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.

Posterior reversible encephalopathy syndrome in a patient with Richter's syndrome on combination DA-R-EPOCH chemotherapy regimen: a case report

Abstract: Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiologic entity characterized by headaches, altered mental status, seizures, visual loss, and a characteristic imaging pattern in brain magnetic resonance images. The exact etiology and pathogenesis of this condition are not yet fully elucidated. A 72-year-old White man presented with 2 weeks of low-grade fever and chills, night sweats, fatigue, dysphagia, and new-onset rapidly increasing cervical lymphadenopathy. He had a history of chronic lymphocytic leukemia with transformation to diffuse large B-cell lymphoma for which he was started on dose-adjusted rituximab, etoposide, prednisone vincristine, cyclophosphamide, and doxorubicin (DA-R-EPOCH). Shortly after treatment initiation, the patient developed severe airway obstruction due to cervical lymphadenopathy that required emergency intubation. A few days later, the cervical lymphadenopathy and the status of the airway improved, and sedation was consequently weaned off to plan for extubation. However, the patient did not recover consciousness and developed generalized refractory seizures. Brain magnetic resonance imaging revealed edema in the cortical gray and subcortical white matter of the bilateral occipital and inferior temporal lobes, consistent with PRES. Posterior reversible encephalopathy syndrome refers to a neurological disorder and imaging entity characterized by subcortical vasogenic edema in patients who develop acute neurological signs and symptoms of a usually reversible nature in different settings, including chemotherapy. Despite its name, PRES is not always fully reversible, and permanent sequelae can persist in some patients. Clinicians should be aware of the possible association between chemotherapy and PRES to ensure early recognition and timely treatment.

ICU Management of the Maxillofacial Surgery Patient

Abstract: Oral and maxillofacial surgery patients may require assessment for their critical care needs or admission to the intensive care unit (ICU) in the perioperative, postinjury, or other acute care settings. Patients who require the intensive care unit may have anatomical concerns, postoperative challenges related to airway patency, or any combination of concomitant trauma, pathology, or comorbid respiratory failure. In order to manage these acutely ill patients, the ICU should be equipped with advanced adjuvants to airway management, experienced providers, and assertive protocols to manage airways, treat infection, and manage the nonsurgical needs. This chapter will provide the foundation for critical care assessment, treatments, and needs in the maxillofacial surgery population.

Disorders of the Pancreas

Abstract: Although the human immunodeficiency virus (HIV) has not been isolated in pancreatic tissue (Bennett et al Mandell, Douglas, and Bennett’s principles and practice of infectious diseases Elsevier/Saunders, Philadelphia, 2015), infections and inflammatory conditions of the pancreas are common during the course of acquired immunodeficiency syndrome (AIDS) and contribute significantly to its associated morbidity and mortality HIV infection itself has been associated with an increased risk of clinical pancreatitis, but specific etiologies are broad These include antiretroviral medications, chemoprophylaxis drugs for opportunistic infections, malignancy, and the virus itself Similarly, bacterial, viral, fungal, and mycobacterial pathogens can contribute to the acute pancreatic inflammatory conditions The pancreas can serve as the primary nidus of infection or ultimately be involved after dissemination of opportunistic infections In addition, one must consider etiologies that are seen in the general population such as gallstones and complications of alcohol and intravenous drug abuse

Editorial - Unintended Consequences: Iatrogenic Disorders of the Medication Use System

Abstract: Though it’s a very simple statement, it’s not as easy as it seems to ‘‘do no harm.’’ A discussion I had with an anesthesiologist revealed his concerns that the emphasis on pain scores may be associated with unanticipated negative events. He may be right. According to a study published in 2005, researchers evaluated patient satisfaction data and adverse drug reaction (ADR) data before and after updated pain management standards incorporated ‘‘pain as the fifth vital sign’’ at H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida. Although patient satisfaction data improved, they reported that opioid ADRs and opioid oversedation or respiratory depression increased after implementation. As a result, the researchers reported that the institution implemented an updated pain/consciousness rating scale that incorporated clinical assessment of patient consciousness in addition to a numeric pain scale. Risk Evaluation and Mitigation Strategies (REMS) programs were developed with the objective of ensuring that the benefits of a drug or biological product outweigh its risks. I had been frustrated with the variation in processes outlined by various REMS programs and attended a session at the 2010 American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting that focused on these programs. One presenter shared a review of the iPledge program for isotretinoin distribution at Kaiser Permanente. Although the program is intended to prevent pregnancies in females taking the drug and prevent drug administration to pregnant patients, one study revealed that an unintended consequence of the program has been reduced prescribing for the drug overall, including male patients. I walked out of the session more frustrated than before. Not only has it been challenging to implement REMS programs in the inpatient setting, but these programs may have unknown negative effects. Recently approved meaningful use regulations have incorporated computerized prescriber order entry (CPOE), which will promote its adoption nationally. The Leapfrog Group has praised the move, but cautioned that health systems are not required to demonstrate that their CPOE systems work as intended before federal funds are awarded. Although CPOE systems reduce the occurrence of some error types, studies have documented error types that are undetected, or are even introduced, by these technologies. In their statement, The Leapfrog Group cited one of their recent reports that revealed that half of the errors evaluated in a simulation study among 214 hospitals were undetected by the CPOE systems. In another study, researchers categorized unintended adverse consequences observed at 5 hospitals with CPOE. The authors defined these categories as more/new work for clinicians, unfavorable workflow issues, neverending system demands, problems related to paper persistence, untoward changes in communication patterns and practices, negative emotions, generation of new kinds of errors, unexpected changes in the power structure, and overdependence on the technology. In a separate study, the same researchers further evaluated the effects of overdependence on CPOE technology. Three prominent problems included patient safety compromise and practice disruption during system downtime, false expectations for accuracy and processing, and a perception that clinicians cannot work efficiently in the absence of CPOE. A trial conducted at 2 academic medical centers in Philadelphia evaluated the impact of a nearly hard-stop intervention to reduce the concomitant use of warfarin and sulfamethoxazole/ trimethoprim. The trial was halted early because 4 patients experienced clinically significant delays due to the intervention when immediate therapy was indicated. In the New England Journal of Medicine last fall, The Joint Commission addressed ORYX core quality measures that have been designated as accountability

Use and Application Of MAUDE In Patient Safety

Abstract: The world health organization defines patient safety as the “absence of preventable harm to a patient during the process of health care and reduction of risk of unnecessary harm associated with health care to an acceptable minimum.” Each day hundreds of thousands of medical devices are utilized for delivering care to patients. As healthcare professionals, it is imperative that we prevent errors, apply lessons learned from our past errors to improve future patient outcomes. The Manufacturer and User Facility Device Experience (MAUDE) database is an online searchable and publicly accessible repository developed by the United States Food and Drug Administration (FDA) for systematic data collection of adverse outcomes related to the medical devices.