Jolene Fox

Utilization of failure mode effects analysis in trauma patient registration.

Aim Our goal was to identify strategies that would reduce risks and improve patient safety during registration of trauma patients and subsequent electronic data linkage. Recently, the health care industry and the Joint Commission on Accreditation of Healthcare Organizations have supported failure mode effects analysis (FMEA) as a tool for proactively reducing risk to patients. Methods We utilized FEMA for a comprehensive evaluation of our trauma patient registration process for system weaknesses. Results We found several areas of our processes that placed patients at risk. On the basis of our findings, we implemented changes that included education of staff, role clarification, task reallocation, and established a list of personnel authorized to request the electronic data linkage process. Further recommendations were made for information system changes, which are under review. Conclusions FMEA helped us to systematically identify and prioritize risks to patient safety. Our findings directed changes, which, in turn, reduced potential errors. We recommend this method of evaluation to other health care personnel interested in improving patient safety.

Optothermal mathematical model and experimental studies for laser irradiation of arteries in the presence of blood flow.

We have developed an optothermal model for the interaction of laser light and the tissue of arterial walls and have checked its validity with animal experiments. The mathematical model consists of a laser diffusing tip positioned intraluminally in a cylindrical artery, in which the diffused laser light is incident on a blood-tissue interface at a distance from the tip. A temperature profile throughout the interface is obtained by considering the optical interaction and the thermal conduction and convection of the blood and tissue. The distribution of light in the media is determined using both Beers law and the Kubelka-Munk two-flux theory in cylindrical coordinates. For experimental in vivo verification, a diffusing tip was inserted in canine arteries and the temperature profile varied by restricting the volume of blood; this simulated degrees of occlusion to determine the influence of blood flow on heat transport. The measured temperature profiles compared favorably to the theoretical results. Temperature profiles are also predicted for a water-filled lumen. The theoretical model will be useful in predicting the depth of ablation and extent of normal tissue damage during laser angioplasty treatment of atherosclerosis.

Effects of benzoporphyrin derivative monoacid on balloon-injured arteries in a swine model of restenosis

We evaluated benzoporphyrin derivative verteporfin (BPD) photodynamic therapy (PDT) and dark effect on the intima (I) and media (M) hyperplasia (H) response of swine iliac arteries to balloon dilatation (Bdil) injury. Four month old Yucatan swine received bdil at 8 ATM pressure to all four iliac arteries. Pigs were randomly assigned to groups. PDT was performed with intraluminal 690 nm, cw laser (200 milliwatts and 30 joules per cm2 tissue). Six weeks later, sites were pressure fixed, and excised at autopsy. Sections from each site were evaluated for I and M thickness, injury score (1 equals normal, 4 equals worst), and smooth muscle cell (SMC) intensity and distribution. Groups were compared using the Mann-Whitney U test. Means for each parameter were determined, and group means used for statistical analysis. Conclusions: (1) Bdil produced IH and MH. (2) PDT enhanced IH. (3) 2 mg/kg BPD reduced MH and produced a favorable trend in IH and injury. (4) No differences in SMC intensity and distribution were present.

An evaluation of potential prognostic indicators in cardiac patients

Cardiovascular disease results in more deaths and higher medical costs than any other medical problem. Cardiac patients may be transported to centers for specialized care. We evaluated historical, current event, and physiologic items (n = 32) for ability to predict use of specialized care and hospital costs. For 199 patients studied, seven items were prognostic. A model classifying patients by presence of predictors was developed. For the group without predictors and the group with multiple predictors, sensitivity and specificity were respectively very good. For 125 (63%) of the patients in middle categories, the model was not sufficiently sensitive to be prognostic. A scoring system for all cardiac patients could not be developed. Patients requiring only diagnostics were responsible for financial deficits, as were all Medicare patient groups. Patients staying longer than seven days, or having surgery, or both, were responsible for the largest deficits (if on Medicare) and the highest profits (if not on Medicare). Advance validation of the need to transport is difficult, with far-reaching medical and financial implications.

In vitro removal of photosensitized rabbit atherosclerotic plaque by dye laser irradiation

Laser removal of atherosclerotic lesions in patients with coronary or peripheral vascular disease is an area of considerable promise and has generated a good deal of interest (1-9). Laser energy from a variety of laser sources has been demonstrated to remove atherosclerotic plaque (2,4,9). However, the.effect of the laser energy on the atherosclerotic material is rather non-selective and vessel perforation and vascular wall damage have been reported as significant complications (10-12). The development of a laser angioplasty system which would selectively or preferentially remove atheromatous material from the vessel, while leaving undamaged the adjacent or underlying arterial wall, would be a significant advancement. Several previous studies (10-12) have shown that atherosclerotic plaque from several animal species selectively accumulates porphyrin photosensitizers, with approximately 2-4 times the porphyrin concentration in atherosclerotic plaque as in unplaqued arterial wall. Our hypothesis was that this preferential accumulation of photosensitizer in the atherosclerotic plaque would enhance absorption of laser energy at a certain wavelength, and in turn produce potentially selective damage to the atherosclerotic plaque, with sparing of the adjacent and underlying arterial wall. The current study examined this hypothesis by evaluating, in vitro, the effect of 632 nm laser energy on dihemato-porphyrin ether photosensitized rabbit atherosclerotic aorta.Laser removal of atherosclerotic lesions in patients with coronary or peripheral vascular disease is an area of considerable promise and has generated a good deal of interest (1-9). Laser energy from a variety of laser sources has been demonstrated to remove atherosclerotic plaque (2,4,9). However, the.effect of the laser energy on the atherosclerotic material is rather non-selective and vessel perforation and vascular wall damage have been reported as significant complications (10-12). The development of a laser angioplasty system which would selectively or preferentially remove atheromatous material from the vessel, while leaving undamaged the adjacent or underlying arterial wall, would be a significant advancement. Several previous studies (10-12) have shown that atherosclerotic plaque from several animal species selectively accumulates porphyrin photosensitizers, with approximately 2-4 times the porphyrin concentration in atherosclerotic plaque as in unplaqued arterial wall. Our hypothesis was that th...

