Implementing American Heart Association Practice Standards for Inpatient ECG ...Allina Health
Implementing American Heart Association Practice Standards for Inpatient ECG Monitoring: An Interventional Study at Abbott Northwestern Hospital presented by Kristin Sandau, PhD, RN
Presentation from the UK NSC conference in December 2016 about the recommendation on the use of pulse oximetry screening for critical congenital heart disease in newborns.
Opening Keynote"From Patient to Population: Providing Optimal Care - The Role for Technology"
Ronald Paulus, MD, MBA
President & CEO
Mission Health System
Utility of primary care based TIA electronic decision support: A cluster randomised controlled trial. Presented by Anna Ranta, Department of Neurology, MidCentral DHB, at HINZ 2014, 12 November 2014, 12pm, Plenary Room
Implementing American Heart Association Practice Standards for Inpatient ECG ...Allina Health
Implementing American Heart Association Practice Standards for Inpatient ECG Monitoring: An Interventional Study at Abbott Northwestern Hospital presented by Kristin Sandau, PhD, RN
Presentation from the UK NSC conference in December 2016 about the recommendation on the use of pulse oximetry screening for critical congenital heart disease in newborns.
Opening Keynote"From Patient to Population: Providing Optimal Care - The Role for Technology"
Ronald Paulus, MD, MBA
President & CEO
Mission Health System
Utility of primary care based TIA electronic decision support: A cluster randomised controlled trial. Presented by Anna Ranta, Department of Neurology, MidCentral DHB, at HINZ 2014, 12 November 2014, 12pm, Plenary Room
The Top 5 Ancillary Services For Urology PracticesClark Love
Reduction in Medicare contract payments and decreased physician reimbursement from insurers are causing decreased physician salaries, medical profits and general revenue. This is driving the desire for urology practices to add ancillary services - and this is a good thing for patients.
ICNC 2019 (poster) More normal scans but comparable post-test referral after ...Joris van Dijk
Background: Myocardial perfusion imaging (MPI) using Rubidium-82 (Rb-82) PET is more accurate than using SPECT. However, downstream clinical treatment strategies have not been compared.
Purpose: Our aim was to compare MPI scan outcomes and post-scan referral for invasive coronary angiography (ICA) between patients undergoing MPI with cadmium-zinc -telluride (CZT)-SPECT or PET in perfectly comparable groups generated by propensity score matching.
Method: 1188 patients who underwent MPI CZT-SPECT (Discovery 570, GE Healthcare) with attenuation correction and 487 patients who underwent Rb-82 PET (D690, GE Healthcare) were retrospectively analyzed. Propensity score-based matching was performed using calcium score category (0, 1-100, 101-400, >400), gender, age, body weight, current smoker, diabetes mellitus, hypercholesterolemia, hypertension and family history as variables. The frequency of normal scans, post scan ICA, and percutaneous coronary intervention (PCI) or coronary bypass surgery (CABG) within six months, were compared between SPECT and PET patients.
Results: After matching, no significant differences were found between the PET (n=487) and SPECT group (n=487) except for weight (91 vs. 87kg, respectively, p<0.001). PET scans were more often interpreted as normal (84% vs. 74%, p<0.001). The number of scans showing ischemia or possible ischemia was lower for PET (10.8%) than for SPECT (21.2%, p<0.001). The percentage of ICA (9.7 vs. 11.3%, p=0.41), PCI (1.9% vs. 2.5%, p=0.51) or CABG (1.4% vs. 1.6%,p=0.80) did not differ between the PET and SPECT, respectively.
Conclusion: As compared to CZT-SPECT, Rb-82 PET MPI results in more normal scans and fewer diagnoses of ischemia and doubtful ischemia. However, this did not translate to fewer ICA and PCI procedures within 6 months, but this may require more experience among referring cardiologists.
What is the place of CT coronary angiography in ED chest pain?kellyam18
CT coronary angiography is a relatively new modality for identifying coronary artery disease. What is its place in ED chest pain assessment. See the evidence -and the evidence gaps- and judge for yourself where it might fit!
The Top 5 Ancillary Services For Urology PracticesClark Love
Reduction in Medicare contract payments and decreased physician reimbursement from insurers are causing decreased physician salaries, medical profits and general revenue. This is driving the desire for urology practices to add ancillary services - and this is a good thing for patients.
ICNC 2019 (poster) More normal scans but comparable post-test referral after ...Joris van Dijk
Background: Myocardial perfusion imaging (MPI) using Rubidium-82 (Rb-82) PET is more accurate than using SPECT. However, downstream clinical treatment strategies have not been compared.
