Clinical Assistant Professor, Medicine - Primary Care and Population Health
Pressure ulcers are insidious complications that affect approximately 2.5 million patients and account for approximately US$11 billion in annual health care spending each year. To date we are unaware of any study that has used a wearable patient sensor to quantify patient movement and positioning in an effort to assess whether adherence to optimal patient turning results in a reduction in pressure ulcer occurrence.This study is a single-site, open-label, two-arm, randomized controlled trial that will enroll 1812 patients from two intensive care units. All subjects will be randomly assigned, with the aid of a computer-generated schedule, to either a standard care group (control) or an optimal pressure ulcer-preventative care group (treatment). Optimal pressure ulcer prevention is defined as regular turning every 2 h with at least 15 min of tissue decompression. All subjects will receive a wearable patient sensor (Leaf Healthcare, Inc., Pleasanton, CA, USA) that will detect patient movement and positioning. This information is relayed through a proprietary mesh network to a central server for display on a user-interface to assist with nursing care. This information is used to guide preventative care practices for those within the treatment group. Patients will be monitored throughout their admission in the intensive care unit.We plan to conduct a randomized control trial, which to our knowledge is the first of its kind to use a wearable patient sensor to quantify and establish optimal preventative care practices, in an attempt to determine whether this is effective in reducing hospital-acquired pressure ulcers.ClinicalTrials.gov, NCT02533726 .
View details for DOI 10.1186/s13063-016-1313-5
View details for Web of Science ID 000373488900003
View details for PubMedID 27053145
Wernicke's encephalopathy (WE) is a life threatening neurological disorder that results from thiamine (Vitamin B1) deficiency. Clinical signs include mental status changes, ataxia, occulomotor changes and nutritional deficiency. The conundrum is that the clinical presentation is highly variable. WE clinical signs, brain imaging, and thiamine blood levels, are reviewed in 53 published case reports from 2001 to 2011; 81 % (43/53) were non-alcohol related. Korsakoff Syndrome or long-term cognitive neurological changes occurred in 28 % (15/53). Seven WE cases (13 %) had a normal magnetic resonance image (MRI). Four WE cases (8 %) had normal or high thiamine blood levels. Neither diagnostic tool can be relied upon exclusively to confirm a diagnosis of WE.
View details for DOI 10.1007/s11065-012-9200-7
View details for Web of Science ID 000305248800010
View details for PubMedID 22577001
The model of collaboration developed by D'Amour and associates can be used to analyze components of collaboration within organizations as shown in Fig. 1. The model covers both interprofessional and interorganizational components of collaboration. A strong supportive organizational infrastructure is the powerful force that sustains successful collaboration between critical care and psychiatry. Professionals' recognition that we have complementary, nonoverlapping clinical skills with recognizance of shared and overlapping populations is vital. The beauty of collaboration is the appreciation of the full value of each participant's unique contribution and diversity. When there are multiple opportunities for collaboration, everyone benefits, especially the critical care patient.
View details for DOI 10.1016/j.ccell.2012.01.003
View details for Web of Science ID 000313395000007
View details for PubMedID 22405713
Infection is a major cause of morbidity and mortality in heart transplantation. Therefore protective isolation has been an inherent part of our postoperative regimen. For retrospective review we selected patients before and after modification of protective isolation. The intensity of protective isolation appeared to have no impact on incidence, morbidity, or mortality resulting from infection in these study groups.
View details for PubMedID 3309216
This article discusses nursing care of the patient who requires hemodynamic monitoring. This will include care of the patient who requires intra-arterial pressure monitoring, central venous pressure (CVP) monitoring, left atrial pressure (LAP) monitoring, and monitoring of left heart pressures, cardiac output, and systemic vascular resistance using a pulmonary artery (PA) catheter.
View details for Web of Science ID A1987G570200009
View details for PubMedID 3644293
Stanford University Medical Center has successfully utilized a left ventricular assist device as bridge support for 9 days in a 52-year-old man awaiting heart transplantation. During this time he developed a pericardial tamponade, but no other serious medical complications occurred. Major nursing care issues focused on pain control, vigorous pulmonary toilet, and left ventricular assist device timing. This article outlines the responsibilities of critical care nurses and what was learned from the experience. The recipient was discharged home 106 days after heart transplantation.
View details for PubMedID 3302185
Since the introduction of cyclosporine, 183 heart transplants have been performed at Stanford University Medical Center. Although cyclosporine has improved survival rates, it is also associated with progressive renal dysfunction. Seventeen of these recipients have been converted from cyclosporine-based therapy to azathioprine-based therapy because of significant nephrotoxicity. Fourteen of these recipients participated in a study to examine change in physical symptoms since immunoconversion. Most reported little change in physical symptoms following conversion, although 79% experienced rejection following the drug change. Overall, the change in immunosuppressive medications had little impact on perceived symptoms.
View details for PubMedID 3305825