A-11 A retrospective analysis of air-evacuated hypothermia patients

This study reviews the outcome of 17 hypothermic patients air evacuated by a civilian helicopter transport service. Age (33 +/- 23), type and duration of exposure, and rewarm methods were examined for each patient. Temperature (T), heart rate (HR), blood pressure (BP), respiratory rate (RR), Glasgow coma score (GCS), trauma score (TS), CRAMS score (CS), and cardiac rhythm in the pre-hospital setting and in the emergency department (ED) were compared to outcome. Eight of the patients had extensive exposure to a cold environment ranging from 4 h to 10 d. The remaining 9 patients were exposed to cold water ranging from 15 min to 4.5 h. By severity of hypothermia as measured in the ED, 6 patients who were hypothermic at the scene were normothermic (t greater than 35 degrees C), 5 patients were classified as mild (t = 35-31.5 degrees C), 3 as moderate (T less than 31.5-25.5 degrees C), and 3 patients were severely hypothermic (T less than 25.5 degrees C). The GCS, TS, and CS were not indicative of outcome. During rewarming, 3 patients had paradoxical temperature drops, and 5 patients had atrial fibrillation. Three patients required cardiopulmonary resuscitation in the field. Two were discharged with resolving disabilities, and 1 expired. No ventricular fibrillation or J waves occurred. All patients were effectively rewarmed without incident. All patient disabilities and the single fatality were not directly related to hypothermia. There were no long-term adverse consequences of helicopter transport in these hypothermic patients.

Implementing a domestic violence screening program.

The purpose of this study was to design and implement a domestic violence (DV) screening protocol. Trauma patients meeting inclusion criteria (hospitalized > 48 hours) were given a four question DV screen. If abuse was found, a comprehensive DV questionnaire followed. Barriers to screening and results were recorded. Compliance during the pilot test showed 23 of 157 (14.6%) admitted patients were screened. In the implementation year, 446 of 721 (61.9%) were screened. During the 10-month follow-up, 499 of 619 (80.6%) patients were screened. Lack of social work resources was the primary barrier to screening, but compliance increased and was maintained after the study period.

A survey of trauma registrars: job requirements, responsibilities, recruitment, and retention.

Study purpose was to describe trauma registrar job requirements, responsibilities, and recruitment/retention practices. An online survey was used. One-third required a high school diploma; two-thirds required a college degree. Most required skills were medical terminology (66%), database management (65%), anatomy (64%), Word (63%). Data responsibilities included abstracting, entry, coding, and validating. Few employers required certification. Twenty-six percent reported problems with recruitment, and 35% with retention. Salary and lack of advancement were primary reasons for employee turnover. Certifications were less relevant than skills; the primary focus was data management. Recommendations for recruitment/retention include job flexibility, educational opportunities, and recognition as a profession.

Mathematical Model And Experimental Studies For Laser Ablation Of Arterial Plaque

We have developed an opto-thermal model for the interaction of laser light and the tissue of arterial walls, and have checked its validity with animal experiments. The mathematical model consists of a laser diffusing tip positioned intraluminally in a cylindrical artery, in which the diffused laser light is incident on a blood/tissue interface at a distance from the tip. Experimental values for the optical scattering, absorption, transmission, and reflection in biological media are taken from the literature. A temperature profile throughout the interface is obtained by considering the optical interaction and the thermal conduction and convection of the blood and tissue. For experimental verification, a diffusing tip was inserted in in vivo canine arteries and the temperature profile was measured by a thermocouple array. The rate of blood flow around the diffusing tip was varied by limiting the volume of blood; this simulated degrees of occlusion to determine the influence of blood flow on heat transport. The measured temperature profile compared favorably to the theoretical results. The theoretical model will be useful in predicting the depth of tissue ablation and extent of normal tissue damage for laser angioplasty treatment of atherosclerosis.

A system design for laser coronary angioplasty

The application of lasers in cardiovascular medicine has captured the imagination of many health care professionals. A major problem associated with coronary artery laser angioplasty has been vessel perforation. Perforation may occur as the result of thermal injury but has frequently been attributed to mechanical injury caused by traumatic optical fiber placement. Research directed at solving the problems associated with coronary artery laser angioplasty is underway with cautious progress being reported. Coronary artery laser angioplasty may become an important therapeutic modality in the treatment of coronary artery disease. A system was, therefore, designed for atraumatic optical fiber placement in coronary arteries.The application of lasers in cardiovascular medicine has captured the imagination of many health care professionals. A major problem associated with coronary artery laser angioplasty has been vessel perforation. Perforation may occur as the result of thermal injury but has frequently been attributed to mechanical injury caused by traumatic optical fiber placement. Research directed at solving the problems associated with coronary artery laser angioplasty is underway with cautious progress being reported. Coronary artery laser angioplasty may become an important therapeutic modality in the treatment of coronary artery disease. A system was, therefore, designed for atraumatic optical fiber placement in coronary arteries.