Intrahepatic Biliary Colloid Carcinoma: A Rare Site for Recurrence.

A new biliary duct (BD) stricture raises questions about the presence of malignancy, especially with a history of metastatic pancreatic cancer. A few cases of colloid carcinoma (CC) of the pancreas have been published, but none have described recurrence in the biliary tract. We report a case of intrahepatic biliary CC that recurred after two years after the last dose of immunotherapy for pancreatic CC.

Use of the Modified Early Warning Score by Medical-Surgical Nurses to Initiate the Rapid Response Team: Impact on Patient Outcomes.

Background: Cardiac arrests are often preceded by several hours of physiological deterioration that may go undetected.

Local Problem: Cardiac arrests frequently occurred on medical-surgical units without prior rapid response team intervention.

Methods: A pre/postintervention design was used to evaluate a protocol to guide the use of the Modified Early Warning Score (MEWS) by medical-surgical nurses to escalate the care of deteriorating adult patients.

Early Use of Remdesivir in Patients Hospitalized With COVID-19 Improves Clinical Outcomes: A Retrospective Observational Study.

Background: Remdesivir treatment, like most antiviral drugs, is likely to be most effective when used early in the course of coronavirus disease 2019 (COVID-19). Optimal timing of remdesivir for the treatment of COVID-19 remains unclear.

Objectives: The aim of this study was to determine whether early treatment with remdesivir improves clinical outcomes: length of stay, need for mechanical ventilation, and death.

A safer, less costly SSI prevention protocol-Universal versus targeted preoperative decolonization.

Surgical site infection after total joint replacement results in significant patient suffering and health care costs. To reduce the risk of surgical site infection after total joint procedures, 1 hospital instituted preoperative universal nasal and skin decolonization, using an alcohol based nasal antiseptic and chlorhexidine bathing. This resulted in reduced infection rates, and associated patient morbidity and costs to the facility.

Characterizing Chemical Terrorism Incidents Collected by the Global Terrorism Database, 1970-2015.

Background: The Global Terrorism Database (GTD) is an open-source database on terrorist incidents around the world since 1970, and it is maintained by the National Consortium for the Study of Terrorism and Responses to Terrorism (START; College Park, Maryland USA), a US Department of Homeland Security Center of Excellence. The consortium reviews media reports to determine if an event meets eligibility to be categorized as a terrorism incident for entry into the database.

Objective: The objective of this study was to characterize chemical terrorism incidents reported to the GTD and understand more about the kinds of chemical agents used, the associated morbidity and mortality, the geography of incidents, and the intended targets.

Impact of the use of local fidaxomicin treatment algorithms for managing Clostridium difficile infection in hospitalized patients in southeastern United States.

Background: Clostridium difficile-associated diarrhea (CDAD) is a major public health threat that results in increased length of stay, hospital readmissions, deaths, and economic burden. CDAD treatment is often guided by severity of disease. Although various tools exist to determine CDAD severity, real-world data evaluating the use of such tools in treatment algorithms are sparse.

The Effects of Guided Imagery on Patients Being Weaned from Mechanical Ventilation.

The study purpose was to assess the effects of guided imagery on sedation levels, sedative and analgesic volume consumption, and physiological responses of patients being weaned from mechanical ventilation. Forty-two patients were selected from two community acute care hospitals. One hospital served as the comparison group and provided routine care (no intervention) while the other hospital provided the guided imagery intervention.

Treatment of Cases of Neisseria gonorrhoeae and Chlamydia trachomatis in Emergency Department Patients.

Background: The aim of this study was to determine the proportion of patients treated appropriately, both presumptively in the emergency department (ED), and at follow-up, among those patients who ultimately tested positive for either Neisseria gonorrhoeae (NG) or Chlamydia trachomatis (CT). Secondary aims were to characterize patients who received appropriate presumptive antibiotic treatment of both NG and CT at the time of ED visit and to compare them to patients who did not receive appropriate presumptive therapy.

Methods: A retrospective chart review was performed on 500 patients randomly chosen from those that had positive NG or CT test results performed in the ED between January 10 and June 11.

Heat-related deaths in Adelaide, South Australia: review of the literature and case findings - an Australian perspective.

Heat waves are not uncommon in Australia, but the event of 2009 was particularly severe and ranks third of the 21 recorded heat wave events in south-eastern Australia in terms of the resulting mortality and morbidity. This is a review of Coronial autopsy findings in South Australia (which has an area of nearly 1 million square kilometres with a population of 1.6 million that predominantly resides within the region of the capital: Adelaide) during the period of the 2009 heat wave.

Utilizing evidence-based design in a community hospital ICU.

This project documents a strategic planning process utilized during an academic clinical experience to establish evidence-based design features in new construction of an intensive care unit at a community hospital, while optimizing safe and cost-effective quality care, based upon evidence-based research.