How good are we at determining risk? Quantifying the accuracy of clinician determined risk for VTE prophylaxis

Objectives: Create and validate a simple tool for concurrent audits of risk stratification, compliance and documentation Evaluate accuracy of clinician risk stratification and prophylatic ordering practice compared with a standardized Caprini RAM across different assigned risk categories Provide recommendations for EPIC VTE Prophylaxis CDS Developmenthttps://jdc.jefferson.edu/patientsafetyposters/1050/thumbnail.jp

Quantifying Patient Reported and Documented Compliance with Adjuncts to Venous Thromboembolism Prophylaxis

Objectives: 1. Measure patient compliance with pharmacologic, mechanical and ambulatory prophylactic measures. 2. Evaluate for agreement between nursing documentation and patient reported compliance with mechanical and ambulatory prophylactic measures.https://jdc.jefferson.edu/patientsafetyposters/1042/thumbnail.jp

Sepsis in two hospitals in Rwanda: A retrospective cohort study of presentation, management, outcomes, and predictors of mortality.

PURPOSE: Few studies have assessed the presentation, management, and outcomes of sepsis in low-income countries (LICs). We sought to characterize these aspects of sepsis and to assess mortality predictors in sepsis in two referral hospitals in Rwanda. MATERIALS AND METHODS: This was a retrospective cohort study in two public academic referral hospitals in Rwanda. Data was abstracted from paper medical records of adult patients who met our criteria for sepsis. RESULTS: Of the 181 subjects who met eligibility criteria, 111 (61.3%) met our criteria for sepsis without shock and 70 (38.7%) met our criteria for septic shock. Thirty-five subjects (19.3%) were known to be HIV positive. The vast majority of septic patients (92.7%) received intravenous fluid therapy (median = 1.0 L within 8 hours), and 94.0% received antimicrobials. Vasopressors were administered to 32.0% of the cohort and 46.4% received mechanical ventilation. In-hospital mortality for all patients with sepsis was 51.4%, and it was 82.9% for those with septic shock. Baseline characteristic mortality predictors were respiratory rate, Glasgow Coma Scale score, and known HIV seropositivity. CONCLUSIONS: Septic patients in two public tertiary referral hospitals in Rwanda are young (median age = 40, IQR = 29, 59) and experience high rates of mortality. Predictors of mortality included baseline clinical characteristics and HIV seropositivity status. The majority of subjects were treated with intravenous fluids and antimicrobials. Further work is needed to understand clinical and management factors that may help improve mortality in septic patients in LICs

Aristotle for the modern Ethicist

Elizabeth Anscombe and Mary Midgley discussed Aristotle’s ethics as an alternative to modern moral philosophy. This idea is best known from Anscombe’s 1958 paper ‘Modern Moral Philosophy’. The mainstream response has been to design a normative theory of ‘virtue ethics’ to rival deontology and consequentialism. This essay argues that that response is inadequate; it misses Anscombe’s point and obscures various aspects of Aristotle’s ethics, in particular his emphasis on friendship and human interconnectedness. This element of Aristotelianism was favoured by Midgley. By returning to Midgley, with the support of Aristotle, it is possible to find an alternative modern Aristotelianism in ethics

The BraveNet prospective observational study on integrative medicine treatment approaches for pain

