Penn study: Sepsis patients fare better in hospitals with higher case volumes

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3-Sep-2014

Contact: Anna Duerr anna.duerr@uphs.upenn.edu 215-349-8369 University of Pennsylvania School of Medicine

PHILADELPHIA Patients with sepsis, one of the most time-sensitive and hard-to-detect illnesses in medicine, are more likely to survive the life-threatening condition when treated at a hospital that sees a higher volume of sepsis cases. New research from the Perelman School of Medicine at the University of Pennsylvania shows a clear relationship between hospitals that treat the most cases of severe sepsis and lower rates of inpatient deaths among those patients. The study, led by David F. Gaieski, MD, an associate professor of Emergency Medicine at Penn, is published online in the American Journal of Respiratory and Critical Care Medicine.

"One of the main barriers to treatment of sepsis is recognizing its early stages, since the symptoms are non-specific and often similar to those of a viral infection. However, early diagnoses and treatment are key to surviving sepsis and it may be that physicians at hospitals that see a larger volume of patients with severe sepsis are more attuned to these non-specific symptoms and have put protocols in place to aid in the detection of these critically ill patients," Gaieski said. "Our results provide preliminary support for the idea that severe sepsis patients may benefit from treatment at higher-volume specialty centers much the same as the reality that patients who've suffered severe injuries are brought to designated trauma centers and those who've had strokes typically come to certified stroke centers."

Sepsis is an illness caused by the body's inflammatory and anti-inflammatory responses to bacteria and other pathogens, including viruses and fungi so it's not solely caused by the pathogens themselves, but also by the cytokines the body releases in response to the pathogens. A bacterial infection anywhere in the body may set off the response that leads to sepsis, which can then cause blood pressure to drop, and major organs and body systems to stop working properly because of poor blood flow. Not only is severe sepsis becoming more common, but the in-hospital mortality rate can be as high as 38 percent, and the illnesses costs the United States health system approximately $24 billion annually. The Centers for Disease Control and Prevention (CDC) currently lists septicemia as the 11th leading cause of death in the U.S., and the burden is expected to increase as the population ages.

The recent Penn study looked at hospital admissions examining the relationship between annual case volume, urban location, organ dysfunction and survival over a seven year period (2004-2010) among a total of 914,200 patients with severe sepsis, culled from the largest national database of publically available inpatient information. The study found an inverse relationship between severe sepsis case volume and inpatient mortality, in both urban and rural hospitals. Overall in-hospital mortality was 28 percent, but the study found that patients treated at higher-volume hospitals (those who treated 500 or more cases per year) had a 36 percent increase in their odds of inpatient survival compared to those treated at lower-volume hospitals (less than 50 cases per year). Typically, the highest volume hospitals are academic medical centers, which tend to be located in urban areas.

The study also examined the association between inpatient severe sepsis mortality and organ dysfunction type, finding that the most common organ system dysfunctions were renal, respiratory and cardiovascular. Additionally, the study found that mortality from severe sepsis increased as the number of organ dysfunctions increased.

Severe sepsis treatment efforts in the Hospital of the University of Pennsylvania's (HUP) emergency department have been focused on early measurement of serum lactate which can help indicate whether enough oxygen is being delivered to tissues in the body as a marker of impending shock. The results are then used to identify potentially critically ill patients more quickly and then deliver protocolized resuscitation during their first hours in the hospital. Since these new protocols were adopted in 2005, Gaieski says that deaths among severe sepsis patients admitted to HUP through the emergency department dropped from 24 percent in 2005 to 11 percent in 2009.

"While it's important that we are getting it right at our tertiary care center, this paper highlights the variability in outcomes across the U.S. The real question here is: can we take the critical next step of disseminating best practices from high performing centers to the rest of the health care system?" says Brendan Carr, MD MS, assistant professor of Emergency Medicine and Epidemiology and senior author on the study. "We need large scale strategies that ensure the best possible outcome for critically ill patients no matter where they are when they get sick. We've built good systems for a few conditions that require early aggressive diagnostics and intervention like trauma and stroke but our response to the unplanned critically ill patient requires us to cooperate across public health, public safety and most importantly, competing healthcare systems."

