Length of Stay and Hospital Cost Reductions After Implementing Bedside Percutaneous Ultrasound Gastrostomy (PUG) in a Critical Care Unit.

Critical care patients receive 50% of gastrostomy tubes placed in the United States. Several gastrostomy placement methods exist, however care processes remain variable and often lack health system cost effectiveness. No data exists on efficiency or cost impact of performing bedside percutaneous ultrasound gastrostomy (PUG) on patients with ventilator-dependent respiratory failure.

Bedside percutaneous ultrasound gastrostomy tube placement by critical care physicians.

Critically ill patients often require gastrostomy tubes. Percutaneous endoscopic gastrostomy has become the most common method of placement but is not widely performed by critical care physicians, in part due to their lack of familiarity and training in upper gastrointestinal endoscopy. Percutaneous ultrasound gastrostomy (PUG) is a novel procedure for gastrostomy tube placement that utilizes ultrasound-based methods already familiar to critical care physicians.

Review of Emerging Pharmacotherapy for the Treatment of Coronavirus Disease 2019.

The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has evolved into an emergent global pandemic. Coronavirus disease 2019 (COVID-19) can manifest on a spectrum of illness from mild disease to severe respiratory failure requiring intensive care unit admission. As the incidence continues to rise at a rapid pace, critical care teams are faced with challenging treatment decisions.

Correlation Between mMINDS and CIWA-Ar Scoring Tools in Patients With Alcohol Withdrawal Syndrome.

Background: Many alcohol withdrawal scoring tools are used in hospitalized patients to assess the severity of alcohol withdrawal and guide treatment. The revised Clinical Institute Withdrawal Assessment (CIWA-Ar) and the modified Minnesota Detoxification Scale (mMINDS) are commonly used but have never been correlated.

Objective: To determine the strength of correlation between the CIWA-Ar and mMINDS scoring tools in patients with alcohol withdrawal syndrome.

Implementation of an ICU-Specific Alcohol Withdrawal Syndrome Management Protocol Reduces the Need for Mechanical Ventilation.

Study Objective: Alcohol use disorders are prevalent and put patients at risk for developing alcohol withdrawal syndrome (AWS). Treatment of AWS with a symptom-triggered protocol standardizes management and may avoid AWS-related complications. The objective of this study was to evaluate whether implementation of a specific intensive care unit (ICU) symptom-triggered protocol for the management of AWS was associated with improved clinical outcomes and, in particular, would reduce the risk of patients with AWS requiring mechanical ventilation.

The Peridural Membrane of the Human Spine is Well Innervated.

There is evidence that low back pain may originate from a peridural membrane (PDM) at the inferior and medial aspect of neural foramen of the lumbar spine. The objective of this investigation was to determine if this membrane contains neural elements suggestive of sensory innervation with nociceptive function. Spines of four embalmed and three non-embalmed human cadavers were dissected using a sagittal approach to the neural foramen.

Adverse Event Reporting and Quality Improvement in the Intensive Care Unit.

Patients in the intensive care unit are at high risk for experiencing adverse events and errors. The high-acuity health care needs of these vulnerable patients expose them to numerous medications, procedures, and health care providers. The occurrence of adverse events is associated with detriments to patient outcomes including increased mortality.

Treatment of Common Low Back Pain: A New Approach to an Old Problem.

Low back pain is very common, but the pathophysiology is poorly understood. We present a new hypothesis regarding the pathophysiology of common low back pain supported by our flexible endoscopic observations of the epidural cavity (epiduroscopy), anatomic dissection of embalmed and fresh cadavers, and careful review of preexisting information available on the anatomy of the epidural space and neuroforamen. A new approach to the treatment of common low back pain based on the hypothesis was developed and is presented in the case reports of five patients.

Development of an interventional pain management specific instrument for methodologic quality assessment of nonrandomized studies of interventional techniques.

Background: The major component of a systematic review is assessment of the methodologic quality and bias of randomized and nonrandomized trials. While there are multiple instruments available to assess the methodologic quality and bias for randomized controlled trials (RCTs), there is a lack of extensively utilized instruments for observational studies, specifically for interventional pain management (IPM) techniques. Even Cochrane review criteria for randomized trials is considered not to be a "gold standard," but merely an indication of the current state of the art review methodology.

Novel integration of systems-based practice into internal medicine residency programs: the Interactive Cost-Awareness Resident Exercise (I-CARE).