BACKGROUND: Chronic pain affects nearly 116 million American adults at an estimated cost of up to $635 billion annually and is the No. 1 condition for which patients seek care at integrative medicine clinics. In our Study on Integrative Medicine Treatment Approaches for Pain (SIMTAP), we observed the impact of an integrative approach on chronic pain and a number of other related patient-reported outcome measures. METHODS: Our prospective, non-randomized, open-label observational evaluation was conducted over six months, at nine clinical sites. Participants received a non-standardized, personalized, multimodal approach to chronic pain. Validated instruments for pain (severity and interference levels), quality of life, mood, stress, sleep, fatigue, sense of control, overall well-being, and work productivity were completed at baseline and at six, 12, and 24 weeks. Blood was collected at baseline and week 12 for analysis of high-sensitivity C-reactive protein and 25-hydroxyvitamin D levels. Repeated-measures analysis was performed on data to assess change from baseline at 24 weeks. RESULTS: Of 409 participants initially enrolled, 252 completed all follow-up visits during the 6 month evaluation. Participants were predominantly white (81%) and female (73%), with a mean age of 49.1 years (15.44) and an average of 8.0 (9.26) years of chronic pain. At baseline, 52% of patients reported symptoms consistent with depression. At 24 weeks, significantly decreased pain severity (−23%) and interference (−28%) were seen. Significant improvements in mood, stress, quality of life, fatigue, sleep and well-being were also observed. Mean 25-hydroxyvitamin D levels increased from 33.4 (17.05) ng/mL at baseline to 39.6 (16.68) ng/mL at week 12. CONCLUSIONS: Among participants completing an integrative medicine program for chronic pain, significant improvements were seen in pain as well as other relevant patient-reported outcome measures. TRIAL REGISTRATION: ClinicalTrials.gov, NCT0118634

Il meticciato nell'Italia contemporanea. Storia, memorie e cultura di massa.

L'idea diffusa degli "italiani brava gente" e della diversit\ue0 della nostra storia rispetto alla storia USA, segnata da razzismo istituzionale, si fonda sul silenziamento del passato coloniale e razzista italiano. Il ripudio della categoria di razza da parte dell'Italia repubblicana e la smentita scientifica dell'esistenza biologica della categoria non hanno cancellato la presenza della razza, formazione storico-culturale che paradossalmente esiste e non esiste. Priva di referenti oggettivi nella realt\ue0, la razza produce in essa effetti significativi, opera sia come categoria sociale e strumento di esclusione, sia come costruzione simbolica e istanza identitaria. A fronte del silenziamento del meticciato storico nell'uso pubblico della storia e nella memoria nazionali del secondo dopoguerra, il saggio sottolinea la presenza diffusa del meticciato nei prodotti della cultura di massa italiani contemporanei e ne indaga i significati con gli strumenti degli studi critici sulla razza e in prospettiva comparata tra Italia e Stati Uniti

The Legend of George J. Willauer MD (1896-1977)

Outline: Childhood and early influences A highlight of his achievements His lasting legac

Barriers to Surgical Care at a Tertiary Referral Hospital in Kigali, Rwanda

Access to surgical care is a major public health crisis for many living in low and middle-income countries. Patients must often overcome barriers to care in order to access needed interventions. Using the Three Delays Model we aim to describe factors contributing to delayed surgical treatment for patients presenting to a tertiary hospital in Kigali, Rwanda. A cross-sectional interview-based pilot study was performed in which all patients undergoing surgery were asked questions to understand their pre-surgical interactions with the healthcare system. Over a three-week period, there were 24 (33%) general and 49 (67%) orthopedic surgery patients. The median number of days from first symptom to the decision to seek care was 1 day while the median number of days from the decision to seek care to arrival at the tertiary hospital was 9.5 days. There was a median of 2.25 days from the arrival at the hospital to surgery and the total time from first symptom to surgery was a median of 12.25 days. Patients experiencing barriers to care had significantly longer times from first symptom to the decision to seek care, as well as from arrival at the hospital to surgery (p \u3c .01). The most significant barriers in terms of impact on time from first symptom to surgery were encountered during the care seeking time period. The most common barriers encountered related to not knowing care was needed, issues with transportation, and surgeon or operating room availability. Initiatives are needed in order to address these barriers. Educational programs designed to help patients identify key danger signs would encourage earlier presentation to providers. Systems based projects to improve road conditions could enhance transport to facilities. Furthermore, training providers at District Hospitals to perform essential surgeries would reduce delays, as well as improve access to both surgeons and operating rooms