Parkview Health Research Repository
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Orthoplastic Approach to the Treatment and Reconstruction of a Neurotrophic Receptor Tyrosine Kinase Type 3 Soft Tissue Sarcoma Arising From the Occipitalis Muscle.
No full textWe present a multidisciplinary approach to the treatment of a neurotrophic receptor tyrosine kinase type 3 (NTRK3) soft tissue sarcoma (STS), arising from the occipitalis muscle. NTRK3 is a mutation only recently described in STS using next-generation sequencing and is rarely implicated in STS.Currently, there is limited literature to guide care. This case demonstrates a successful treatment option utilizing a multidisciplinary team and unique reconstruction with a hair-bearing scalp. To the best of our knowledge, this is the first case report showing an NTRK3 mutation STS arising from the occipitalis muscle. The utilization of staged hair-bearing tissue expansion post-wide R0 resection to reconstruct the scalp defect is a challenging reconstruction method. We present a single clinical experience discussing a 40-year-old female with an NTRK3 mutation STS arising from the occipitalis muscle and involving the scalp. The diagnosis was made after the analysis of a punch biopsy specimen by a bone and soft tissue pathologist as a low-grade sarcoma harboring a sperm antigen with calponin homology and coiled-coil domains 1-like (SPECC1L)-NTRK3 fusion transcript. The patient underwent R0 resection by orthopedic oncology surgery and craniofacial microvascular plastic surgery. Staged reconstruction via hair-bearing tissue expansion was performed by the latter. Eighteen months after the index procedure, no recurrent disease was detected, and the hair-bearing reconstruction was fully healed with well-concealed scars. This case is a successful treatment method for a low-grade STS harboring a SPECC1L-NTRK3 fusion transcript. There is little published literature to guide care for low-grade NTRK3 mutation STS. This case highlights the importance of multidisciplinary care for STS
Effect of Weighted Blanket Versus Traditional Practices on Anxiety and Pain in Patients Undergoing Elective Surgery: A Multicenter Randomized Controlled Trial.
No full textPerioperative anxiety is common in surgical patients and linked to poor outcomes. This multicenter randomized controlled trial assessed the effect of the use of a warm weighted blanket on presurgical anxiety and pain, as well as postsurgical restlessness, nausea, and vomiting. Levels of anxiety and pain were measured in adult patients using a 100-point visual analog scale before elective surgery. Patients received either a warm weighted blanket (n = 74) or a traditional sheet or nonweighted blanket (n = 74). Patients in the intervention group had significantly lower preoperative anxiety scores (mean [SD] = 26.28 [25.75]) compared to the control group (mean [SD] = 38.73 [30.55], P = .008). However, the intervention had no significant effect on presurgical pain or postsurgical nausea, vomiting, or restlessness. These results suggest that weighted blankets reduce preoperative anxiety in adult patients
Issue 10: Pulmonary & Critical Care Insider
Get PDFPulmonary & Critical Care Insider Issue 10
Compiled by Bharat Bajantri, MD, and librarian Sarah Ellsworth, MLS for the clinicians of the Pulmonary and Critical Care team of Parkview.
The Pulmonary & Critical Care Insider newsletter was created by Dr. Bharat Bajantri, MD and Sarah Ellsworth, MLS in 2023 as a form of current awareness for current practice at our hospital, Parkview Health.
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Topics:
VIEWPOINTS:
Biologics for treating uncontrolled severe asthma
Don\u27t you quit on cannot quit smokers.
Paxlovid may not be your magic bullet for Covid-19 infection.
