Decreased Cerebral Perfusion Under Anesthesia During Radiation Treatment: A Case Report.

Radiation therapy allows patients to receive focused radiation to a tumor. Some patients require anesthesia for their daily treatments. For head and neck tumors, a thermoplastic mask is created to minimize movement.

Anatomy of a successful stewardship intervention: Improving perioperative prescribing in penicillin-allergic patients.

Objective: To evaluate whether a series of quality improvement interventions to promote safe perioperative use of cephalosporins in penicillin-allergic patients improved use of first-line antibiotics and decreased costs.

Design: Before-and-after trial following several educational interventions.

Setting: Academic medical center.

A Streamlined Approach to Optimize Perioperative Antibiotic Prophylaxis in the Setting of Penicillin Allergy Labels.

Background: Patients with penicillin allergy labels often receive alternative antibiotics for perioperative prophylaxis, as opposed to first-line cephalosporins (cefazolin/cefuroxime). Provider misconceptions about the risk of cross-reactivity likely drive this prescribing behavior, which is problematic because of its association with increased risk of surgical-site infections.

Objective: To develop, implement, and assess the safety of a streamlined approach to perioperative antibiotic selection for surgical patients with a penicillin allergy label, to reduce the use of second-line antibiotics.

Crowdsourcing sugammadex adverse event rates using an in-app survey: feasibility assessment from an observational study.

Background: Mobile applications (apps) have become a ubiquitous source of clinical decision support. We sought to ascertain the feasibility of using an app platform to obtain a crowdsourced measure of adverse drug reaction reporting rates associated with sugammadex administration and compare it with traditionally-derived estimates.

Methods: Using the widely-distributed anesthesia calculator app, 'Anesthesiologist', we surveyed anesthesia providers regarding their experience with adverse drug reactions associated with sugammadex administration.

Initial experience with the unrestricted introduction of sugammadex at a large academic medical center: a retrospective observational study examining postoperative mechanical ventilation and efficiency outcomes.

Background: Sugammadex rapidly reverses deep neuromuscular blockade, but owing to cost, questions remain about its optimal utilization. After the unrestricted introduction of sugammadex at Emory University Hospital, we hypothesized that reductions would be demonstrated in the primary outcome of post-anesthesia care unit (PACU) mechanical ventilation (MV) and secondary outcomes of PACU length of stay (LOS) and emergence time (surgery end to anesthesia end time in the PACU).

Methods: This retrospective observational study included patients undergoing general anesthesia over a 12-month period.

The efficacy of medical team training: improved team performance and decreased operating room delays: a detailed analysis of 4863 cases.

Objectives: Medical team training (MTT) has been touted as a way to improve teamwork and patient safety in the operating room (OR).

Methods: OR personal completed a 1-day intensive MTT training. A standardized briefing/debriefing/perioperative routine was developed, including documentation of OR miscues, delays, and a case score (1-5) assigned by the OR team.

Lower syringe sharing and re-use after syringe legalization in Rhode Island.

Increased access to sterile syringes reduces the transmission of HIV, viral hepatitis and other infectious diseases, without increasing injection drug use. In Rhode Island, in 2000, syringes were legalized to reduce spread of disease but remained outlawed in Massachusetts until 2006. Drug users undergoing inpatient detoxification in Rhode Island and Massachusetts were surveyed about their syringe usage between October 2001 and August 2003.

Demographic, geographic, and temporal patterns of ambulance runs for suspected opiate overdose in Rhode Island, 1997-20021.

We examine ambulance runs for suspected opiate overdose from 1997 to 2002 using a Rhode Island Department of Health database. Of the 8,763 ambulance runs for overdoses, 18.6% were for suspected opiate overdoses.

Linkage with methadone treatment upon release from incarceration: a promising opportunity.

Injection drug users (IDUs) are at increased risk for HIV, viral hepatitis, and tuberculosis, and making up more than a quarter of the incarcerated population in the United States. Methadone maintenance treatment of opiate addiction is highly effective at reducing drug use, drug-related criminal activity, and risk of HIV transmission. Recently released inmates are at particularly high risk for overdose and disease transmission.

Prisoners' attitudes toward Hepatitis B vaccination.

Background: Hepatitis B continues to be a substantial problem in the United States despite the existence of a safe and effective vaccine. Vaccination programs for inmates could reach many high-risk individuals but little is known about U.S.

A syringe prescription program to prevent infectious disease and improve health of injection drug users.

Injection drug users (IDUs) are at increased risk for many health problems, including acquisition of human immunodeficiency virus (HIV) and hepatitis B and C. These risks are compounded by barriers in obtaining legal, sterile syringes and in accessing necessary medical care. In 1999, we established the first-ever syringe prescription program in Providence, Rhode Island, to provide legal access to sterile syringes, reduce HIV risk behaviors, and encourage entry into medical care.

Strategies to improve access to sterile syringes for injection drug users.

The high prevalence of infection with HIV and other blood-borne pathogens in injection drug users (IDUs) is directly related to the lack of syringe access. Needle exchange programs (NEPs), syringe prescription, and syringe deregulation are 3 approaches to increasing access to sterile syringes for IDUs. The benefits of NEPs have been repeatedly demonstrated, but the impact of NEPs has been limited by a lack of federal funding.