Background: The Accreditation Council for Graduate Medical Education and American Board of Internal Medicine have identified cost-awareness as an important component to residency training. Cost-awareness is generally not emphasized in current, traditional residency curricula despite the recognized importance of this topic.

Description: Using a traditional Morning Report structure and actual charge data from our institution, the charges associated with trainee-directed workup of clinical cases are compared in a friendly competition among medical students, interns, residents, and faculty.

Lumbosacral epiduroscopy findings predict treatment outcome.

Objective: The aim of this study was to evaluate the significance of diagnostic markers obtained through epiduroscopy by evaluating the accuracy of outcome prediction after treatment of epidural pathology using epiduroscopy.

Design: A prospective observational study of 139 patients was performed. Patients with chronic low back and leg pain were included.

Epiduroscopy for patients with lumbosacral radicular pain.

Lumbosacral radicular pain is a pain in the distribution area of one of the nerves of the lumbosacral plexus, with or without sensory and/or motor impairment. A major source of lumbosacral radicular pain is failed back surgery, which is defined as persistent or recurrent pain, mainly in the region of the lower back and legs even after technically, anatomically successful spine surgeries. If lumbosacral radicular neuropathic pain fails to respond to conservative or interventional treatments, epiduroscopy can be performed as part of a multidisciplinary approach.

Prevalence of adverse reactions to radiopaque contrast reported by patients presenting for interventional pain procedure.

Introduction: Adverse reactions to radiopaque contrast media (RCM) are well documented with a wide range of incidences reported. The objective of this study was to determine how many patients in a sample of 200 who presents for interventional pain treatments report a history of adverse reactions to RCM.

Methods: Data from 200 outpatients were collected using a self-administered questionnaire.

Diagnosis of the vertebral level from which low back or leg pain originates. A comparison of clinical evaluation, MRI and epiduroscopy.

Background: The precise localization of painful structures in the spine of patients with low back pain and/or pain radiating (LBP/RP) to the lower extremities is important for targeted therapeutic intervention. The aim of the study reported here was to determine and compare the spinal segment(s) where pain was elicited via endoscopic evaluation vs. the vertebral level from where the pain was thought to originate as determined by clinical evaluation and by MRI.

The peridural membrane of the spinal canal: a critical review.

There exists substantial evidence that a peridural membrane (PM) is present in the spinal canal of humans and, like the pleura and peritoneum, has one or more physiologic functions. Innervation of the PM suggests that it may become a source of pain if injured. Although debated, the physiology of this structure has important implications with respect to neuraxial distribution of drugs and for back and radiating pain.

The story of the Texas Pain Society: formation and function of a regional pain society.

The idea of forming a Texas Pain Society came to the Founders in 1987 due to disparity and deficiencies in the practice of pain management in the United States and, in particular, the State of Texas. The Founders considered very carefully the implication of forming such a society. They diligently mapped out the mission and goals of the Texas Pain Society in those early formative years.

Hyaluronidase: a review of approved formulations, indications and off-label use in chronic pain management.

Importance Of The Field: Hyaluronidase for injection is an adjuvant that increases the absorption and dispersion of other injected drugs or fluids (hypodermoclysis); and improves absorption of radiopaque agents in subcutaneous urography. Ovine hyaluronidase is approved for the treatment of vitreous hemorrhages.

Areas Covered In This Review: We review approved indications for injectable hyaluronidase and off-label uses as well as safety, efficacy and dosing information.

Incidence and severity of epidural fibrosis after back surgery: an endoscopic study.

Background: Epidural fibrosis has been implicated in the etiology of persistent pain after back surgery (Failed Back Surgery Syndrome [FBSS]). Using spinal endoscopy to view the lumbosacral epidural cavity, the incidence, severity, and appearance of epidural fibrosis was evaluated in patients with FBSS.

Methods: A prospective cohort observational study using epidural endoscopy was done involving 78 patients with persistent pain after back surgery.

Cell types obtained from the epidural space of patients with low back pain/radiculopathy.

Background: We investigated if correlations exist between medical history, tissue abnormalities, and cell types retrieved from the epidural space of patients with chronic low back pain (LBP) and chronic radicular pain (RP).

Methods: Approval was obtained from the Institutional Review Board for the Protection of Human Subjects to study 191 patients undergoing epiduroscopy. Visual inspection was performed and abnormal areas were identified.