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"Brendan" "Carr"

Sam A Bores, William Pajerowski, Brendan G Carr, Daniel Holena, Zachary F Meisel, C Crawford Mechem, Roger A Band
BACKGROUND: The optimal approach to prehospital care of trauma patients is controversial, and thought to require balancing advanced field interventions with rapid transport to definitive care. OBJECTIVE: We sought principally to examine any association between the amount of prehospital IV fluid (IVF) administered and mortality. METHODS: We conducted a retrospective cohort analysis of trauma registry data patients who sustained penetrating trauma between January 2008 and February 2011, as identified in the Pennsylvania Trauma Systems Foundation registry with corresponding prehospital records from the Philadelphia Fire Department...
February 28, 2018: Journal of Emergency Medicine
Michael T Mullen, William Pajerowski, Steven R Messé, C Crawford Mechem, Judy Jia, Michael Abboud, Guy David, Brendan G Carr, Roger Band
BACKGROUND AND PURPOSE: We evaluated the impact of a primary stroke center (PSC) destination policy in a major metropolitan city and used geographic modeling to evaluate expected changes for a comprehensive stroke center policy. METHODS: We identified suspected stroke emergency medical services encounters from 1/1/2004 to 12/31/2013 in Philadelphia, PA. Transport times were compared before and after initiation of a PSC destination policy on 10/3/2011. Geographic modeling estimated the impact of bypassing the closest hospital for the closest PSC and for the closest comprehensive stroke center...
February 28, 2018: Stroke; a Journal of Cerebral Circulation
James J McCarthy, Brendan Carr, Comilla Sasson, Bentley J Bobrow, Clifton W Callaway, Robert W Neumar, Jose Maria E Ferrer, J Lee Garvey, Joseph P Ornato, Louis Gonzales, Christopher B Granger, Monica E Kleinman, Chris Bjerke, Graham Nichol
The American Heart Association previously recommended implementation of cardiac resuscitation systems of care that consist of interconnected community, emergency medical services, and hospital efforts to measure and improve the process of care and outcome for patients with cardiac arrest. In addition, the American Heart Association proposed a national process to develop and implement evidence-based guidelines for cardiac resuscitation systems of care. Significant experience has been gained with implementing these systems, and new evidence has accumulated...
February 26, 2018: Circulation
Syeda Nadia Shah Gilani, Akash Mehta, Alfonso Garcia-Fadrique, Babatunde Rowaiye, Veronika Jenei, Sanjeev Dayal, Kandiah Chandrakumaran, Norman Carr, Faheez Mohamed, Tom Cecil, Brendan Moran
BACKGROUND: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) benefits selected patients with peritoneal mesothelioma. We present the outcomes of this treatment strategy in a UK peritoneal malignancy national referral centre. METHODS: Observational retrospective analysis of data prospectively collected in a dedicated peritoneal malignancy database between March 1998 and January 2016. RESULTS: Of 1586 patients treated for peritoneal malignancy, 76 (4...
February 12, 2018: International Journal of Hyperthermia
Ramin Ebrahimi, Sandeep Gupta, Brendan M Carr, Muath Bishawi, Faisal G Bakaeen, G Hossein Almassi, Joseph Collins, Frederick L Grover, Jacquelyn A Quin, Todd H Wagner, A Laurie W Shroyer, Brack Hattler
Optimal antiplatelet therapy after coronary artery bypass graft (CABG) surgery remains controversial. This study evaluated the role of dual antiplatelet therapy using aspirin and clopidogrel (DAPT) versus antiplatelet therapy using aspirin only (ASA) on post-CABG clinical outcomes and costs. In the Department of Veterans Affairs Randomized On/Off Bypass (ROOBY) trial, clopidogrel use after CABG was prospectively collected beginning in year 2 of this study to include 1,525 of the 2,203 original ROOBY patients who received aspirin after CABG...
January 2, 2018: American Journal of Cardiology
Shelby K Shelton, Steve B Chukwulebe, David F Gaieski, Benjamin S Abella, Brendan G Carr, Sarah M Perman
AIM: International classification of disease (ICD-9) code 427.5 (cardiac arrest) is utilized to identify cohorts of patients who suffer out-of-hospital cardiac arrest (OHCA), though the use of ICD codes for this purpose has never been formally validated. We sought to validate the utility of ICD-9 code 427.5 by identifying patients admitted from the emergency department (ED) after OHCA. METHODS: Adult visits to a single ED between January 2007 and July 2012 were retrospectively examined and a keyword search of the electronic medical record (EMR) was used to identify patients...
