Safety and the anatomy of the retroperitoneal lateral corridor with respect to the minimally invasive lateral lumbar intervertebral fusion approach.

Safe and reproducible outcomes of the lateral lumbar intervertebral fusion (LLIF) procedure rely on meticulous care and understanding of the anatomy of the lateral corridor. This review aims to describe the different important anatomic considerations when performing LLIF and offer technical notes that may help increase the safety of this procedure. The LLIF procedure is divided into 5 stages: patient positioning, abdominal wall dissection, retroperitoneal space dissection, deployment of the surgical retractors, and diskectomy.

Effective treatment of eating disorders: Results at multiple sites.

We report the results of a study based on 1,428 patients with eating disorders treated at 6 clinics. These patients were consecutively referred over 18 years and used inpatient and outpatient treatment. The subjects were diagnosed with anorexia nervosa, bulimia nervosa, or an eating disorder not otherwise specified.

Innovation pilot study: acute care for elderly unit--promoting patient-centric care.

Purpose: Older patients, defined as age 65 years or older, comprise more than 40% of admissions to the acute care environment. These patients' needs are different; cognitive impairment, chronic health issues, caregiver burden, and maintenance of functional level present challenges to healthcare organizations when caring for this population on a general medical-surgical unit.

Background: A pilot project, the creation of a six-bed Acute Care for Elderly (ACE) unit situated within a 33-bed medical-surgical unit, was established to meet the unique needs of this older patient population.

The challenge of innovation and the high-performance team.

Purpose: This paper describes the use of a high-performance team model in the leadership of a healthcare construction project with a vision of fostering innovation in the design and building process. This model facilitated the effective implementation of = Lean principles and a joint governance model combining stakeholders under a shared vision.

Background: The healthcare facility discussed is a California healthcare district in San Diego.

Collagen matrix staple line reinforcement in gastric bypass.

Background: Staple line leaks and bleeding, anastomotic strictures, and marginal ulcers are significant complications of Roux-en-Y gastric bypass (RYGB) for morbid obesity. Reinforcing the staple lines with bovine collagen matrix reinforcement (CMR) might safely decrease the incidence of leaks and bleeding without causing other complications. Our objective was to determine the effect in RYGB of reinforcing the linear and circular gastric staple lines with CMR on the outcomes including abdominal septic events, blood transfusions, and the incidence of stricture and marginal ulceration of the gastrojejunostomy in a private bariatric surgery practice at 2 Surgical Review Committee Center of Excellence community hospitals.

Wildfire disaster leads to facilities evacuation.

Disaster preparedness in the healthcare setting traditionally focuses on accepting the capacity surge and influx of patients in time of crisis. The concept of a hospital evacuation is given little thought, and minimal time is spent practicing even though healthcare organizations have identified a hazard vulnerability that may require a full-scale evacuation. One healthcare organization recently pushed its staff to stretch its idea of disaster preparedness when it evacuated a community hospital and skilled nursing facility to ensure the safety of its patients and staff.

Ziprasidone therapy in elderly patients with psychotic mood disorders and Parkinson's disease.

Objective: To illustrate and discuss issues relevant to treatment of four elderly psychotic patients with multiple comorbidities, including a history of mood disorder and some level of movement disorder.

Participants: Four patients diagnosed with a major mood disorder and comorbid Parkinson's disease were treated successfully with adjunctive ziprasidone at doses of 80 to 160mg/d. Two of the patients had major depressive disorder, recurrent, with psychotic features (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV] DSM-IV 296.

Ziprasidone for dementia in elderly patients: case review.

Treatment of elderly patients with dementia-related behavioral disturbances and depression-related psychosis poses a significant problem, considering patients' frailty and use of polypharmacy for comorbid medical disorders. This case series describes the use of ziprasidone, a novel atypical antipsychotic, in three frail, elderly patients admitted to the hospital for behavioral disturbances secondary to dementia-related illness after their current treatment failed to improve symptoms or produced intolerable side effects. At admission, none of the patients were taking medications contraindicated for use with ziprasidone.

A rare case of Salmonella-mediated sacroiliitis, adjacent subperiosteal abscess, and myositis.

We report the case of a 16-year-old female who was ultimately diagnosed with Salmonella sacroiliitis, adjacent subperiosteal abscess, and myositis of the left iliopsoas, gluteus medius, and obturator internus muscles. Early and accurate recognition of this syndrome and other infectious musculoskeletal syndromes can prove difficult for the emergency physician, as these disease processes require special attention to pain of proportion to physical findings and a high index of suspicion.

Critical care of the morbidly obese.

This article describes the special needs of the critically ill morbidly obese, with a focus on the care of the postoperative obesity surgery patient. The technique of surgery is described elsewhere in this journal. Details of nursing care complicated by obesity are discussed.

Care of the obesity surgery patient requiring immediate-level care or intensive care.

Most bariatric surgery patients are triaged directly to the medical surgical floor postoperatively. However, patients at high risk due to comorbid factors, who have failed postoperative extubation or have suffered intraoperative complication, may require intensive care unit (ICU) or intermediate-level care (IMC). The special needs of the morbidly obese IMC/ICU patient include: triage, mobility, visiting, fluid resuscitation, management of sleep apnea, airway management, transporting for out of ICU procedures, and preventing pressure ulcers.

Making the most of your time: the benefits of converting patient education programs into continuing nursing education.

Educating hospital staff and patients is a time-consuming, yet essential component to a successful bariatric surgery program. The process of converting patient education and support group sessions into continuing education opportunities for hospital staff is described. This also provides hospital staff with direct exposure to patient testimony of concerns and obstacles to following treatment plans.

Signs of genital trauma in adolescent rape victims examined acutely.

Background: Adolescent females are the most frequent victims of sexual assault, but studies to document the presence of genital findings in patients examined within 72 hours, using magnification and dye, have not been published. This study was designed to document the frequency and types of genital injuries in adolescent women following acute sexual assault, using chart and photograph review.Methods: A retrospective chart review was done of examination records of all female patients age 14 to 19 years of age who were evaluated at a Sexual Assault Response Team program over a 5 year period.

Chronic hemospermia due to müllerian duct cyst: diagnosis by magnetic resonance imaging.

Hemospermia usually is considered of minor consequence. It rarely is identified with a specific pathological disorder. A case of hemospermia secondary to a müllerian duct cyst diagnosed by magnetic resonance scanning is reported.

Resources of adaptation for daily living.

Occupational therapy addresses the chronically disabled person's adaptation to problems in daily living. Resources of adaptation are those inherent abilities and lifelong learnings which the individual uses to deal with daily living problems. Adaptation is described as flexible behavior to meet the changing needs of a changing environment.