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1.
J Contin Educ Nurs ; 51(10): 484-488, 2020 Oct 01.
Article in English | MEDLINE | ID: mdl-32976618

ABSTRACT

BACKGROUND: Nasogastric tube placement is widely taught, and tube maintenance relies on astute nursing care with adherence to both institutional and evidence-based recommendations. However, precise adherence to current recommendations relies on knowledge base regarding the identification of malfunctioning gastric drainage tubes. Troubleshooting skills are crucial in maintaining patient safety and recognizing malfunction. METHOD: Educational sessions on nasogastric and orogastric decompression tube management, led by a surgical intensive care fellow at a level 1 trauma center, were offered to critical care nurses. A presession and postsession survey evaluated the nurses' subjective and objective knowledge and comfort with naso/orogastric decompression tube management. RESULTS: Ninety-seven critical care RNs participated. For all questions, the proportion of correct answers significantly increased from presession survey to postsession survey (p < .001). Ninety-seven percent of all participants found the session to be very helpful. CONCLUSION: Physician-led educational sessions on naso/orogastric decompression tube management were well-received and improved subjective and objective measurements of nurses' knowledge and comfort level with gastric decompression tubes. [J Contin Educ Nurs. 2020;51(10):484-488.].


Subject(s)
Intubation, Gastrointestinal , Nurses , Nursing Care , Clinical Competence , Drainage , Education, Nursing , Humans
3.
J Surg Res ; 243: 434-439, 2019 11.
Article in English | MEDLINE | ID: mdl-31279270

ABSTRACT

BACKGROUND: As the availability and use of robotic surgery increases, current data suggest comparable outcomes to laparoscopic surgery but at an increased cost. Elective sigmoid resection for diverticular disease is the most common colorectal application of robotic surgery and there is limited comparative data specifically for this indication. METHODS: We identified all elective cases of laparoscopic- and robot-assisted surgery for diverticular disease among a practice of 7 colorectal surgeons within an established enhanced recovery protocol. We performed propensity matching based on surgical indications (recurrent disease, ongoing symptoms, or fistula), stoma creation, and body mass index to create a matched cohort. Our primary outcomes were return of bowel function, length of stay, opioid use, and pain scores during the first 72 h postoperatively. Secondary outcomes were operative room and hospital charges. RESULTS: From 2011 to 2016, 69 robotic cases were propensity matched from a group of 222 laparoscopic cases to create a 1:1 case ratio that was equivalent in terms of patient demographics and operative indications. Time to first bowel movement was slightly quicker in the robotic group (1 [1] versus 2 [1.5], P = 0.09), while length of stay (3.5 [1.6] versus 3.6 [1.4] d, P = 0.64) was equivalent. Pain scores were lower in the robotic group on day 0 (4.6 versus 6.1, P = 0.0001), but similar on day 1 and day 2 (4.3 versus 4.1, P = 0.62 and 3.8 versus 3.3, P = 0.19). There was no difference in postoperative 72-h opioid use between groups (110.8 MME [144.5] versus 97.4 MME [101.5], P = 0.70). In the robotic arm operating room charges were slightly more ($2835 ± $394 versus $2196 ± $359, P < 0.0001), but total hospital charges were over significantly increased ($41,159 [$7840] versus $25,761 [$11,689], P < 0.0001). CONCLUSIONS: Via a carefully matched cohort of elective sigmoid resection for diverticular disease at a single community institution, we have demonstrated that laparoscopic- and robotic-assisted surgery result in clinically equivalent return of bowel function, length of stay, postoperative pain, and opioid use.


Subject(s)
Colectomy/statistics & numerical data , Diverticulosis, Colonic/surgery , Laparoscopy/statistics & numerical data , Robotic Surgical Procedures/statistics & numerical data , Sigmoid Diseases/surgery , Aged , Colectomy/methods , Female , Humans , Male , Middle Aged , Propensity Score , Retrospective Studies
6.
Am J Surg ; 217(3): 552-555, 2019 03.
Article in English | MEDLINE | ID: mdl-30352664