ORIGINAL STUDY SUMMARY
The DanGer Trial
The ACCESS Trial
The PREOXI Trial
SNAPSHOTS:
Monitoring capillary refill time in septic shock
New Diagnostic Algorithm for Allergic Bronchopulmonary Aspergillosis/Mycosis 202
AN UNUSUAL CASE OF SYNCOPE DUE TO LARGE AORTIC VALVE THROMBI
No full textSection snippets Background Aortic valve thrombi are rare and life-threatening and can present in unusual ways. We present a case of a female in her 40s with a history of non-ischemic transient cardiomyopathy who presented with syncope. Case A 45-year-old female with a history of non-ischemic cardiomyopathy presented to our hospital for the sudden loss of consciousness while sitting on the toilet with the return of consciousness at the hospital. Physical examination was unremarkable. EKG and CT head had no acute abnormality; however, a chest CT angiogram noted an opacification in the ascending aorta, and a TTE showed a mobile aortic valve mass. Decision-making Intraoperative TEE confirmed a non-coronary cusp thrombus, which was removed via partial sternotomy. A cusp repair was completed with a bovine pericardial patch. Biopsy confirmed thrombus. Conclusion This case highlights the rare but critical nature of aortic valve thrombi. Early diagnosis, using imaging like echocardiography, CT, or MRI, is crucial due to significant morbidity and mortality risks. Treatment depends on thrombus size, location, and symptoms, often requiring surgery for large or symptomatic cases. Preventive measures are vital, including managing aortic valve disease and hypercoagulable conditions
2023 Parkview Research Repository Library Report - Infographic
Get PDFA infographic compilation of data regarding readership and metrics of content in the Parkview Research Repository for the year of 2023. The platform, Digital Commons, is provided by Elsevier and the institutional repository is managed by the Parkview Research Library. This institutional repository (IR) was started in 2017 and is accessible worldwide
Identifying Improvement Opportunities for the Utilization of Carbapenems at a Community Health System.
Get PDFPresented at the Great Lakes Pharmacy Resident Conference. West Lafayette, IN: April 2024.
This study found opportunities to improve utilization of carbapenems, such as by delabeling inappropriate penicillin and cephalosporin allergies, modifying order sets, providing education, and initiating alerts to prompt de-escalation
Toddlers’ physiological response to parent\u27s mobile device distraction and technoference
No full textGiven the prevalence of mobile device use, especially among parents of young children, the current study examines the impact of mobile device distraction (technoference) on toddlers’ physiological and emotional functioning. We suspected that toddlers’ would demonstrate difficultly maintaining physiological and emotional homeostasis when parents became distracted by a mobile device. In this study, we examined toddlers’ (N = 129, M age = 29.05 months) physiological and behavioral responses across three conditions in an induced technoference task that mimicked elements of a traditional still face paradigm (i.e., social engagement, phone distraction, and social recovery). Similar to previous studies employing still face with younger infants, a majority of toddlers demonstrated a loss of positive affective tone mirrored by heart rate increase and respiratory sinus arrhythmia (RSA) decrease (vagal withdrawal) during the phone distraction condition relative to the initial and final social engagement conditions. However, some toddlers demonstrated vagal activation (RSA increase) to parents’ phone distraction. Greater RSA withdrawal was linked to decreased positive affect and increased negative affect for children during parents’ phone distraction. Parents who reported higher levels of technoference were more likely to have children who demonstrated lower vagal reactivity (greater vagal withdrawal) to parents’ phone distraction while parents attitudes about technoference (e.g., “it is okay to use a mobile device in front of my child”) was found to be linked to higher RSA reactivity (greater vagal activation). Findings are discussed in relation to Porges’ polyvagal theory and the possible role that interactive dynamics play in children\u27s emerging regulatory syste
Optimization of beta-lactam dosing in critically ill patients with continuous veno-venous hemofiltration or augmented renal clearance.
Get PDFPresented at the ASHP Midyear Clinical Meeting. New Orleans, LA
This evaluation found that traditional dosing of beta-lactams found in practice is often (20 to 90%) suboptimal when compared to ideal evidence-based dosing, that optimizes efficacy while limiting adverse effects from drug toxicity
Issue 7: Pulmonary & Critical Care Insider
Get PDFPulmonary & Critical Care Insider Issue 7
Compiled by Bharat Bajantri, MD, and librarian Sarah Ellsworth, MLS for the clinicians of the Pulmonary and Critical Care team of Parkview.
