Saint Francis University

About: Saint Francis University is a education organization based out in Loretto, Pennsylvania, United States. It is known for research contribution in the topics: Population & Osteoblast. The organization has 1694 authors who have published 2038 publications receiving 87149 citations.

Evaluation of i.v. medication waste

Abstract: As hospitals nationwide face budget restrictions and demands for decreased costs, pharmacy departments are increasingly pressured to discover new ways to save money. Many avenues have been explored, including enhanced formulary management, use of optimal vial sizes and multidose vials, and decreased

Safety and Tolerance of Enteral Nutrition in the Medical and Surgical Intensive Care Unit Patient Receiving Vasopressors.

Abstract: BACKGROUND Multiple societal guidelines recommend enteral nutrition (EN) be initiated within 24 to 48 hours of admission to the intensive care unit (ICU) once a patient is hemodynamically stable. Gastrointestinal intolerance and occurrence of bowel ischemia have been a concern for patients receiving vasopressors while concurrently receiving luminal nutrients. The study objective was to determine whether patients receiving vasopressors while concomitantly receiving enteral nutrients had more incidences of bowel ischemia and intolerance than those receiving EN without vasopressor agents. METHODS This retrospective study included 319 medical and surgical ICU patients from a level 1 trauma center. The patients were either receiving vasopressors simultaneously with EN (n = 178) or EN alone (n = 141). Data regarding gastric residual volume (GRV), new abdominal pain, emesis, and bowel ischemia were collected. RESULTS There were more patients who had elevated GRV in the group that received vasopressors than patients who did not (20% vs 7%; P-value < .01). There were no differences between rates of bowel ischemia, emesis, or new abdominal pain between the 2 groups. CONCLUSION Based on our findings, EN is generally well tolerated and safe for those patients simultaneously receiving vasopressors.

Generalized cerebral atrophy seen on MRI in a naturally exposed animal model for creutzfeldt-jakob disease

Abstract: Background: Magnetic resonance imaging has been used in the diagnosis of human prion diseases such as sCJD and vCJD, but patients are scanned only when clinical signs appear, often at the late stage of disease. This study attempts to answer the questions “Could MRI detect prion diseases before clinical symptoms appear?, and if so, with what confidence?” Methods: Scrapie, the prion disease of sheep, was chosen for the study because sheep can fit into a human sized MRI scanner (and there were no large animal MRI scanners at the time of this study), and because the USDA had, at the time of the study, a sizeable sample of scrapie exposed sheep, which we were able to use for this purpose. 111 genetically susceptible sheep that were naturally exposed to scrapie were used in this study. Results: Our MRI findings revealed no clear, consistent hyperintense or hypointense signal changes in the brain on either clinically affected or asymptomatic positive animals on any sequence. However, in all 37 PrP Sc positive sheep (28 asymptomatic and 9 symptomatic), there was a greater ventricle to cerebrum area ratio on MRI compared to 74 PrP Sc negative sheep from the scrapie exposed flock and 6 control sheep from certified scrapie free flocks as defined by immunohistochemistry (IHC). Conclusions: Our findings indicate that MRI imaging can detect diffuse cerebral atrophy in asymptomatic and symptomatic sheep infected with scrapie. Nine of these 37 positive sheep, including 2 one-year old animals, were PrP Sc positive only in lymph tissues but PrP Sc negative in the brain. This suggests either 1) that the cerebral atrophy/neuronal loss is not directly related to the accumulation of PrP Sc within the brain or 2) that the amount of PrP Sc in the brain is below the detectable limits of the utilized immunohistochemistry assay. The significance of these findings remains to be confirmed in human subjects with CJD.

Biatrial and right ventricular deformation imaging: Implications of the recent EACVI consensus document in the clinics and beyond

Abstract: In this review, right ventricular (RV), right atrial (RA), and left atrial (LA) strain in some selected clinical situations has been discussed in light of the current literature. To exemplify the significance of the use of multichamber strain, we have provided some illustrations of common cardiac problems. The recently published European Association of Cardiovascular Imaging (EACVI) consensus document for standardization of RV, RA, and LA strain, using the currently available software, has fulfilled the aspirations of investigators world over who have been studying atrial strain using a bailed-out algorithm designed principally to quantify left ventricular deformation. The purpose of this review was to reiterate the value of the application of RV and biatrial strain imaging in research and day-to-day clinical practice, using the 2-dimensional speckle tracking echocardiography (2D-STE). Also, we present a short report on how RA strain may remain coupled to pulmonary hemodynamics. Besides, we have highlighted the technical challenges of atrial strain quantification. We have not used the nomenclature of chamber deformation proposed by the EACVI document as the publications cited in this review have used different sets of nomenclature.

Is It Time to Reconsider Prophylactic Cranial Radiation in Non–Small-Cell Lung Cancer?

Abstract: TO THE EDITOR: In their recent article in Journal of Clinical Oncology, Johung et al report prolonged survival in patients with brain metastasis from ALK-rearranged non–small-cell lung cancer (NSCLC) when treated with radiotherapy (RT; stereotactic radiosurgery [SRS] or whole-brain radiotherapy [WBRT]), along with tyrosine kinase inhibitor (TKI) therapy. The authors highlight the critical importance of the interventions for controlling intracranial disease in this particular subtype of patients with NSCLC. Although 30% of patients had brain metastases at the time of initial diagnosis and no prior TKI therapy, 49% of patients in the study had started ALK-targeted TKIs before the development of their brain metastases. However, it is not clearly stated if, when, for how long, and in what fraction of these patients the TKIs were interrupted, continued, or restarted during or after the RT. This piece of information may have therapeutic implications in the control of not only extracranial disease but also of CNS disease. Blood-brain barrier (BBB) disruption can be induced by irradiation. RTwith doses of 20 to 30Gywith fraction size of 2Gymay increase the permeability of the BBB to enhance the effect of systemic anticancer therapy. Poor penetration of TKIs through the BBB hinders the anticancer efficacy of these drugs in metastatic brain tumors. Alternative dosing schemes and/or increased doses have been suggested for patients who have systemic disease control but CNS progression while they are receiving crizotinib. An analysis of the first-line RT delivery (SRS v WBRT) in the study by Johung et al shows no difference in survival, but there is a trend toward increased failure of brain therapy for those patients who received first-line SRS as opposed toWBRT. Could this suggest a lesser disruption of the BBB with SRS and lesser penetration of systemic anticancer therapy to the rest of the brain? Prior randomized controlled trials and several prospective and retrospective studies have evaluated the role of prophylactic cranial radiation (PCI) in the general population of patients with locally advanced NSCLC. All of these studies have consistently shown a decrease and/or delay in brain metastases with PCI without major differences in global cognitive function or quality of life. The lack of overall survival benefit, however, has been partly attributed to poor extracranial disease control and/or poor performance status of the general population of patients with NSCLC. The population of patients with ALK-rearranged NSCLC in the study mostly presented with stage IV disease but only 30% of them had brain metastases at the time of diagnosis. The patients’ median overall survival time was more than 4 years. A majority of patients (74%) presented with multiple brain metastases but excellent performance status (80%). We commend the authors of the study for their hypothesisgenerating work. Although we agree with the authors, that interventions to control intracranial disease are critical, on the basis of all this information, we cannot help but wonder about and reconsider the possible utility of PCI in this particular patient population. PCI might help not only by having a direct effect on micrometastatic CNS disease but also by increasing the permeability of the BBB to the antitumor effects of TKIs. Future studies that evaluate the role of PCI with or without TKIs in this particular setting can be informative and helpful.