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Penn study: Sepsis patients fare better in hospitals with higher case volumes

USS PCEM3B (2013-2014) Preah Sihanouk Province Trip ‘s Photo Presentation – Video

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USS PCEM3B (2013-2014) Preah Sihanouk Province Trip #39;s Photo Presentation
This is an album photo which eventually describes one of my memorable trips with medical school classmates to Preah sihanouk Province. The length of video is too long but I just want to make...

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Rhode Island Medical Imaging Installs Its Third 3T MR Scanner at Pawtucket Site

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Pawtucket, Rhode Island (PRWEB) September 03, 2014

Accessing Rhode Island Medical Imagings (RIMI) state-of-the-art imaging services will be more convenient than ever for residents of northern Rhode Island and Southeastern Massachusetts. Rhode Island Medical Imagings third 3T magnetic resonance imaging (MRI) system will be installed in the Blackstone Valley Medical Building at 333 School Street in Pawtucket on September 4, 2014.

The 3T MRI system, which has been available at RIMIs East Greenwich and East Providence locations since the spring of 2011 and fall of 2013 respectively, captures images of the highest possible resolution and has features that provide additional patient comfort. These features, which are especially beneficial to patients who might experience anxiety during an MRI examination, include:

In addition to being the first and only Diagnostic Imaging Center of Excellence in Rhode Island, RIMI is the only medical imaging provider to offer the benefits of 3T imaging with the convenience of an out-patient setting in the Ocean State. Bringing 3T MRI technology to the Pawtucket office provides patients in northern Rhode Island and Southeastern Massachusetts with a more convenient option when requiring an MRI examination.

The T in 3T stands for Tesla, which is the unit of measurement representing the strength of a magnetic field. A 3T MRI scanner has two times the strength of a 1.5T scanner and 10 to 15 times the strength of an open MRI machine.

RIMI radiologists hold faculty positions at the Warren Alpert Medical School of Brown University and subspecialize in all areas of medical imaging, including womens imaging; bone, joint and muscle imaging; neurology; cardiology; and pediatrics. Furthermore, RIMI radiologists are on staff at Rhode Island Hospital, Women & Infants, Hasbro Childrens Hospital and The Miriam Hospital.

For more information, call Rhode Island Medical Imaging at (401) 432-2400.

About Rhode Island Medical Imaging

Established in 1943, Rhode Island Medical Imaging (RIMI) maintains the highest standards of practice in medical diagnostic imaging. Their network of private facilities is staffed by board certified radiologists, registered technologists, and dedicated office personnel, offers physicians and patients prompt and professional service using state-of-the-art technology. The team of radiologists has broad based experience and subspecialty training in all areas of diagnostic imaging, providing patients with immediate access to consultations in any medical imaging subspecialty. RIMI radiologists also perform and interpret the full spectrum of imaging examinations at Rhode Island Hospital, Women & Infants Hospital, and the Miriam Hospital. Those activities are complemented by their academic commitment to The Warren Alpert Medical School of Brown University. RIMIs goal is to provide every physician and patient with the highest quality in contemporary diagnostic imaging. For more information about Rhode Island Medical Imaging, visit http://www.rimirad.com.

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Rhode Island Medical Imaging Installs Its Third 3T MR Scanner at Pawtucket Site

Eastern Shore teacher removed for troubling writing

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An Eastern Shore teacher was put on leave and taken for medical evaluation after authorities grew concerned about his writings including a novel about a school shooting and a letter with "suicidal undertones" and a model he constructed at his home of a school building.

But with authorities initially supplying few details, the case of 24-year-old Patrick Wayne McLaw blew up online. Commentators from across the political spectrum worried that his rights were being trampled by an overreaching government that was policing the teacher's thoughts rather than his actions.

