Outcomes in patients with spontaneous bacterial peritonitis utilizing first-line or alternative agents for secondary prophylaxis.

Purpose: The American Association for the Study of Liver Diseases guidelines recommend ciprofloxacin as a first-line option for spontaneous bacterial peritonitis (SBP) prophylaxis, citing literature that is over 30 years old. There is insufficient data and guidance for prophylaxis in cases of fluoroquinolone treatment failure or intolerance. This study aimed to evaluate outcomes in patients whose antimicrobial prophylaxis was switched from first-line therapies to an alternative agent versus those who were not switched following recurrent SBP.

Evaluation of Burnout and Work-Life in Surgical Trauma Acute Care Units.

Introduction: Stressors unique to trauma patients may potentiate burnout in the trauma care team. Among health care workers, nurses historically demonstrate high rates of burnout and are often the first caregivers in which patients interact. There is limited research, however, investigating burnout in trauma nurses.

Rate of Nonsurgical Admissions at a Level 1 Trauma Center: Impact of a Trauma Nurse Practitioner Model.

The American College of Surgeons (ACS) mandates all trauma centers conduct individual case reviews of nonsurgical admissions when rates of allocation to this service exceed 10% of all inpatient traumas. Nonsurgical admission rates at the study institution, which is a Level I trauma center, historically exceeded this ACS criterion. In an effort to decrease nonsurgical admissions, the study institution recruited trauma nurse practitioners (TNPs) who began managing low acuity patients with oversight from trauma attending physicians.

The impact of burnout syndrome on practitioners working within rural healthcare systems.

Introduction: Burnout syndrome (BOS) affects up to 50% of healthcare practitioners. Limited data exist on BOS in paramedics/firstresponders, or others whose practice involves trauma. We sought to assess the impact of BOS in practitioners of rural healthcare systems involved in the provision of trauma care within West Virginia.

Nurse Practitioners' Role in Improving Service for Elderly Trauma Patients.

Preexisting conditions and decreased physiological reserve in the elderly frequently complicate the provision of health care in this population. A Level 1 trauma center expanded its nurse practitioner (NP) model to facilitate admission of low-acuity patients, including the elderly, to trauma services. This model enabled NPs to initiate admissions and coordinate day-to-day care for low-acuity patients under the supervision of a trauma attending.

Determination of Optimal Weight-Based Enoxaparin Dosing and Associated Clinical Factors for Achieving Therapeutic Anti-Xa Assays for Deep Venous Thrombosis Prophylaxis.

Background: Previous studies have evaluated dose-to-weight ratios to define best practices for obtaining therapeutic anti-Xa assays for enoxaparin venous thromboembolism (VTE) prophylaxis. These studies have not examined relationships among dosing, patient characteristics, and therapeutic assays. This study examines factors associated with therapeutic assays and enoxaparin prophylaxis.

Improving Pharmacologic Prevention of VTE in Trauma: IMPACT-IT QI Project.

Enoxaparin regimens commonly used for prophylaxis fail to achieve optimal anti-factor Xa levels in up to 70 per cent of trauma patients. Accordingly, trauma services at the study institution endeavored to develop a standardized approach to optimize pharmacologic prevention with enoxaparin. An enoxaparin venous thromboembolism (VTE) prophylaxis protocol implemented in October 2015 provided weight-adjusted initial dosing parameters with subsequent dose titration to achieve targeted anti-factor Xa levels.

An Outcome Analysis of Nurse Practitioners in Acute Care Trauma Services.

The department of trauma at a Level 1 trauma center sought to improve outcomes by enhancing the continuity of care for patients admitted to trauma services. Departmental leadership explored opportunities to improve this aspect of patient care through expansion of existing trauma nurse practitioner (NP) services. The restructured trauma NP service model was implemented in September 2013.

Substance exposure and helmet use in all-terrain vehicle accidents: Nine years of experience at a level 1 trauma center.

Introduction: The surging popularity of all-terrain vehicles (ATV) in the United States has caused an "epidemic of injuries and mortality." The U.S.

The effect of ethanol on lactate and base deficit as predictors of morbidity and mortality in trauma.

Objective: The objective of this study was to assess the predictive value of lactate and base deficit in determining outcomes in trauma patients who are positive for ethanol.

Methods: Retrospective cohort study of patients admitted to a level 1 trauma center between 2005 and 2014. Adult patients who had a serum ethanol, lactate, base deficit, and negative urine drug screen obtained upon presentation were included.

Readmission within 30 days of discharge after hip fracture care.

The Affordable Care Act currently requires hospitals to report 30-day readmission rates for certain medical conditions. It has been suggested that surveillance will expand to include hip and knee surgery-related readmissions in the future. To ensure quality of care and avoid penalties, readmissions related to hip fractures require further investigation.

Treatment of vancomycin-resistant enterococcus with quinupristin/dalfopristin and high-dose ampicillin.

Objective: To report the successful treatment of vancomycin-resistant Enterococcus (VRE) bacteremia using the combination of quinupristin/dalfopristin and high-dose ampicillin.

Case Summary: A 38-year-old African American woman with relapsed acute myeloid leukemia and neutropenic fever developed VRE bacteremia following 3 successive courses of vancomycin for methicillin-resistant staphylococcal infections. Treatment with linezolid was initiated; however, after 9 days of therapy, blood cultures continued to reveal VRE and the patient became febrile.