ABSTRACT

BACKGROUND: Immediately fatal motorcycle crashes have not been well characterized. This study catalogues injuries sustained in fatal motorcycle crashes and assesses the impact of crash conditions on injury patterns. METHODS: Autopsy records from the office of the medical examiner of Kent County, MI and publicly available traffic reports were queried for information pertaining to motorcyclists declared dead on-scene between January 1, 2007, and December 31, 2016. RESULTS: A total of 71 autopsies of on-scene motorcycle crash fatalities were identified. The two most prevalent injuries were traumatic brain injury (TBI) (85%) and rib fractures (79%). The majority of fatalities occurred in daylight hours (54.3%) and in a 55 mph speed limit zone (63.8%). CONCLUSIONS: This study provides a catalogue of the injuries sustained in immediately fatal motorcycle crashes and the associated conditions. Advocacy efforts that highlight the risks associated with motorcycle riding and that promote safe riding practices are warranted.


Subject(s)
Accidents, Traffic/mortality , Motorcycles , Wounds and Injuries/mortality , Adult , Cause of Death , Female , Head Protective Devices/statistics & numerical data , Humans , Male , Michigan/epidemiology , Middle Aged , Prevalence
7.
Am J Surg ; 215(3): 424-427, 2018 Mar.
Article in English | MEDLINE | ID: mdl-29126593

ABSTRACT

BACKGROUND: In April of 2012, Michigan repealed its 35-year-old universal motorcycle helmet law in favor of a partial helmet law, which permits motorcyclists older than 21 years old with sufficient insurance and experience to drive un-helmeted. We evaluated the clinical impact of the repeal. METHODS: The Michigan Trauma Quality Improvement Program's trauma database was queried for motorcycle crash patients between 1/1/09-4/12/12 and between 4/13/12-12/31/14. RESULTS: There were 1970 patients in the pre-repeal analysis and 2673 patients in the post-repeal analysis. Following the repeal, patients were more likely to be un-helmeted (p < 0.001) and to have a traumatic brain injury (p < 0.001). Patients were also more likely to require neurosurgical interventions (relative risk 1.4, p = 0.011). CONCLUSION: Following the repeal of the universal helmet law, there has been a significant increase in traumatic brain injuries and neurosurgical interventions. This analysis highlights another detrimental impact of the repeal of the universal helmet law.


Subject(s)
Accidents, Traffic , Brain Injuries, Traumatic/etiology , Head Protective Devices/trends , Motorcycles/legislation & jurisprudence , Adult , Brain Injuries, Traumatic/epidemiology , Brain Injuries, Traumatic/prevention & control , Brain Injuries, Traumatic/surgery , Databases, Factual , Female , Humans , Male , Michigan/epidemiology , Middle Aged , Multivariate Analysis , Neurosurgical Procedures/trends , Retrospective Studies , Risk Factors , Young Adult
8.
Am J Med Sci ; 346(1): 82-5, 2013 Jul.
Article in English | MEDLINE | ID: mdl-23426084

ABSTRACT

Adrenal myelolipomas are rare, usually benign unilateral tumors. Their management has controversially been discussed. The authors here present a 53-year-old African American female Jehovah's witness with postmenopausal uterine bleeding on chronic anticoagulation and episodic right flank pain who was found to have bilateral myelolipomas in addition to primary hyperparathyroidism. In collaboration with gynecology, midline laparotomy was performed to remove uterus and both ovaries in addition to the right adrenal gland for a 62 × 79 mm myelolipoma. An open biopsy of the left adrenal mass measuring 42 × 43 mm revealed myelolipoma and ruled out malignancy. Pathology confirmed bilateral myelolipomas, endometrial polyps, and leiomyomata uteri. After an uneventful recovery, the patient then underwent a right inferior parathyroidectomy for parathyroid adenoma. This case illustrates the challenges in deciding when to surgically intervene for bilateral adrenal myelolipoma and, for the first time, associates various other endocrinopathies, although no known endocrine neoplasia syndrome variant was present.


Subject(s)
Adrenal Gland Neoplasms/diagnosis , Blood Coagulation Disorders/complications , Hyperparathyroidism, Primary/diagnosis , Hyperthyroidism/diagnosis , Myelolipoma/diagnosis , Adrenal Gland Neoplasms/complications , Adrenal Gland Neoplasms/diagnostic imaging , Chronic Disease , Female , Humans , Hyperparathyroidism, Primary/complications , Hyperthyroidism/complications , Middle Aged , Myelolipoma/complications , Myelolipoma/diagnostic imaging , Tomography, X-Ray Computed
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