Purpose: Our aim was to compare MPI scan outcomes and post-scan referral for invasive coronary angiography (ICA) between patients undergoing MPI with cadmium-zinc -telluride (CZT)-SPECT or PET in perfectly comparable groups generated by propensity score matching.
Method: 1188 patients who underwent MPI CZT-SPECT (Discovery 570, GE Healthcare) with attenuation correction and 487 patients who underwent Rb-82 PET (D690, GE Healthcare) were retrospectively analyzed. Propensity score-based matching was performed using calcium score category (0, 1-100, 101-400, >400), gender, age, body weight, current smoker, diabetes mellitus, hypercholesterolemia, hypertension and family history as variables. The frequency of normal scans, post scan ICA, and percutaneous coronary intervention (PCI) or coronary bypass surgery (CABG) within six months, were compared between SPECT and PET patients.
Results: After matching, no significant differences were found between the PET (n=487) and SPECT group (n=487) except for weight (91 vs. 87kg, respectively, p<0.001). PET scans were more often interpreted as normal (84% vs. 74%, p<0.001). The number of scans showing ischemia or possible ischemia was lower for PET (10.8%) than for SPECT (21.2%, p<0.001). The percentage of ICA (9.7 vs. 11.3%, p=0.41), PCI (1.9% vs. 2.5%, p=0.51) or CABG (1.4% vs. 1.6%,p=0.80) did not differ between the PET and SPECT, respectively.
Conclusion: As compared to CZT-SPECT, Rb-82 PET MPI results in more normal scans and fewer diagnoses of ischemia and doubtful ischemia. However, this did not translate to fewer ICA and PCI procedures within 6 months, but this may require more experience among referring cardiologists.
What is the place of CT coronary angiography in ED chest pain?kellyam18
CT coronary angiography is a relatively new modality for identifying coronary artery disease. What is its place in ED chest pain assessment. See the evidence -and the evidence gaps- and judge for yourself where it might fit!
Impact of access site on bleeding and ischemic events in patients with non-ST-segment elevation myocardial infarction treated with prasugrel at the time of percutaneous coronary intervention or as pretreatment at the time of diagnosis: the ACCOAST access substudy
Neurointerventional Therapy for Brain Aneurysms and Acute Stroke Allina Health
By Yasha Kadkhodayan, MD. Overview of interventional neuroradiology approaches to brain aneurysm and stroke care, discussion of processes in place at Abbott Northwestern to enhance the delivery of stroke care.
A speech given in Yodak Hospital, the 6th International Symposium of Cardiac Thorascopic Surgery, 10/25/2014; a report of endoscopic cardiac surgery in Taiwan
Excerise Tolerance and Post-Operative Outcomes in Patients with Pulmonary Hyp...Aalap Shah
We evaluate the predictive value of patient-reported functional status on hospital length of stay (LOS) and morbidity/mortality for PHTN patients undergoing non-cardiac, non-obstetric procedures at our institution.
Enhancing Mental Health Care Transitions: A Recovery-Based ModelAllina Health
Enhancing Mental Health Care Transitions: A Recovery-Based Model - Mental Health Care Navigators and Inpatient Psychiatry presented by Christina Schwartz, BA Psychology, MHP, Mental Health Navigator and Heather Sievers, RN, MSN, MA Counseling Psychology, PI Advisor
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
2. PE PATIENT CARE COORDINATION
Referring hospital
Telemetry
ICU
ED
Hospitalist
Crit ical Care
IR
Cardiology
Hematology
Thoracic surgery
Courtesy of Dr. Bjorn Engstrom
3.
4.
5.
6. Critical Care Research Program Goals
• Conduct research studies pertinent to the practice of critical care and hospitalist
medicine at ANW that will improve patient outcomes, enhance quality of care
and care coordination, and reduce costs
• Generate peer-reviewed publications and presentations at regional, national, and
international meetings, as well as best practice guidelines and protocols
• Contribute to the attraction and retention of world-class providers by offering an
environment that promotes and supports investigator-initiated research
• Convene investigators regularly to review and prioritize new study proposals,
examine progress of ongoing studies, and provide support and advice to
investigators
7. Critical Care Research Program
Participants
• Intensivists
• Hospitalists
• Med Education
• ED, Cardiology,
Pulmonary, IR,
Pain Service, CV
Surgery
• Clinical Pharmacy
Clinical Units
• Med/Surg ICU
• Neuro ICU
• CV ICU
• Hospital units
Partners
• Division of
Applied Research
• ANW Foundation
• ICU QI specialists
and CNS
• MHI Research
8.
9.