January 13, 2018: Resuscitation
Jacquelyn A Quin, Brack Hattler, Annie Laurie W Shroyer, Darlene Kemp, G Hossein Almassi, Faisal G Bakaeen, Brendan M Carr, Muath Bishawi, Joseph F Collins, Frederick L Grover, Todd H Wagner
BACKGROUND: The optimal methodology to identify cardiac versus non-cardiac cause of death following cardiac surgery has not been determined. METHODS: The Randomized On/Off Bypass Trial was a multicenter, randomized, controlled clinical trial of 2203 patients (February 2002-May 2008) comparing 1-year cardiac outcomes between off-pump and on-pump bypass surgery. In 2013, the Veterans Affairs (VA) Cooperative Studies Program funded a follow-up study to assess 5-year outcomes including mortality...
December 13, 2017: Journal of Cardiac Surgery
David Marcozzi, Brendan Carr, Alisha Liferidge, Nicole Baehr, Brian Browne
Traditional approaches to assessing the health of populations focus on the use of primary care and the delivery of care through patient-centered homes, managed care resources, and accountable care organizations. The use of emergency departments (EDs) has largely not been given consideration in these models. Our study aimed to determine the contribution of EDs to the health care received by Americans between 1996 and 2010 and to compare it with the contribution of outpatient and inpatient services using National Ambulatory Medical Care Survey and National Hospital Discharge Survey databases...
January 1, 2017: International Journal of Health Services: Planning, Administration, Evaluation
Amelia K Boehme, Brendan G Carr, Scott Eric Kasner, Karen C Albright, Michael J Kallan, Mitchell S V Elkind, Charles C Branas, Michael T Mullen
BACKGROUND AND PURPOSE: Sex and race disparities in recombinant tissue plasminogen activator (rt-PA) use have been reported. We sought to explore sex and race differences in the utilization of rt-PA at primary stroke centers (PSCs) compared to non-PSCs across the US. METHODS: Data from the National (Nationwide) Inpatient Sample (NIS) 2004-2010 was utilized to assess sex differences in treatment for ischemic stroke in PSCs compared to non-PSCs. RESULTS: There were 304,152 hospitalizations with a primary diagnosis of ischemic stroke between 2004 and 2010 in the analysis: 75,160 (24...
2017: Frontiers in Neurology
Akash Mehta, Rohin Mittal, Kandiah Chandrakumaran, Norman Carr, Sanjeev Dayal, Faheez Mohamed, Brendan Moran, Tom Cecil
BACKGROUND: Right hemicolectomy is routinely recommended in patients with histologic findings of high-grade appendix tumors after appendicectomy. Undetected peritoneal disease may be encountered at surgery. In high-grade appendix tumors with disease detected radiologically, complete cytoreduction may not be possible and outcomes poor. For these reasons, we adopted a policy of prophylactic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. OBJECTIVE: The purpose of this study was to quantify the rates of peritoneal and nodal metastatic disease in patients with high-grade appendix tumors without obvious metastatic disease and to report the long-term outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in these patients...
November 2017: Diseases of the Colon and Rectum
Judd E Hollander, Theresa M Davis, Charles Doarn, Jason C Goldwater, Stephen Klasko, Curtis Lowery, Dimitrios Papanagnou, Peter Rasmussen, Frank D Sites, Danica Stone, Brendan G Carr
In January 2015, the US Secretary of Health and Human Services announced targets for the transformation of Medicare reimbursement from a fee-for-service model to payments based on alternative payment models. People now use technology for virtually everything - from paying bills to purchasing almost anything; it is therefore natural to think that they will use technology to take ownership of their own health care. The remote provision of health care, where providers and patients are not in the same location, will allow patients to receive the right care, at the right time, at the right place, and in the manner they consider right for them...
October 4, 2017: Population Health Management
Judy Jia, Roger Band, Michael E Abboud, William Pajerowski, Michelle Guo, Guy David, C Crawford Mechem, Steven R Messé, Brendan G Carr, Michael T Mullen
BACKGROUND: Accurate recognition of stroke symptoms by Emergency Medical Services (EMS) is necessary for timely care of acute stroke patients. We assessed the accuracy of stroke diagnosis by EMS in clinical practice in a major US city. METHODS AND RESULTS: Philadelphia Fire Department data were merged with data from a single comprehensive stroke center to identify patients diagnosed with stroke or TIA from 9/2009 to 10/2012. Sensitivity and positive predictive value (PPV) were calculated...
