Detroit Receiving Hospital

About: Detroit Receiving Hospital is a healthcare organization based out in Detroit, Michigan, United States. It is known for research contribution in the topics: Vancomycin & Population. The organization has 877 authors who have published 850 publications receiving 37202 citations. The organization is also known as: Detroit General.

Appropriateness of Bolus Antihypertensive Therapy for Elevated Blood Pressure in the Emergency Department.

Abstract: Introduction: While moderate to severely elevated blood pressure (BP) is present in nearly halfof all emergency department (ED) patients, the incidence of true hypertensive emergencies inED patients is low. Administration of bolus intravenous (IV) antihypertensive treatment to lowerBP in patients without a true hypertensive emergency is a wasteful practice that is discouragedby hypertension experts; however, anecdotal evidence suggests this occurs with relatively highfrequency. Accordingly, we sought to assess the frequency of inappropriate IV antihypertensivetreatment in ED patients with elevated BP absent a hypertensive emergency. Methods: We performed a retrospective cohort study from a single, urban, teaching hospital.Using pharmacy records, we identified patients age 18-89 who rec eived IV antihypertensivetreatment in the ED. We defined treatment as inappropriate if documented suspicion for anindicated cardiovascular condition or acute end-organ injury wa s lacking. Data abstractionincluded adverse events and 30-day readmission rates, and analy sis was primarily descriptive. Results: We included a total of 357 patients over an 18-month period. The mean age was 55;51% were male and 93% black, and 127 (36.4%) were considered in appropriately treated.Overall, labetalol (61%) was the most commonly used medication, followed by enalaprilat(18%), hydralazine (18%), and metoprolol (3%). There were no significant differences betweenappropriate and inappropriate BP treatment groups in terms of clinical characteristics oradverse events. Hypotension or bradycardia occurred in three (2%) patients in the inappropriatetreatment cohort and in two (1%) patients in the appropriately treated cohort. Survival todischarge and 30-day ED revisit rates were equivalent. Conclusion: More than one in three patients who were given IV bolus antihypertensive treatmentin the ED received such therapy inappropriately by our definitio n, suggesting that significantresources could perhaps be saved through education of providers and development of clearlydefined BP treatment protocols.

Massive bone allografts for limb salvage.

Abstract: tion, massive bone allografting for limb salvage is a useful alternative to metallic implants and endoprostheses. Failure and complication rates of allografts are high but these problems can be treated successfully. Approximately 75% of patients will survive the first 3 years after the initial allograft. during which most complications

Automating reports with microsoft word.

Abstract: Automating the production of routine reports does not necessarily require programming in a traditional computer language. If you are conversant with Microsoft Word, its macro facility will allow you to develop a customized report generator in a familiar environment with only a modest amount of programming. Furthermore, Word will take care of many important details, including the length of lines, automatic centering of text, and printer support. While the programming requires some work, the resulting report generator will save considerable time and can be mastered by a novice.

Pharmacodynamic characterization of nephrotoxicity associated with once-daily aminoglycoside

Abstract: Study Objective. To characterize nephrotoxicity associated with an individualized serum concentration target-specific, once-daily aminoglycoside (ODA) program. Design. Concurrent and retrospective study. Setting. University-affiliated trauma hospital. Patients. Two hundred patients treated with ODA and 100 treated with individualized traditional dosing (TDA). Interventions. Empiric dosing for both groups was based on patient-specific pharmacokinetics and severity of infection. Regimens were modified according to predetermined target maximum and minimum serum concentrations for both groups. Measurements and Main Results. Nephrotoxicity occurred in 7.5% patients treated with ODA and 14.7% receiving TDA (p=0.05). Minimum serum concentrations, length of aminoglycoside therapy, and cumulative area under the curve (AUC) were all dependently related to nephrotoxicity, and concomitant vancomycin and other nephrotoxic drugs were independently related to the disorder. The cumulative AUC was greatest in patients receiving TDA (p=0.03), and the modeled probability of becoming toxic at any given cumulative AUC was significantly greater with TDA than with ODA (p<0.01). Clinical and microbiologic outcomes were similar between groups. Maximum concentration:minimum inhibitory concentration ratios were higher (p<0.01) and number of days to organism eradication was shorter in the ODA group (p=0.04). Conclusion. The trend was toward decreased nephrotoxicity in patients treated with ODA compared with TDA, and at any given cumulative AUC, the risk of toxicity was lower for ODA.