How good are we at determining risk? Quantifying the accuracy of clinician determined risk for VTE prophylaxis

Objectives: Create and validate a simple tool for concurrent audits of risk stratification, compliance and documentation Evaluate accuracy of clinician risk stratification and prophylatic ordering practice compared with a standardized Caprini RAM across different assigned risk categories Provide recommendations for EPIC VTE Prophylaxis CDS Developmenthttps://jdc.jefferson.edu/patientsafetyposters/1050/thumbnail.jp

Quantifying Patient Reported and Documented Compliance with Adjuncts to Venous Thromboembolism Prophylaxis

Objectives: 1. Measure patient compliance with pharmacologic, mechanical and ambulatory prophylactic measures. 2. Evaluate for agreement between nursing documentation and patient reported compliance with mechanical and ambulatory prophylactic measures.https://jdc.jefferson.edu/patientsafetyposters/1042/thumbnail.jp

Sepsis in two hospitals in Rwanda: A retrospective cohort study of presentation, management, outcomes, and predictors of mortality.

PURPOSE: Few studies have assessed the presentation, management, and outcomes of sepsis in low-income countries (LICs). We sought to characterize these aspects of sepsis and to assess mortality predictors in sepsis in two referral hospitals in Rwanda. MATERIALS AND METHODS: This was a retrospective cohort study in two public academic referral hospitals in Rwanda. Data was abstracted from paper medical records of adult patients who met our criteria for sepsis. RESULTS: Of the 181 subjects who met eligibility criteria, 111 (61.3%) met our criteria for sepsis without shock and 70 (38.7%) met our criteria for septic shock. Thirty-five subjects (19.3%) were known to be HIV positive. The vast majority of septic patients (92.7%) received intravenous fluid therapy (median = 1.0 L within 8 hours), and 94.0% received antimicrobials. Vasopressors were administered to 32.0% of the cohort and 46.4% received mechanical ventilation. In-hospital mortality for all patients with sepsis was 51.4%, and it was 82.9% for those with septic shock. Baseline characteristic mortality predictors were respiratory rate, Glasgow Coma Scale score, and known HIV seropositivity. CONCLUSIONS: Septic patients in two public tertiary referral hospitals in Rwanda are young (median age = 40, IQR = 29, 59) and experience high rates of mortality. Predictors of mortality included baseline clinical characteristics and HIV seropositivity status. The majority of subjects were treated with intravenous fluids and antimicrobials. Further work is needed to understand clinical and management factors that may help improve mortality in septic patients in LICs

Aristotle for the modern Ethicist

Elizabeth Anscombe and Mary Midgley discussed Aristotle’s ethics as an alternative to modern moral philosophy. This idea is best known from Anscombe’s 1958 paper ‘Modern Moral Philosophy’. The mainstream response has been to design a normative theory of ‘virtue ethics’ to rival deontology and consequentialism. This essay argues that that response is inadequate; it misses Anscombe’s point and obscures various aspects of Aristotle’s ethics, in particular his emphasis on friendship and human interconnectedness. This element of Aristotelianism was favoured by Midgley. By returning to Midgley, with the support of Aristotle, it is possible to find an alternative modern Aristotelianism in ethics

Il meticciato nell'Italia contemporanea. Storia, memorie e cultura di massa.

L'idea diffusa degli "italiani brava gente" e della diversit\ue0 della nostra storia rispetto alla storia USA, segnata da razzismo istituzionale, si fonda sul silenziamento del passato coloniale e razzista italiano. Il ripudio della categoria di razza da parte dell'Italia repubblicana e la smentita scientifica dell'esistenza biologica della categoria non hanno cancellato la presenza della razza, formazione storico-culturale che paradossalmente esiste e non esiste. Priva di referenti oggettivi nella realt\ue0, la razza produce in essa effetti significativi, opera sia come categoria sociale e strumento di esclusione, sia come costruzione simbolica e istanza identitaria. A fronte del silenziamento del meticciato storico nell'uso pubblico della storia e nella memoria nazionali del secondo dopoguerra, il saggio sottolinea la presenza diffusa del meticciato nei prodotti della cultura di massa italiani contemporanei e ne indaga i significati con gli strumenti degli studi critici sulla razza e in prospettiva comparata tra Italia e Stati Uniti

Performance Indicators of National Musculoskeletal Trauma Care Quality and Equity: A Scoping Review

The purpose of this scoping review is to aggregate and describe performance indicators relating to musculoskeletal trauma care, in terms of both quality and equity, that are available in the literature

A Novel Approach to Brachial Plexus Injections: A Technical Report

Background: Brachial plexus injects are common procedures for pain management of the upper limb. Complications from theses injections, however, can be severe leading to permanent neurological deficit. The purpose of this technical report is to introduces a safe novel approach for brachial plexus injections. Case Presentation: A 45-year-old woman with type 2 complex region pain disorder underwent a novel brachial plexus injection. The patient was brought to the operating room where fluoroscopy was used to locate the T2 lamina. A 17-gauge introducer needle was maneuvered through the interlaminar space and into the epidural space. The stylet was removed and a Brevi Kath® (Epimed, Dallas, TX) was passed through the C7-T1 foramen into the brachial plexus region. Contrast was used to ensure proper placement and absence of vascular pickup. The injection was then given, and the catheter withdrawn. The procedure was done without complication and the patient had a 40% reduction in pain symptoms based on a visual analog scale. She was cleared to restart physical therapy. Conclusions: This novel technique approaches the brachial plexus by gaining access to the thoracic epidural space and following the spinal nerves through their respective foramen. The use of fluoroscopy and contrast ensures correct placement of injection. A blunt catheter limits the risk of injury. This approach may benefit patients who have failed standard techniques using local landmarks or those that are not ideal candidates due to previous injury or pre-existing conditions. Key words: Interventional pain, injection, brachial plexus, pain management, fluoroscopy</jats:p

The Legend of George J. Willauer MD (1896-1977)

Outline: Childhood and early influences A highlight of his achievements His lasting legac