2017: Frontiers in Neurology
Renee Y Hsia, Jaime King, Brendan G Carr
No abstract text is available yet for this article.
December 2017: Annals of Emergency Medicine
Rhea E Powell, Amanda M B Doty, Kristin L Rising, David N Karp, Avi Baehr, Brendan G Carr
CONTEXT: Nonprofit hospitals are mandated to perform a community health needs assessment, develop an implementation strategy to address community needs, and invest in improving community health through community benefit investments in order to maintain the tax exemptions afforded nonprofit hospitals. OBJECTIVE: We sought to describe the regional health needs identified across community health needs assessments and the portfolio of implementation strategies reported to address those needs...
August 21, 2017: Journal of Public Health Management and Practice: JPHMP
Anne V Grossestreuer, David F Gaieski, Michael W Donnino, Joshua I M Nelson, Eric L Mutter, Brendan G Carr, Benjamin S Abella, Douglas J Wiebe
BACKGROUND: Methods for comparing hospitals regarding cardiac arrest (CA) outcomes, vital for improving resuscitation performance, rely on data collected by cardiac arrest registries. However, most CA patients are treated at hospitals that do not participate in such registries. This study aimed to determine whether CA risk standardization modeling based on administrative data could perform as well as that based on registry data. METHODS AND RESULTS: Two risk standardization logistic regression models were developed using 2453 patients treated from 2000-2015 at three hospitals in an academic health system...
2017: PloS One
Howard K Mell, Shannon N Mumma, Brian Hiestand, Brendan G Carr, Tara Holland, Jason Stopyra
No abstract text is available yet for this article.
October 1, 2017: JAMA Surgery
Elinore J Kaufman, Sara F Jacoby, Catherine E Sharoky, Brendan G Carr, M Kit Delgado, Patrick M Reilly, Daniel N Holena
BACKGROUND: Police transport (PT) of penetrating trauma patients has the potential to decrease prehospital times for patients with life-threatening hemorrhage and is part of official policy in Philadelphia, Pennsylvania. We hypothesized that rates of PT of bluntly injured patients have increased over the past decade. METHODS: We used Pennsylvania Trauma Outcomes Study registry data from 2006-15 to identify bluntly injured adult patients transported to all 8 trauma centers in Philadelphia...
November 2017: Prehospital Emergency Care
Douglas J Wiebe, Daniel N Holena, M Kit Delgado, Nathan McWilliams, Juliet Altenburg, Brendan G Carr
Trauma centers need objective feedback on performance to inform quality improvement efforts. The Trauma Quality Improvement Program recently published recommended methodology for case mix adjustment and benchmarking performance. We tested the feasibility of applying this methodology to develop risk-adjusted mortality models for a statewide trauma system. We performed a retrospective cohort study of patients ≥16 years old at Pennsylvania trauma centers from 2011 to 2013 (n = 100,278). Our main outcome measure was observed-to-expected mortality ratios (overall and within blunt, penetrating, multisystem, isolated head, and geriatric subgroups)...
May 1, 2017: American Surgeon
Daniel N Holena, Elinore J Kaufman, M Kit Delgado, Douglas J Wiebe, Brendan G Carr, Jason D Christie, Patrick M Reilly
BACKGROUND: Failure to rescue (FTR) is defined as death after an adverse event. The original metric was derived in elective surgical populations and reclassifies deaths not preceded by recorded adverse events as FTR cases under the assumption these deaths resulted from missed adverse events. This approach lacks face validity in trauma because patients often die without adverse events as a direct result of injury. Another common approach simply excludes deaths without recorded adverse events, but this approach reduces the reliability of the FTR metric...
October 2017: Journal of Trauma and Acute Care Surgery
Niamh Mary O'Boyle, Irene Barrett, Lisa M Greene, Miriam Carr, Darren Fayne, Brendan Twamley, Andrew J S Knox, Niall O Keely, Daniela M Zisterer, Mary Jane Meegan
Estrogen receptor (ER) is an important target for the design of drugs such as tamoxifen (2a) and fulvestrant (5). Three series of ER-ligands based on the benzoxepin scaffold structure were synthesised - series I containing an acrylic acid, series II with an acrylamide and series III with an acid substuent. These compounds were shown to be high affinity ligands for the ER with nanomolar IC50 binding values. Series I acrylic acid ligands were generally ERα selective. In particular, compound 13e featuring a phenylpenta-2,4-dienoic acid substituent was shown to be antiproliferative and downregulated ERα and ERβ expression in MCF-7 breast cancer cells...
April 20, 2017: Journal of Medicinal Chemistry
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