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Institution

Saint Francis University

EducationLoretto, Pennsylvania, United States
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.


Papers
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Journal ArticleDOI
TL;DR: 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.
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
30 Apr 2021
TL;DR: The MAUDE database as discussed by the authors 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.
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.
Journal ArticleDOI
TL;DR: The mortality benefit of corticosteroids appears to be greatest in septic shock patients with high vasopressor requirements, evidence of multiorgan failure, and primary lung infections.
Abstract: Purpose The utility of low-dose corticosteroids in septic shock is reviewed. Summary Low-dose corticosteroids are suggested as treatment for septic shock patients who remain hemodynamically unstable despite adequate fluid resuscitation and vasopressor therapy. However, the risks and benefits of corticosteroids are unclear in this patient population. Previous multicenter trials have yielded conflicting results on the survival benefits of corticosteroids. The recently published Adjunctive Corticosteroid Treatment in Critically Ill Patients with Septic Shock (ADRENAL) and Activated Protein C and Corticosteroids for Human Septic Shock (APROCCHSS) trials provide valuable but opposing insight into this ongoing debate. Discordant findings related to mortality in these trials are likely related to differences in study design, corticosteroid regimen, and baseline characteristics among enrolled patients. The utility of adding fludrocortisone to hydrocortisone compared with using hydrocortisone alone is unclear. There does not appear to be an advantage to administering corticosteroids as a continuous infusion to reduce the rate of hyperglycemia or providing a taper to prevent rebound hypotension. Conclusion The mortality benefit of corticosteroids appears to be greatest in septic shock patients with high vasopressor requirements, evidence of multiorgan failure, and primary lung infections. Corticosteroids consistently lead to a faster reversal of shock and may shorten the duration of mechanical ventilation. Corticosteroids do not seem to increase the risk of superinfection at low doses but frequently lead to a higher frequency of hyperglycemia. We recommend the administration of corticosteroids to septic shock patients with escalating doses of vasopressors and evidence of multiorgan dysfunction.
Book ChapterDOI
01 Jan 2018
TL;DR: New techniques performed through a single limited incision at the tarsometatarsal site that do not require traditional surgical dissection, capsular balancing, or osteotomy of the first metatarsal phalangeal joint are introduced and that facilitate fixation constructs tailored to allow the patient immediate protected weight bearing.
Abstract: Arthrodesis of the first tarsometatarsal joint is a common procedure for patients with HAV deformity. The acceptance of this procedure has gone through an evolution over several generations. Traditional observations such as hypermobility and atavism are commonly cited as indications for TMTJ level of correction; however there is a wealth of new information which calls into question some of these ideas. The most striking new concept is the addition of the evaluation and management of the frontal plane of the deformity. In this chapter the authors will introduce new techniques performed through a single limited incision at the tarsometatarsal site that do not require traditional surgical dissection, capsular balancing, or osteotomy of the first metatarsal phalangeal joint and that facilitate fixation constructs tailored to allow the patient immediate protected weight bearing. The procedure and modifications discussed in this chapter are much different both in indications and technical execution than what has been historically described. Specifically, we do not use high intermetatarsal angle and hypermobility of the medial column as necessary indications for the procedure but use the anatomic apex of the deformity to choose the level of correction. Since the metatarsal is not deformed, we feel that correction at a proximal level to correct the position of the deviated metatarsal gives the most anatomic result as well as being a convenient location for triplane correction.

Authors

Showing all 1697 results

NameH-indexPapersCitations
Steven M. Greenberg10548844587
Linus Pauling10053663412
Ernesto Canalis9833130085
John S. Gottdiener9431649248
Dalane W. Kitzman9347436501
Joseph F. Polak9140638083
Charles A. Boucher9054931769
Lawrence G. Raisz8231526147
Julius M. Gardin7625338063
Jeffrey S. Hyams7235722166
James J. Vredenburgh6528018037
Michael Centrella6212011936
Nathaniel Reichek6224822847
Gerard P. Aurigemma5921217127
Thomas L. McCarthy5710710167
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Performance
Metrics
No. of papers from the Institution in previous years
YearPapers
20234
20228
2021146
2020133
2019126
201897