Mitigation of ED Patient Boarding: Transferring Admissions from the Center City ED to Methodist

Objectives: Objectively analyze transferred patient transfers cases as far as LOS (length of stay), final diagnosis, and transfer failure. Assess patient satisfaction with the transfer process as means to identify areas for improvement as well as potential patient safety issues

Emergency reversal of antiplatelet agents in patients presenting with an intracranial hemorrhage: A clinical review

Abstract Objective: Prehospital use of antiplatelet agents has been associated with an increased risk for ICH as well as a secondary increase in ICH volume after the initial hemorrhage. Strategies to reestablish platelet aggregation are used in clinical practice, but without any established guidelines or recommendations. This article serves to evaluate the literature regarding “reversal” of antiplatelet agents in neurosurgical populations. Methods: PUBMED and MEDLINE databases were searched for publications from 1966 to 2009 relating to intracranial hemorrhage and antiplatelet agents. The reference sections of recent articles, guidelines and reviews were reviewed and pertinent articles identified. Studies were classified by two broad subsets; those describing intracranial hemorrhage relatable to a traumatic mechanism and those with a spontaneous intracranial hemorrhage. Two independent auditors recorded and analyzed study design and the reported outcome measures. Results: For the spontaneous intracranial hemorrhage group, 9 reports assessing antiplatelet effects on various outcome measures were identified. Eleven studies evaluating the use of prehospital antiplatlets prior to a traumatic intracranial hemorrhage were examined. Conclusion: The data assessing the relationship between outcome and prehospital antiplatelet agents in the setting of ICH is conflicting in both the trauma and the stroke literature. Only one retrospective review specifically addressed outcomes after attempted reversal with platelet transfusion. Further study is needed to determine whether platelet transfusion ameliorates hematoma enlargement and/or improves outcome in the setting of acute ICH

Case Report: Hemorrhage into an Occult Spinal Ependymoma after Epidural Anesthesia

Epidural anesthesia is a procedure which is well tolerated and has a low incidence of adverse events. In performing caesarean sections, regional anesthesia (spinal or epidural) is the preferred modality for anesthetic delivery. Although rare with continuous epidural anesthesia, epidural hematomas have been reported to occur with an incidence between 1:150,000 and 1:190,00010. An underlying bleeding diathesis has been implicated as a causative factor. We present the sixth reported case of hemorrhage into an occult intradural neoplasm after spinal or epidural anesthesia. Similar lesions have not been reported in the recent spine literature

Simulated spinal cerebrospinal fluid leak repair: an educational model with didactic and technical components.

BACKGROUND: In the era of surgical resident work hour restrictions, the traditional apprenticeship model may provide fewer hours for neurosurgical residents to hone technical skills. Spinal dura mater closure or repair is 1 skill that is infrequently encountered, and persistent cerebrospinal fluid leaks are a potential morbidity. OBJECTIVE: To establish an educational curriculum to train residents in spinal dura mater closure with a novel durotomy repair model. METHODS: The Congress of Neurological Surgeons has developed a simulation-based model for durotomy closure with the ongoing efforts of their simulation educational committee. The core curriculum consists of didactic training materials and a technical simulation model of dural repair for the lumbar spine. RESULTS: Didactic pretest scores ranged from 4/11 (36%) to 10/11 (91%). Posttest scores ranged from 8/11 (73%) to 11/11 (100%). Overall, didactic improvements were demonstrated by all participants, with a mean improvement between pre- and posttest scores of 1.17 (18.5%; P = .02). The technical component consisted of 11 durotomy closures by 6 participants, where 4 participants performed multiple durotomies. Mean time to closure of the durotomy ranged from 490 to 546 seconds in the first and second closures, respectively (P = .66), whereby the median leak rate improved from 14 to 7 (P = .34). There were also demonstrative technical improvements by all. CONCLUSION: Simulated spinal dura mater repair appears to be a potentially valuable tool in the education of neurosurgery residents. The combination of a didactic and technical assessment appears to be synergistic in terms of educational development

Small Bowel Obstruction: Facilitating Diagnosis and Optimizing Resuscitation and Management

Objective Standardize practice patterns and improve consistency in procedure documentation in ED management of Small Bowel Obstruction (SBO) Significant practice variability exists among ED providers for SBO management, specifically in regard to utilization of diagnostic imaging as well as rates of NG tube (NGT) placement and subsequent documentation Data review performed by our group demonstrated that of all NG tubes placed, only 61% were documented Wide range of practice patterns for diagnostic imaging (see graphics in Results

Human Resource Management in Health Care Industries for Generation Y: Challenges of the 21st Century

Frequent turnover is observed in health care industries worldwide. The purpose of this study was to determine the impacts of management initiatives and soft HRM on Generation Y (Gen Y) employee retention to combat the massive losses due to Gen Y\u27s high turnover rates. This study collected the survey data from 500 Gen Y health care providers employed by private hospitals and clinics in Bangladesh. Partial least squares structural equation modelling (PLS-SEM) was used to analyse the model to assess the parameters in the path model. The findings show the significant positive effects of management initiatives and soft HRM on Gen Y employees\u27 retention. Thus, this research contributes to the body of knowledge related to healthcare industries by enriching the perception of management initiatives and soft HRM on employee retention. Furthermore, this study found significant positive effects of management initiatives and soft HRM on Gen Y employee retention mediating through job satisfaction

Performance analysis of the overcurrent protection for the renewable distributed generation dominated microgrids

This paper aims to present a study of the conventional protection scheme i.e. overcurrent (OC) protection’s malfunctioning in the microgrids dominated by inverter interfaced distributed generator (IIDG) under a range of scenarios by injecting faults at different locations of the network. Due to low cost and inherent back-up protection, overcurrent scheme is considered to be the main protection for the distribution networks and microgrids. However, the integration of IIDG in large number might introduce several protection challenges for microgrids. Existing literature discusses the protection issues that might arise in microgrids due to addition of distributed generation, but those challenges are not practically studied. Hence, in this paper, several fault cases are simulated by changing fault positions and using different combinations of IIDGs in the network so that protection challenges can be fully explored and performance of the overcurrent relays in the IIDG dominated microgrids can be analysed under those simulated cases

The Financial and Psychosocial Impact of Medicinal Cannabis

Introduction: Therapeutic utilization of medicinal cannabis for symptom management in oncology patients is a burgeoning area of research focus. We hypothesize that medicinal cannabis use can result in subjective improvements in quality of life (QOL) metrics for cancer patients. Methods: Adult palliative care patients at a medical oncology clinic are consented to the study after being certified to access medicinal cannabis. After three months, subjective changes in QOL, including well-being, financial burden, pain, chemotherapy induced nausea and vomiting (CINV), and other categories are recorded via telephone interview. Responses are documented with a numerical Likert scale (from 1-5, with a score of 1 = greatly decreased satisfaction, and 5 = greatly increased satisfaction; a score of 3 is no change from baseline). Scores \u3e3.5 were deemed meaningful in terms of improvement. Results: An aggregate of 35 patient scores showed meaningful increases in subjective satisfaction across most metrics. Satisfaction with CINV symptoms showed the most marked improvement, with an average score of 3.63. While pain scores were similar at 3.53, more general QOL metrics were lower, at 3.46. Most patients did not find the cost to be burdensome, with an average score of 3.03. Discussion: The initial 35 interviews of our desired n of 120 suggest that medicinal cannabis may provide analgesic, antiemetic, and anxiolytic benefits for cancer patients. We anticipate that additional interviews will follow this pattern. If so, our study could bolster the evidence that therapeutic use of medicinal cannabis may be helpful for patients undergoing cancer treatment