Showing papers by "Detroit Receiving Hospital published in 2013"

Carbapenem-resistant Acinetobacter baumannii: epidemiology, surveillance and management.

Abstract: Carbapenem-resistant Acinetobacter baumannii pose a significant threat to hospitalized patients, as therapeutic options are scarse Alarmingly, rates of carbapenem-resistance in A baumannii are on the rise and are slowly becoming a routine phenotype for this organism This review focuses on infection control strategies for identification and control of A baumannii, as well the available therapeutic options

Diagnosis and treatment of drug-induced hyperthermia

Abstract: Purpose The etiology, pathophysiology, clinical presentation, and management of drug-induced hyperthermia (DIH) syndromes are reviewed. Summary DIH syndromes are a rare and often overlooked cause of body temperature elevation and can be fatal if not recognized promptly and managed appropriately. There are five major DIH syndromes: (1) neuroleptic malignant syndrome, (2) serotonin syndrome, (3) anticholinergic poisoning, (4) sympathomimetic poisoning, and (5) malignant hyperthermia. The differential diagnosis of DIH syndromes can be challenging because symptoms are generally nonspecific, ranging from blood pressure changes and excessive sweating to altered mental status, muscle rigidity, convulsions, and metabolic acidosis. Evidence from the professional literature (per a MEDLINE search for articles published through November 2011) indicates that few currently available treatment options can reduce the duration of hyperthermia; therefore, prompt identification of the provoking agent based on the patient9s medication history, the clinical presentation, and the timing of symptom onset is essential to determine the appropriate treatment and mitigate potentially life-threatening sequelae. For all DIH syndromes, appropriate management includes the immediate discontinuation of the suspected offending agent(s) and supportive care (external cooling, volume resuscitation as needed); in some cases, pharmacologic therapy (e.g., a benzodiazepine, bromocriptine, dantrolene) may be appropriate, with the selection of a specific agent primarily determined by the medication history and suspected DIH syndrome. Conclusion DIH is a hypermetabolic state caused by medications and other agents that alter neurotransmitter levels. The treatment of DIH syndromes includes supportive care and pharmacotherapy as appropriate. Am J Health-Syst Pharm. 2013; 70:34-42

Lead toxicity and management of gunshot wounds in the lumbar spine

Abstract: Introduction Gunshot wounds are one of the commonest causes of spinal injury. Management of these patients differs from other blunt trauma injuries to the spine. We present a case of a gunshot wound to the lumbar spine that occurred in 1985 which was treated non-operatively.

Retrograde Versus Antegrade Intramedullary Nailing of Gunshot Diaphyseal Femur Fractures

Abstract: Background The use of retrograde nailing for gunshot wound femur fractures is controversial due to concerns of knee sepsis after this procedure since the knee is entered to introduce the nail into the canal.

Falls and balance confidence in persons with and without injection-related venous ulcers.

Abstract: OBJECTIVES:: With aging of injection users and the high occurrence of venous disease in their legs, falls are a potential health problem. We examined falls and balance confidence in persons with (VU+) and without (VU-) injection-related venous ulcers (VUs). METHODS:: This study used a cross-sectional, retrospective, comparative design with 31 participants VU+ and 30 VU- recruited in a medical clinic. Participants' legs were assessed for clinical manifestations of venous disease. Participants completed background and fall questionnaires and the Activities-specific Balance Confidence (ABC) Scale. RESULTS:: Participants included 35 men and 26 women (mean age = 54 years); 93% were African American. Falling in the past year was reported by 65% of patients VU+ and 40% VU- (P = 0.048); 29 of these patients fell 2 or more times in the past year. Higher scores on the ABC Scale (N = 61) were significantly related to fewer falls (r = -0.68). Activities-specific Balance Confidence scores were lower/worse for the patients VU+ (P = 0.039). Area under the receiver operating curve for patients VU+ was significant; we found area under the curve of 0.84 and a cutoff score of 80.3% for ABC predictive of recurrent fallers with sensitivity of 84% and specificity of 83%. The ABC test had an internal consistency reliability of 0.97. CONCLUSIONS:: Persons VU+ reported worse balance confidence and more falls than those without these ulcers. The ABC test was related to falls. With aging of injection users and increased occurrence of VUs, examining balance confidence and falls is crucial in long-term patient safety. Language: en

Robot-assisted right ureteral polypectomy: A case report.

Abstract: Ureteral polyps are a rare cause of ureteral obstruction in the adult and pediatric populations. Fibroepitheial polyps (FEP) are the most common type of ureteral polyps. This clinical entity is very rare, warranting periodic clinical review by practitioners, and new advancements in laparoscopy allow new surgical approaches to its cure. We present the case of a 20-year-old male with right sided flank pain. He was found to have right uretero-pelvic junction (UPJ) obstruction and subsequently underwent laparoscopic robotic-assisted right collecting system exploration, excision of polyps and right ureteropyeloplasty. Ureteral polyps were excised and determined to be fibroepithelial in origin based on the pathological report. Our case highlights the importance of having FEP in the differential diagnosis of ureteral obstruction. We also found that laparoscopic robot-assisted polypectomy is a safe and acceptable surgical option for the excision of ureteral polyps.

The prevalence of pain and its association with psychosocial factors for indigent adults enrolled in a primary care clinic

Abstract: OBJECTIVES Pain is a symptom reported in 50% to 70% of primary care visits and negatively impacts both physical and psychological functioning. People at risk of receiving inadequate management of pain include the indigent and people of color. The purpose of this exploratory, descriptive, cross-sectional study was to describe the prevalence of pain and its relation to functional status, depressive symptoms, perception of control over pain and coping in an urban, primary care clinic for indigent adults. METHODS Individuals (N=301) attending a primary care clinic for indigent adults were surveyed. Patients were 22 to 64 years of age, experienced pain during the past 2 weeks, and were able to understand and respond in English. RESULTS Ninety-two percent of the sample was African American and the average worst pain score was 8.4/10. The majority of patients had depression symptoms (77%), with pain most affecting patients' function with sleep, ability to work, and walking. Patients reporting higher pain scores had significantly lower perception of control over pain and reduced control over life in general. Higher reported pain levels were also significantly correlated with higher catastrophizing, depressive symptoms, and interference with function scores. DISCUSSION Pain levels were reported as high and affected psychological and physical functioning. This study was unique in the high percentage of African American participants and being conducted in a primary care clinic for indigent adults. Greater understanding of this population's pain will assist clinicians to assess pain comprehensively, provide education, and make treatment decisions for these patients.

Neurophysiological monitoring with brainstem evoked potentials can be a valuable tool for patients undergoing vertebrobasilar stenting and angioplasty-initial experience.

Abstract: Introduction:Brainstem auditory evoked potentials (BAEPs) are routinely used during a variety of intracranial surgeries involving the posterior fossa and endovascular procedures including coiling of cerebral aneurysms. However, use of BAEPs has not been reported in vertebrobasilar stenting.Methods:S