing Ages and Parity

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Ehud Lebel ◽  
Yuri Mishukov ◽  
Liana Babchenko ◽  
Arnon Samueloff ◽  
Ari Zimran ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Institutional Review Board ◽  
Mineral Density ◽  
X Ray ◽  
Normal Limits ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
History Of ◽  
Breast Fed

Changes of bone during pregnancy and during lactation evaluated by bone mineral density (BMD) may have implications for risk of osteoporosis and fractures. We studied BMD in women of differing ages, parity, and lactation histories immediately postpartum for BMD,T-scores, andZ-scores. Institutional Review Board approval was received. All women while still in hospital postpartum were asked to participate. BMD was performed by dual-energy X-ray absorptiometry (DXA) machine at femoral neck (FN) and lumbar spine (LS) by a single technician. Of 132 participants, 73 (55.3%) were ≤30 years; 27 (20.5%) were primiparous; 36 (27.3%) were grand multiparous; 35 (26.5%) never breast fed. Mean FNT-scores andZ-scores were higher than respective mean LS scores, but all means were within the normal limits. Mean LST-scores andZ-scores were highest in the grand multiparas. There were only 2 (1.5%) outliers with lowZ-scores. We conclude that, in a large cohort of Israeli women with BMD parameters assessed by DXA within two days postpartum, meanT-scores andZ-scores at both the LS and FN were within normal limits regardless of age (20–46 years), parity (1–13 viable births), and history of either no or prolonged months of lactation (up to 11.25 years).

scholarly journals Feasibility of an Internet-Based Global Ranking Instrument

2011 ◽  
Vol 3 (1) ◽  
pp. 67-74 ◽  
Author(s):  
Seshadri C Mudumbai ◽  
David M Gaba ◽  
John Boulet ◽  
Steven K Howard ◽  
M. Frances Davies
Keyword(s):  
Institutional Review Board ◽  
University Teaching ◽  
Tertiary Referral ◽  
Single Item ◽  
Global Ranking ◽  
Online Technologies ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Referral Hospitals ◽  
Global Ratings

Abstract Background Single-item global ratings are commonly used at the end of undergraduate clerkships and residency rotations to measure specific competencies and/or to compare the performances of individuals against their peers. We hypothesized that an Internet-based instrument would be feasible to adequately distinguish high- and low-ability residents. Materials and Methods After receiving Institutional Review Board approval, we developed an Internet-based global ranking instrument to rank 42 third-year residents (21 in 2008 and 21 in 2009) in a major university teaching hospital's department of anesthesiology. Evaluators were anesthesia attendings and nonphysicians in 3 tertiary-referral hospitals. Evaluators were asked this ranking question: “When it comes to overall clinical ability, how does this individual compare to all their peers?” Results For 2008, 111 evaluators completed the ranking exercise; for 2009, 79 completed it. Residents were rank-ordered using the median of evaluator categorizations and the frequency of ratings per assigned relative performance quintile. Across evaluator groups and study years, the summary evaluation data consistently distinguished the top and bottom resident cohorts. Discussion An Internet-based instrument, using a single-item global ranking, demonstrated feasibility and can be used to differentiate top- and bottom-performing cohorts. Although ranking individuals yields norm-referenced measures of ability, successfully identifying poorly performing residents using online technologies is efficient and will be useful in developing and administering targeted evaluation and remediation programs.

scholarly journals Cerebral Air Emboli Differentially Alter Outcome after Cardiopulmonary Bypass in Rats Compared with Normal Circulation

2007 ◽  
Vol 107 (5) ◽  
pp. 768-775 ◽  
Author(s):  
Bettina Jungwirth ◽  
Kristine Kellermann ◽  
Manfred Blobner ◽  
Wolfgang Schmehl ◽  
Eberhard F. Kochs ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Institutional Review Board ◽  
Dose Effect ◽  
Regression Analyses ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Dependent Relation ◽  
Dose Dependent ◽  
Dose Escalating

Background Cerebral air emboli (CAE) are thought to contribute to adverse cerebral outcomes following cardiac surgery with cardiopulmonary bypass (CPB). This study was designed to investigate the effect of escalating volumes of CAE on survival and neurologic and histologic outcomes. In addition, the effect of xenon administration during CAE on these outcomes was determined. Methods With institutional review board approval, four groups were studied (n = 15). In two CPB-CAE groups, rats were subjected to 90 min CPB with 10 repetitively administered CAE. Rats in two sham-CAE groups were also exposed to CAE but not to CPB. Rats were randomly assigned to sequential dose cohorts receiving CAE ranging from 0.2 to 10 microl in a dose-escalating fashion. Groups were further subdivided into xenon (56%) and nitrogen groups. Rats with severe neurologic damage were killed; others were neurologically tested until postoperative day 7, when infarct volumes were determined. Survival and neurologic and histologic outcomes were tested with logistic regression analyses (P &lt; 0.05). Results This study demonstrates a dose-dependent relation between CAE volumes and survival, neurologic outcome, and histologic outcome. For all outcomes, CPB adversely affected the dose-effect curves compared with sham-CAE groups (P &lt; 0.05). Xenon demonstrated no impact on either outcome. Conclusions This study describes the successful incorporation of CAE in a rodent CPB model and allows identifying suitable CAE volumes for subsequent studies. CAE exhibit a differential effect on outcome in rats undergoing CPB versus those not exposed to CPB. Perioperative administration of xenon remained without any effect on outcome.

scholarly journals Cervical 3 to Cervical 6 Laminectomy for Arteriovenous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (5) ◽  
pp. E200-E200
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Arteriovenous Malformation ◽  
Surgical Resection ◽  
Video Recording ◽  
Institutional Review Board ◽  
Digital Subtraction ◽  
Pia Mater ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Complete Obliteration ◽  
System 1

Abstract According to the Spetzler spinal cord classification system,1 this patient had an extradural-intradural arteriovenous malformation (AVM), also known as a type III or juvenile AVM. The patient underwent a surgical resection of the lesion via a cervical 3 to cervical 6 laminoplasty. Direct observation confirmed intra- and extramedullary components. During the surgical resection, an attempt was made to avoid transgressing the pia mater. Therefore, the traversing vessels were interrupted during the circumdissection. The nidus was removed, and postprocedural digital subtraction angiography confirmed complete obliteration. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

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