In Response: Maintenance ECT

Therapy resistance, relapsing illness, and rapid cycling are aspects of chronic affective illness that continue to frustrate us. ECT was re-introduced to answer the problem of therapy resistant depression. In their recent review, Matzen et al. (I), report their experience in eight cases treated with maintenance ECT. They argue that maintenance ECT should also be considered for relapsing depressive illness. No systematic study of maintenance ECT has been undertaken since the early I950s, and yet, as reported by Kramer (2) it continues to be used. Kramer directed inquiries to members of the International Association for the Advancement of Electrotherapy. Of 86 respondents, 51 reported they used maintenance treatments in 1986. Usage was small, however, approximately three patients per practitioner in a year. Despite the lack of experimentally derived guidelines, the procedures were relatively uniform. After an illness had responded to a course of ECT, treatments were given at weekly intervals, followed after a few weeks by bi-weekly, then monthly treatments. The treatment practice described by Matzen et al. are similar

Correspondence: From Max Michael, Jr. to G. Dekle Taylor on Jacksonville Hospitals Educational Program, Inc. Letterhead, 1968-11-20

This letter contains a discussion on the proposed survey and the future of the Duval Medical Cente

Improving Safety of Direct Oral Anticoagulant (DOAC) Dosing in Patients with Severe Chronic and End-Stage Renal Disease

The significance of this study is to determine the degree of inconsistency in dosing practice of DOACs at a quaternary care institution such as Thomas Jefferson University Hospital. What is the primary indication for anticoagulation in out population? What percentage is dosed correctly? Are patients primarily over or underdosed

The History of Urological Care and Training at Thomas Jefferson University

The Department of Urology at Thomas Jefferson University and Thomas Jefferson University Hospital is generally acknowledged as the oldest formal Department of Urology in the US, formally designated as the Department of Genitourinary Surgery in 1904. The Department has been under the direction of 8 chairmen and has trained over 144 residents and 25 fellows with over 200 Jefferson Medical College graduates specializing in urology. Thomas Jefferson University was originally founded as Jefferson Medical College in 1824. Dr. George McClelland petitioned Jefferson College at Cannonsburg (now Washington and Jefferson College) to add a medical school to their institution. While technically part of Jefferson College in western Pennsylvania, Jefferson Medical College was to be located in Philadelphia under the direction of the medical faculty. By 1838, Jefferson Medical College gained its own charter and was no longer affiliated with Jefferson College. As a proprietary school, the faculty administrated and managed all the finances of the school. This included the sale of “tickets” to attend lectures. An infirmary to treat the poor was established in 1825. This dispensary to treat indigent patients under student observation was the first instituted by any medical school in the United States. Eventually, all medical schools in the United States adopted Jefferson’s example of combining lectures with practical patient experience. In 1969 Thomas Jefferson University was established that incorporated Jefferson Medical College, the College of Allied Health Sciences, the College of Graduate Studies and the Jefferson Medical College Hospital

Evaluating the Efficacy of a Nursing-Driven versus Provider-Driven Heparin Protocol

At Thomas Jefferson University Hospital patients who require heparin infusions are monitored either by nursing alone or the resident and the nurse together. This project aims to determine: Which protocol more efficiently shortens the time to therapeutic? Are patients therapeutic longer under a certain protocol? Do more patients under either protocol suffer from bleeding complications

Actor engagement with service providers

Actor engagement has received significant scholarly and practitioner attention in recent years due to its anticipated outcomes and relevance for organisational success. Yet, despite significant interest in the concept, several theoretical gaps remain. Particularly, the literature has largely overlooked actor engagement with focal objects beyond the brand. Similarly, extant discourse lacks a comprehensive understanding of how actors engage differently. Thus, to better understand the nuances and intricacies of actor engagement beyond the existing focus of brands, and to discover how actors engage differently, this thesis centres on actor engagement with a service provider and delves into actor dispositions to engage. The service provider was chosen as a focal object due to their critical role in service organisations and the paucity of research specifically focused on service providers in an engagement context. The importance of service providers is well recognised, given that the success of service organisations largely depends upon their performance. Yet, engagement scholars have given scant attention to these crucial focal objects in the examination of the engagement concept. To address these knowledge gaps, this research presents three distinct but interrelated papers. The first paper examines actor engagement with service providers within a service system and extends the focus of engagement to multiple engagement foci. Specifically, the paper investigates how the individual dimensions of engagement with a service provider and brand combine to lead to engagement with the broader context. In brief, this paper contributes to an increased understanding of the integrated nature of engagement with a range of focal objects across different levels within a service system. The results suggest that engagement with the service provider facilitates engagement with other focal objects, which further validates the importance of examining actor engagement with service providers across the subsequent two papers. Paper two explores the factors that constitute an actor’s disposition to engage and responds to calls by numerous scholars to shed light on the nature of engagement dispositions. The findings of a series of in-depth interviews reveal three dimensions of engagement dispositions, namely individual actor traits, context-related actor characteristics, and focal object-related actor characteristics, with each dimension consisting of a unique make up of attributes. In total, 14 attributes were identified as constituents of an actor’s disposition to engage with a service provider. This paper contributes to the engagement literature by being the first to empirically consider what constitutes an actor’s disposition to engage and provides a conceptual framework that depicts the impact of engagement dispositions on actor engagement activities. Building on these insights, the third paper employs a survey methodology to empirically examine the impact of engagement dispositions on actor engagement activities. Specifically, it investigates the direct effects of individual attributes on affective, behavioural and cognitive engagement with the service provider. The findings illustrate that the dimensions of engagement dispositions and their constituent attributes have varied impacts on the dimensions of engagement. In particular, actor characteristics related to the focal object and context emerged as relevant for engagement activity, whereas no significant associations between individual actor traits and engagement activity were found. This provides insights into how each actor engages in a unique way. In summary, this research offers unique and meaningful theoretical and practical implications by emphasising the importance of the service provider as a focal object of engagement, providing a framework to consider an actor’s engagement disposition, as well as an understanding of the impact of engagement dispositions on specific engagement activities.Thesis (Ph.D.) -- University of Adelaide, Adelaide Business School, 201