The Pulmonary & Critical Care Insider newsletter was created by Dr. Bharat Bajantri, MD and Sarah Ellsworth, MLS in 2023 as a form of current awareness for current practice at our hospital, Parkview Health. The content resides within critical care and pulmonary related topics and this information is compiled into four main formats. Original Study Summaries: New research publications are read, reviewed, then concisely summarized for clinical interpretation with professional perspectives. Viewpoints: Editorial clinical perspective pieces on current practices. This includes mini-reviews. Snapshots: Quick reference of updated clinical practice or guidance. Contributions: Relevant submissions from other professionals.
All content in Pulmonary & Critical Care Insider is reviewed and referenced by healthcare and library professionals. Information provided is intended to disseminate new information and encourage best practices through perspective and discussion.
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Topics:
VIEWPOINTS
2023 GUIDELINE FOR ATRIAL FIBRILLATION MANAGEMENT: Regularly regular superseded Irregularly irregular!
ANTICOAGULATION FOR TRANSIENT SUBCLINICAL ATRIAL FIBRILLATION: Benefits outweigh the risks... Does not really mean Benefits outweigh the risks!
ORIGINAL STUDY SUMMARIES: Initiation of Continuous Renal Replacement Therapy Versus Intermittent Hemodialysis in Critically Ill Patients with Severe Acute Kidney Injury: A Secondary Analysis of STARRT AKI Trial.
ORIGINAL STUDY SUMMARIES: Blood Eosinophil-guided Oral Prednisolone for COPD Exacerbations in Primary Care in the UK (STARR2): A Non Inferiority, Multicentre, Double-Blind, Placebo Controlled, Randomised Controlled Trial.
ORIGINAL STUDY SUMMARY & PERSPECTIVE: Providing Cleaning Recommendations for Positive Airway Pressure Devices Afterall, CPAP does not really need to be so clean! : Written by Bharat Bajantri, MD in collaboration with Srinivasan Devanathan, MD and Manuel Martinez, MD
SNAP SHOTS:
How many steps a day can really be healthy? Not 10,000. (step count and cardiovascular outcomes)
WEANSAFE says it\u27s safe to wean: BE BRAVE! (weaning from mechanical ventilation)
Somethings we do wrong , b ut cannot do it right either! Can we try harder? (ph levels
Implementing Services for Pediatric Cystic Fibrosis Treatment in a Community Hospital.
Get PDFThis project aimed to describe how the pharmacy department prepared to care for pediatric patients with cystic fibrosis, a new population being cared for at the institution.
PURPOSE: Our community hospital was recently charged with providing care for pediatric people with cystic fibrosis (PwCF). Pediatric PwCF generally need a higher level of care than is required by other pediatric patients cared for at our institution. This project aimed to prepare the pharmacy department to care for this specialized population safely and efficiently.
SUMMARY: The implementation process was divided into 3 phases to accomplish the larger purpose. These phases were as follows: (1) creating order sets and protocols; (2) providing staff and clinical pharmacists with training and resources; and (3) creating and managing clinical decision support. The central aspect of preparing inpatient pharmacy staff to care for PwCF was the development of antibiotic dosing protocols and order sets comprised of intravenous and oral antibiotics as well as aminoglycoside and vancomycin pharmacokinetic guides. A pharmacokinetic calculator was created to assist with aminoglycoside dosing and monitoring. During phase 2, pharmacist education modules were created to provide guidance on cystic fibrosis and medications commonly used to treat it. As the newly designed protocols were enacted, education was provided on how to use them. Phase 3 occurred concurrently, as clinical decision support was vital to completing phases 1 and 2.
CONCLUSION: The phased approach was imperative to the project\u27s success and kept individual components on track. All parts were completed in just over one year