Mike A. Lewis, sheriff of Wicomico County, where McLaw lives with his mother, said the teacher's writings which include two self-published novels and a four-page letter he allegedly sent last month to a school official in Dorchester along with the model in his backyard, raised legitimate fears.

McLaw was put on leave with pay from his job as a language arts teacher at Mace's Lane Middle School in Cambridge before the school year began last week, Dorchester County school officials said.

McLaw has not been charged with any crime. Attorney David Moore told The Los Angeles Times that his client is "receiving treatment."

When McLaw was taken for a medical evaluation last month at Peninsula Regional Medical Center, local news organizations noted the two novels he published under the pen name "Dr. K.S. Voltaer."

One, set in 2902, details a massacre at Ocean Park High School, claiming the lives of 947 individuals "the largest school massacre in the nation's history," according to its description on Amazon.com.

McLaw's mother, Kay White, declined to discuss the allegations against him. But she said the school model, so large that McLaw erected a building in their backyard to house it, was just something he enjoyed making.

McLaw's attorney could not be reached for comment Tuesday.

Wicomico County State's Attorney Matthew A. Maciarello said the news media has mischaracterized the case as McLaw's being persecuted for writing fiction.

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Eastern Shore teacher removed for troubling writing

Starcraft 2: Wings of Liberty – Mission 10 – Whispers of Doom [CRO] – Video

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Starcraft 2: Wings of Liberty - Mission 10 - Whispers of Doom [CRO]
Deseta epizoda novog serijala na mom kanalu.... Malo za promijenu jedna strategija umjesto pucacina... Deseti dio: -Prva Prophecy misija - Whispers of Doom Ljubitelji strategija definitnivno...

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Starcraft 2: Wings of Liberty - Mission 10 - Whispers of Doom [CRO] - Video

Liberty Twp. inks new contract with sheriffs office

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LIBERTY TWP.

The Butler County Sheriffs Office is set to continue providing law enforcement for this growing township.

Liberty Twp. trustees on Tuesday night unanimously approved the township entering into a 5-year contract with the sheriffs office.

The agreement, which goes into effect Oct. 1., follows and is now synchronized with a 5-year levy voters recently approved, according to Caroline McKinney, the townships spokeswoman.

The contract follows a two-year term finalized because the township switched to a flat-fee concept that was new for both parties.

I like that we know where were going to be for the next five years, said Trustee President Christine Matacic. The reason we had the 2-year contract is because it was something new we were trying and we wanted to make sure it worked for both parties.

Matacic said the spirit of the whole contract was to make sure both sides were coming out ahead, not that any one side was gaining an advantage.

We have the (daily) coverage for our residents that they need and we have the backup of the sheriffs department if and when need it, Matacic said.

Trustee Vice President Tom Farrell said he wasnt pleased with how long negotiations took, but was pleased that they went fairly smoothly.

The sheriffs office has provided police services to the Liberty Twp. since the early 1990s.

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Liberty Twp. inks new contract with sheriffs office

Liberty TripAdvisor Cheapens as Trading Begins: Chart of the Day

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Shares of TripAdvisor Inc. (TRIP)s largest stockholder, spun off last week, are already getting cheaper by comparison with those of the online-travel agency.

The CHART OF THE DAY compares the share price of Liberty TripAdvisor Holdings Inc. (LTRPA), formerly a part of billionaire John Malones Liberty Interactive Corp. (LINTA), with the per-share value of its TripAdvisor holding.

Libertys gap widened to $6.31 a share yesterday from $5.74 on Aug. 28, its first day of post-spinoff trading, and $5.85 on Aug. 29, according to data compiled by Bloomberg. The figures reflect its ownership of 31 million TripAdvisor shares and its 73.7 million post-spinoff shares outstanding.

The spread was $6.26 a share at the end of trading today.