Spinal anesthesia: should everyone receive a urinary catheter?: a randomized, prospective study of patients undergoing total hip arthroplasty.

BACKGROUND: The objective of this randomized prospective study was to determine whether a urinary catheter is necessary for all patients undergoing total hip arthroplasty under spinal anesthesia. METHODS: Consecutive patients undergoing total hip arthroplasty under spinal anesthesia were randomized to treatment with or without insertion of an indwelling urinary catheter. All patients received spinal anesthesia with 15 to 30 mg of 0.5% bupivacaine. The catheter group was subjected to a standard postoperative protocol, with removal of the indwelling catheter within forty-eight hours postoperatively. The experimental group was monitored for urinary retention and, if necessary, had straight catheterization up to two times prior to the placement of an indwelling catheter. RESULTS: Two hundred patients were included in the study. There was no significant difference between the two groups in terms of the prevalence of urinary retention, the prevalence of urinary tract infection, or the length of stay. Nine patients in the no-catheter group and three patients in the catheter group (following removal of the catheter) required straight catheterization because of urinary retention. Three patients in the catheter group and no patient in the no-catheter group had development of urinary tract infection. CONCLUSIONS: Patients undergoing total hip arthroplasty under spinal anesthesia appear to be at low risk for urinary retention. Thus, a routine indwelling catheter is not required for such patients

Outcomes Reporting in Regional Anesthesia Patients: A Comparison of Manual Phone Calls Versus Automated Phone App Messaging

Automation of patient follow-up via mobile phone apps have the potential to save time for physicians, standardize responses from patients, and increase the patient response rate. Studies that assess the effectiveness of mobile phone-based surveys have been favorable, with completion rates of about 60% in the surgical population. The impact of mobile phone-based patient management in anesthesia deserves further study. This study examines the follow-up success rates of (1) manual phone calls (the current standard of care) vs. (2) automated patient outreach (APO) in patients who receive a regional anesthesia block procedure. As part of normal follow up, anesthesia team members contact surgical patients who have received a regional nerve block to assess for potential side effects or complications. This study is comparing two different modes patient outreach. Patients will be randomized to receive either a manual phone call from a member of the anesthesia care team or the APO treatment. Of patients randomized to the APO treatment, automated messages will request the patient to download the “JeffAnesthesia” app and answer post-care surveys. Both treatment arms will contain the same survey questions. The primary endpoint, the follow-up success rate defined by a patient completing a set of survey questions, will be compared. Secondary endpoints, such as patient satisfaction, will also be recorded from the survey responses. Patient enrollment is ongoing, and data to formulate preliminary results is forthcoming to understand the impact of outreach modalities on patient outcomes reporting and satisfaction

Functional Outcomes after Lumbar Fusion in Opioid-Tolerant Patients

Introduction: Prolonged opioid use after lumbar fusion surgery is implicated with increased hospital readmissions, higher postoperative pain scores, and longer return to work time. There are several non-modifiable risk factors for postoperative opioid use including socioeconomic status and gender. The purpose of this study was to determine the effects of opioid-tolerance on PROMs and to determine risk factors for prolonged opioid use after lumbar spine surgery. Method: Using retrospective cohort analysis, patients who underwent lumbar spinal fusion at TJUH were identified and determined to be either opioid-naïve or opioid-tolerant using the Pennsylvania PDMP. Outcomes included number of opioid tablets consumed, duration of time using opioids, and patient-reported outcome measures (ODI, PCS-12, MCS-12, VAS Back, VAS Leg). Univariate and multivariate analysis were used to compare outcomes between the two groups. Logistic regression was used to determine independent predictors for prolonged opioid use which was defined as greater than one postoperative opioid prescription script filled. Results: A total of 260 patients were included in the final cohort, of which, 138 were opioid-tolerant and 122 were opioid naïve. Opioid-tolerant patients showed decreased improvement in PROMs compared to the opioid-naïve patients (p=0.043). The number of preoperative pills prescribed was a significant predictor for prolonged opioid use after lumbar fusion. Conclusion: The number of pills prescribed preoperatively was found to be a predictor for prolonged opioid use after lumbar fusion surgery. Overall, our results demonstrated that naïve patients have improved health-related quality of life outcome scores compared to opioid-tolerant patients after lumbar fusion