10. High Risk = enhanced monitoring and treatment
team notification + continuous capnography/oxymetry
device
Moderate Risk = enhanced monitoring and
treatment team notification
Standard Risk = standard ortho unit
monitoring protocol
ANW Postoperative Patient Monitoring Algorithm Proposal
11. Portable CXR: low
sensitivity and specificity,
frequently non-diagnostic
Chest CT: need to
transport to radiology,
radiation exposure, cost
US Consolidation
US Effusion
US Consolidation
US Interstitial Pattern
14. Variable N Age % Male Ventilator Days
P/F Ratio at
Intubation
ICU
LOS
Hospital
LOS
% Inhospital
Mortality
All Patients 250 65 (23-93) 48 4.1 (0.1-34.4) 222.5 (63-584) 7.8 (1.0-40.8) 13 (2-58) 24
Diagnosis
Pneumonia 76 66 (28-93) 45 5.0 (0.5-15.8) 184 (88-494) 9.9 (1.7-38.6) 14 (3-41) 18
Aspiration 34 72 (49-91) 47 4.3 (0.1-34.4) 232 (86-483) 8.0 (1.3-30.8) 15 (2-39) 24
Sepsis 29 67 (30-87) 59 3.7 (0.5-13.2) 233 (158-530) 8.3 (1.4-25.4) 15 (2-58) 21
CHF 27 71 (50-89) 44 2.3 (0.8-15.0) 218 (68-417) 5.8 (1.7-21.8) 10 (2-25) 30
Cardiac Arrest 22 67 (31-79) 45 4.6 (0.3-13.8) 254 (64-584) 7.0 (1.5-20.5) 12 (2-48) 45
ARDS 18 61 (30-78) 39 7.2 (0.6-13.5) 161 (63-336) 11.3 (3.1-36.9) 15 (7-37) 33
COPD/Asthma 17 64 (55-87) 59 2.3 (1.3-11.6) 234 (120-348) 4.3 (1.9-12.1) 9 (2-12) 24
Other* 27 65 (23-88) 52 3.9 (0.9-10.8) 248 (75-474) 7.6 (1.0-40.8) 15 (2-51) 19
Pulmonary Ultrasound Scoring System for Intubated Critically Ill Patients
and its Association to Clinical Metrics and Mortality*
*Manuscript submitted
PI Dr. D. Tierney
15. Pulmonary Ultrasound Scoring System for Intubated Critically Ill
Patients and its Association with Clinical Metrics and Mortality*
*Manuscript submitted
PI Dr. D. Tierney
20. STUDY INVESTIGATORS CLINICAL IMPACT
Systemic and catheter-directed
thrombolysis for pulmonary
embolism
ANW Intensivist Service, DAR, Hospitalists TPA for PE order set; Severe PE
Management Algorithm; PE Response Team
Respiratory failure in orthopedic
surgery patients
ANW Intensivist Service, DAR, IM Residency,
Pharmacy, Pain Service
Recommendations on triage and
management of postoperative orthopedic
surgery patients
Pulmonary ultrasound scoring system
for intubated ICU patients
IM Residency, DAR, Hospitalists Introduction of a new pulmonary ultrasound
imaging technique in ANW ICU
Antibiotic use and infection in
therapeutic hypothermia
ANW Intensivist Service, DAR,
MHI/Cardiology
Inform best practices of antibiotic use in
post-cardiac arrest patients
Neuroprognostication in therapeutic
hypothermia
MN Epilepsy/Neurology, ANW Intensivist
Service, DAR, Noran Clinic
Provide clinicians with data that enhance
prediction of neurologic prognosis in post-
cardiac arrest patients
Impact of mandatory intensivist
consultation after cardiac surgery
ANW Intensivist Service, DAR,
MHI/Cardiology
Identify opportunities to improve outcomes
in post-cardiac surgery patients
Hemodynamics in Therapeutic
Hypothermia
MHI/Cardiology, ANW Intensivist Service,
DAR, Hospitalists
Understand the performance of different
methods of cardiac output measurement in
hypothermia patients
Complications and outcomes in ICU
patients with neurologic diagnosis
ANW Intensivist Service, DAR, ANW Neuro-
IR
Analyze ANW-specific neuro ICU patient
population and identify opportunities to
improve outcomes
Validation of clinical deterioration
tool
ANW Intensivist Service, DAR Prediction of clinical deterioration in a
hospitalized patient
ICU Patient Registries ANW Intensivist Service, DAR, Health
Catalyst
Organize and use clinical data to improve
ICU outcomes
22. Clinical Dilemma
Research Protocol
• Practice recommendations
• Order sets
• New clinical programs
Abstract/poster at regional,
national and international
conferences
• Improved outcomes
• Improved care coordination
• Reduced costs
• Peer-reviewed publication
• Patient registry
• Funding sources
Clinical
Impact
Build
Research Capacity