Susquehanna Financial came up with a narrower spread -- about $2 a share -- through a comparison that used Libertys enterprise value, or market value plus debt after subtracting cash. The company borrowed $400 million before the separation and retained $50 million after paying a special dividend to Liberty Interactive.

Liberty TripAdvisor may ultimately exchange its stake for some of the companys assets, Joseph Stauff, a New York-based analyst at Susquehanna, wrote yesterday in a report. Any deal may come with a control premium of about 23 percent, he wrote.

TripAdvisor, based in Newton, Massachusetts, has two classes of common stock. Liberty TripAdvisor owns an entire class that has 10 votes per share, which allows the Englewood, Colorado-based company to have 57 percent of the voting rights and only 22 percent of its equity.

To contact the reporter on this story: David Wilson in New York at dwilson@bloomberg.net

To contact the editors responsible for this story: Chris Nagi at chrisnagi@bloomberg.net Michael P. Regan, Jeremy Herron

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Liberty TripAdvisor Cheapens as Trading Begins: Chart of the Day

Liberty Ross After Rupert Sanders Split, Kristen Stewart Affair: "I Have No Problem With Anyone Involved"

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There's life after love for Liberty Ross. After her heartbreaking divorce from her husband of 10 years -- a split that followed his summer 2012 fling with Kristen Stewart -- the British model, actress, and mom is doing better than ever.

"It's amazing what two years does," Ross, 35, told Harper's Bazaar UK in an interview from the September issue. "Today, I feel happier than I've ever felt, and I'm in such a great place. All of us are: my kids are great, Rupert's amazing, we have all moved on and everyone is doing really well."

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The British beauty filed for divorce from her filmmaker husband Rupert Sanders in January 2013, a half-year after photos surfaced of Sanders cheating with Stewart, the star of his big-budget Snow White and the Huntsman movie. The situation was even stickier, as Ross also appeared in the film, starring as the mother of Stewart's titular character.

"I have no words to describe what we went through," Ross told Vanity Fair last October. "But I think, for me, something always has to completely die for there to be a rebirth. And, for me, I feel like I'm going through a rebirth."

PHOTOS:Kristen Stewart and Rupert Sanders

Ross, however, is not harboring resentment from the whole ordeal.

"People need to learn to forgive," she told Harper's. "I have no problem with anyone involved. I'm completely compassionate, I really am. No life is perfect, we all have our problems and issues and I believe that it's good to be true to who you are."

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While the cheating scandal was far from expected, Ross added that her relationship with Sanders wasn't exactly perfect before the affair. After exchanging vows in 2002, the couple welcomed daughter Skyla, now 9, and son Tennyson, now 7.

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Liberty Ross After Rupert Sanders Split, Kristen Stewart Affair: "I Have No Problem With Anyone Involved"

Liberty Ross Says She's Forgiven Ex and Kristen Stewart: "I Have No Problem With Anyone Involved"

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Liberty Ross is refusing to be stuck in the past.

The British model opened up to Harper's Bazaar about life after Rupert Sanders'affairwithKristen Stewart and how she's been able to really move on.

"Unfortunately, we live in a world where everything is so overexposed that it's actually terrifying. I was horrified at how relentless and extraordinary going through something like that was," she told the fashion magazine.

"I was able to go and be somewhere secluded for a good month. And then when school went back, I had no choice but to be as strong a woman as I could be for the children."

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But she further divulged that one of the key factors in getting past the traumatic incident was forgiveness.

"People need to learn to forgive. I have no problem with anyone involved. I'm completely compassionate, I really am. No life is perfect, we all have our problems and issues and I believe that it's good to be true to who you are."

She continued, "Rupert and I were together since we were very, very young. I was 18essentially, I married my first boyfriend. I always used to say we were more like a brother and sister anyway. We'd been together for so long, we weren't really evolving together as a couple so much."

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Liberty Ross Says She's Forgiven Ex and Kristen Stewart: "I Have No Problem With Anyone Involved"