Mary Jane Reed

Bariatric Surgery: Shedding the Monetary Weight of Prescription Costs in the Managed Care Arena

Background: Prescription costs for treatment of comorbidities associated with morbid obesity is a considerable annual health-care expenditure. This study addressed the effect of Roux-en-Y gastric bypass (RYGBP) on diabetic and anti-hypertensive pharmaceutical utilization and cost savings at our institution. Methods: Retrospective data from the electronic database of 51 consecutive patients, who underwent RYGBP from March 2001 to May 2002 were studied. Patients had BMI >40 associated with obesity-related diabetes and hypertension. Prescription medications utilized by this cohort were reviewed preoperatively and at 3- and 9-month intervals postoperatively. Significance was analyzed by paired t-test. Results: Prevalence of diabetes and hypertension was 55.7% (29/53) and 44.3% (24/53) respectively, and 34% (18/53) patients had both co-morbidities. Preoperatively, patients were on an average of 2.44 ± 1.86 medications at a cost of

Pulmonary System and Obesity

187.24 ±

Preeclampsia, Eclampsia and HELLP Syndrome

237.41 per month. Postoperatively, the mean number of medications was reduced to 0.56 ± 0.81 agents (P<0.001) at a monthly cost of

Respiratory Diseases of Pregnancy

42.53 ± 116.60 (P<0.001). Conclusions: RYGBP can decrease the prescription medication requirements, resulting in significant cost-savings in the treatment of obesity-related hypertension and diabetes. This study found a 77.3% reduction in total cost of diabetic and anti-hypertensive medications.

Noninvasive Mechanical Ventilation After Chemical Disasters

There are several challenges in the management of respiratory failure in the obese population. Pulmonary physiology is significantly altered leading to reduced lung volumes, decreased compliance, abnormal ventilation and perfusion relationships, and respiratory muscle inefficiency. These complications can lead to a prolonged requirement for mechanical ventilation and increased intensive-care-unit length of stay.

Inhalational Anthrax and Bioterrorism: Key Recommendations for Acute Respiratory Failure

The patient with severe preeclampsia and its associated conditions of eclampsia and HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) syndrome usually present to Labor and Delivery and are often cared for completely by the obstetrical team, however in more complicated cases these patients should be treated with a multidisciplinary approach including critical care and other subspecialties as needed. Preeclampsia is a systemic disease characterized by hypertension and proteinuria that occurs in pregnancy and the puerperium. Severe complications include seizure (eclampsia), cerebral hemorrhage, liver capsule hematoma and rupture, renal failure and oliguria as well as pulmonary edema, heart failure and cardiomyopathy. This chapter reviews a typical presentation of severe preeclampsia, eclampsia and HELLP syndrome and management of this condition.

Outcomes of preoperative weight loss in high-risk patients undergoing gastric bypass surgery

Respiratory complaints in the gravid patient are often difficult to identify as a disease state, expected physiologic changes of pregnancy or both. Understanding the underlying pulmonary physiologic changes that come with pregnancy as well as those conditions which are unique to the pregnant patient will help arrive at the correct diagnosis and management. Recognizing that the gravid patient has other physiologic changes that contribute to decreased respiratory reserve, increased risk of aspiration, infection, and difficult airway can help in managing these patients acutely.

Pulmonary Infiltrates in the Surgical ICU: Prospective Assessment of Predictors of Etiology and Mortality

The term chemical agent has traditionally been defined as a substance intended for use in military operations to kill, seriously injure, or incapacitate humans (or animals) through its toxicological effects [1]. These agents have been used in warfare for thousands of years. Recent events, such as the 1994 sarin nerve agent attack in Matsumoto, Japan and the 1995 Tokyo subway destructive release of this chemical, have made it clear that health care providers need to be prepared to handle chemical agent attacks.

Outcomes among elderly bariatric patients at a high-volume center

Anthrax is caused by exposure to Bacillus anthracis an aerobic, Gram-positive, spore-forming bacterial infection that most commonly infects herbivore mammals. Human infection occurs in those with close exposure to infected animal products. In fact, the first reported cases of anthrax, during the mid-1800s, were related to the textile and tanning industries in both England and Germany [1]. Infections were first documented in mill workers who were frequently exposed to imported animal fibers contaminated with B. anthracis spores.