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.

Trust, mistrust, racial identity and patient satisfaction in urban African American primary care patients of nurse practitioners.

Abstract: PURPOSE: To analyze relationships between cultural mistrust, medical mistrust, and racial identity and to predict patient satisfaction among African American adults who are cared for by primary-care nurse practitioners using Cox's Interaction Model of Client Health Behaviors. DESIGN: A descriptive-correlational study was conducted with a convenience sample of 100 community-dwelling adults. METHODS: Participants completed the Cultural Mistrust Inventory; Group Based Medical Mistrust Scale; Black Racial Identity Attitude Scale; Trust in Physician Scale; Michigan Academic Consortium Patient Satisfaction Questionnaire; and provided demographic and primary care data. ANALYSIS: Correlations and stepwise multiple regression techniques were used to examine the study aims and correlational links between the theoretical constructs of client singularity, client-professional interaction, and outcome. FINDINGS AND CONCLUSIONS: Cox's model indicated a complex view of African American patients' perspectives on nurse practitioners. Participants simultaneously held moderate cultural mistrust of European American providers and mistrust of the health care system, and high levels of trust and satisfaction with their nurse practitioners. One racial identity schema (conformity) and trust of nurse-practitioner (NP) providers explained 41% of variance in satisfaction. CLINICAL RELEVANCE: An African American patient's own attitudes about racial identity and the client-professional relationship have a significant effect on satisfaction with primary care.

Tolerability of bolus versus continuous gastric feeding in brain-injured patients.

Abstract: Brain injured patients may exhibit altered gastric emptying; thus, some believe post-pyloric feeding to be tolerated better than gastric feeding Reliable post-pylorus access can be difficult to obtain, so gastric feeding remains the preferred route for administering nutrition Feeding intolerance may be associated with increased complications and costs We sought to compare bolus (B) versus continuous (C) gastric feeding in brain injured patients This retrospective cohort study was carried out at a neurological/neurosurgical intensive care unit at a Level 1 trauma and tertiary referral center Our subjects were 152 consecutive patients over two years Use of B or C feedings was based on clinicians' preferences Abdominal examination and gastric residuals (> 75 mL over four hours) defined feeding intolerance (FI) Putative risks for FI were compared between the groups Demographic characteristics were similar between groups B (n = 86) and C (n = 66) Feeding intolerance occurred more often in group B than in group C (605% vs 379%, p = 0009) Group C patients achieved 75% of nutritional goals faster than group B patients (median 33 vs 46 days; p = 003) Prokinetic agent use was similar between the groups and did not reduce the time to achieve nutritional goals There was a trend towards a reduction in the incidence of infections in group C (p = 005) Independent predictors of FI included: sucralfate (OR 23), propofol (OR 21), pentobarbital (OR 39) or paralytic (OR 3) use; older age (OR 5); days receiving mechanical ventilation (OR 12); and admission diagnosis of either intracerebral hemorrhage (OR 22) or ischemic stroke (OR 19) Continuous gastric feeding is better tolerated than B feedings in patients with acute brain injuries Use of prokinetic agents did not affect time to achievement of nutritional goals Use of common medications including sucralfate and propofol were associated with FI

Validation of the effectiveness of a vancomycin nomogram in achieving target trough concentrations of 15-20 mg/L suggested by the vancomycin consensus guidelines.

Abstract: Study Objective. To assess and validate the effectiveness of a newly constructed vancomycin dosing nomogram in achieving target trough serum concentrations of 15–20 mg/L. Design. Prospective multicenter study. Setting. Five tertiary care teaching hospitals. Patients. A total of 200 adults who required vancomycin dosages targeted to attain recommended trough vancomycin serum concentrations of 15–20 mg/L. Intervention. The new nomogram, which based dosing on weight and renal function, was used to calculate patients' initial vancomycin dosages. Serum trough concentrations were measured before the fourth or fifth dose, and dosages were adjusted as needed. Measurements and Main Results. Median patient age was 56 years (interquartile range [IQR] 49–65 yrs), median weight was 71.2 kg (IQR 63–85 kg), and median creatinine clearance was 66.5 ml/minute (IQR 52–82 ml/min). The median initial vancomycin trough concentration achieved was 17.5 mg/L (IQR 15.0–20.0 mg/L), with 116 patients (58%) achieving the initial target trough of 15–20 mg/L. The median percent error was 13.6%, and the mean ± SD error for predicted versus actual serum trough concentrations was −0.50 ± 0.021 mg/L. One hundred fifty-four patients (77%) eventually achieved the trough target concentration within a median of 2 days. One hundred forty patients (70%) achieved initial troughs of 14–21 mg/L and 160 (80%) achieved troughs of 13–22 mg/L. Nine patients (4.5%) experienced nephrotoxicity while receiving vancomycin, which occurred after a median of 8 days of therapy. The median initial vancomycin trough concentration for these patients was 18.5 mg/L (IQR 15.3–19.3 mg/L), with eight of the nine patients having trough concentrations of 15 mg/L or greater. Conclusion. Fifty-eight percent of patients achieved the target trough of 15–20 mg/L (median 17.5 mg/L). The performance of the nomogram improved to 80% when the trough range was adjusted to 13–22 mg/L. Caution should be applied when using this nomogram. The nomogram should not replace clinical judgment, and dosage adjustments should be based on pharmacokinetic-pharmacodynamic targets and clinical response.