A novel standard to evaluate the impact of therapeutic agents on patient safety - The BURDEN OF THERAPY™.

Purpose: Currently, treatment-emergent adverse events (TEAEs) during a clinical study are summarized over the entire study period.

Objective: Develop and validate a novel methodology, BURDEN OF THERAPY (BOTh), to quantify presence and severity of TEAEs on each day of study.

Methods: BOTh utilizes patient-level safety data to derive a quantitative estimate for the burden of TEAEs that all or individual patients experience on each day of a clinical study.

Importance of patient selection for patient-controlled epidural analgesia (PCEA), as even low-concentration solutions may lead to a very high block.

Patient-controlled epidural analgesia (PCEA) is an excellent choice of analgesia technique in labor; however, patient selection for such treatment is important. A 14 year old healthy parturient receiving PCEA had a very high block due to patient noncompliance.

Successful implementation of a family and patient activated rapid response team in an adult level 1 trauma center.

Background: When cardiac arrests occur in hospitalized patients, delays in treatment are associated with lower survival and poorer outcomes. Patients often show a physiological deterioration hours before cardiac or pulmonary arrest. As a result, many hospitals have implemented a rapid response team (RRT) as part of their involvement in the 100,000 Lives Campaign sponsored by the Institute for Healthcare Improvement.

Detecting an infiltrated intravenous catheter using indigo carmine: a novel method.

An extravasated IV catheter may have serious clinical consequences. These include the inability to circulate emergency medications, cause pain on injection, infection at the site, and tissue damage. Clinical signs such as swelling, redness, and pain with injection are valuable, but may not be helpful in the presence of obesity, edema, or in a tracheally intubated and sedated patient.

Scavenging in the operating room.

Purpose Of Review: The use of inhalation general anesthetic gases has led to contamination of the operating room environment. Chronic exposure to these agents has been associated with a number of adverse health effects. Controversy remains with regard to these health effects, and whether further reducing the level of operating room contamination should be a high priority.

Use of a modifier reduces inconsistency in the American Society of Anesthesiologists Physical Status Classification in parturients.

In this study, we sought to determine whether there is a significant discrepancy among a group of practitioners when rating pregnant patients using the ASA Physical Status Classification and whether this discrepancy could be resolved with the addition of a modifier for pregnancy. Our results indicate that significant discrepancy occurs and that it is reduced with the use of the modifier, especially when referring to the healthy parturient.

Hyperbaric therapy for a postpartum patient with prolonged epidural blockade and tomographic evidence of epidural air.

Unlabelled: We used the epidural technique "loss of resistance to air" to provide labor analgesia in a healthy parturient. Inadequate analgesia required epidural catheter replacement using the same technique. Delayed recovery of sensory and motor blockade postpartum necessitated computed tomography and magnetic resonance imaging studies.

Local anesthetic requirements are greater in dystocia than in normal labor.

Background: Dystocia is characterized by abnormal progress of labor and is a common contemporary indication for cesarean delivery in the United States. There has been considerable controversy as to whether epidural analgesia causes dysfunctional labor leading to cesarean delivery for dystocia. The minimum local analgesic concentration (MLAC) is a clinical model used to determine the relative potencies of local anesthetics in the first stage of labor.

The use of a uniquely designed anesthetic scavenging hood to reduce operating room anesthetic gas contamination during general anesthesia.

Unlabelled: Numerous studies have suggested that chronic exposure to trace levels of anesthetic gas is harmful to operating room (OR) personnel. In the delivery of pediatric general anesthesia, an uncuffed endotracheal tube (ETT) is normally used which can result in considerable volatile anesthetic and nitrous oxide contamination of the OR. In this report, we present a method to reduce exposure to these anesthetic gases by means of an anesthetic scavenging hood (ASH).

A novel ambulatory intravenous holder: preliminary findings.

Many devices serve as portable systems for IV equipment but are expensive and use complex electronic controls. We present a novel device to facilitate safe ambulation of IV-dependent patients. This device was effective in delivering required therapeutic flow rates over time periods desired for unattended operation.