Christ's Hospital Research Articles

Does Midazolam Cause Retrograde Amnesia, and Can Flumazenil Reverse That Amnesia?

Does Midazolam Cause Retrograde Amnesia, and Can Flumazenil Reverse That Amnesia?

Pain Management Handbook: An Interdisciplinary Approach

Medical-surgical nurse educator, Christ Hospital, Jersey City, NJ. Oncology nurse specialist, Christ Hospital, Jersey City, NJ.

Birth Trauma

OBJECTIVE : To determine the current incidence of clavicular fracture (CF), facial nerve injury (FNI) and brachial plexus injury (BPI) and identify the existence, if any, of associated perinatal factors with each injury. STUDY DESIGN : A case-controlled study design was selected and the study conducted for births between January 1, 1985 and January 1, 1990, at Christ Hospital and Medical Center, a tertiary care center with level III perinatal services in suburban Chicago. Among a population of 19,370 consecutive deliveries, we identified the occurrences of CF, FNI and BPI by database search, and maternal and neonatal chart reviews. A control group was randomly selected. Maternal, labor, delivery and neonatal variables were then compared between the birth trauma and control groups for each specific injury. RESULTS : The incidence per 1,000 live births and per 1,000 live-born cephalic singletons delivered vaginally for CF was 4.5 and 5.7 ; for FNI, 0.6 and 0.7 ; and for BPI, 0.9 and 1.1, respectively. To varying degrees, the data demonstrate that the occurrences of these injuries are associated significantly more often with prolonged gestation, epidural anesthesia, prolonged second stage of labor, oxytocin use, forceps delivery, shoulder dystocia, macrosomia, low Apgar scores and a previous maternal obstetric history of macrosomia when compared to controls. Other significantly associated variables include the presence of meconium in labor and neonatal hyperbilirubinemia. Despite the presence of multiple perinatal factors that are individually associated statistically with the injured groups, multiple logistic regression analysis predicted 44.2% of CF's, none of the FNIs and only 19% of the BPIs. CONCLUSION : While multiple perinatal variables are statistically associated with the specific birth injuries studied, the use of multiple logistic regression analysis shows that the ability to predict these injuries is markedly limited.

Functional Role of a Negative Regulatory Element in DevelopmentStage Specific Expression of Rat Cardiac Myosin Heavy Chain Gene. •259

The αmyosin heavy chain (αMHC) gene encodes a major cardiac contractile protein. Steadystate level of its mRNA are decreased during embryonic heart development and hypertrophy of the adult rat heart, mainly due to transcriptional regulation. While several ciselements and cognate binding factors involved in its positive regulation are described, the mechanism of its negative regulation remains unknown. We have identified a strong negative regulatory element (NRE) in the 5′ untranslated region of this gene. To study if NRE sequences play a role in the negative regulation of αMHC gene transcription in embryonic heart, we transfected the αMHC promoter/ chloramphenicol acetyl transferase (CAT) reporter constructs into primary cultures of 18 day fetal rat heart. The wild type (WT) construct included 600/420 bp sequence (in relation to transcription start site) of αMHC promoter. The deletion mutants comprised 600/63 promoter sequences and internal deletion of NRE within WT construct. The percent increase in CAT expression due to NRE deletion was compared with that obtained by direct in vivo injections of these constructs in adult heart. NRE deletion resulted in 15fold induction of CAT expression in fetal heart, but 8fold increase in adult heart. Gelshift assay with NRE sequence and nuclear extracts prepared from fetal and adult heart showed two complexes with distinct mobilities in fetal heart but one complex in adult heart. The adult heart complex corresponded to the slowermobility complex of the fetal heart. These data suggests that differential binding of nuclear factors to NRE sequence may be responsible for its stronger effect in fetal heart that may contribute to the in vivo suppression of αMHC gene transcription during embryonic heart development (Supported by a grant from Christ Hospital Med Fund).

The ABCs of teaching advanced cardiac life support.

This article describes the evolution in methods used at The Christ Hospital in Cincinnati, Ohio, to teach advanced cardiac life support over the past 10 years. The interactive nature of the teaching methods has improved participants' enjoyment of this course. With smaller teaching groups, instructors find this course challenging and fun to teach. This article provides outlines of teaching stations at The Christ Hospital and examples in which to implement the current advanced cardiac life support content according to the American Heart Association's teaching recommendations.

Aging and cardiovascular disease: a summary of the Eighth Münster International Arteriosclerosis Symposium.

This unique symposium focused on the remarkable increase in the older population that is occurring in many countries of the world. The international experts spoke on the effects of aging on cardiovascular disease, which is by far the most prominent cause of morbidity and mortality in the elderly. The program highlighted some of the most prominent changes that occur in the elderly and influence the toll that cardiovascular disease takes. The program was divided into four sessions: (1) the effects of aging on some of the cardiovascular risk factors; (2) the effects of aging on the heart muscle; (3) reports on recent studies of the effects of aging on morphology and function of the conduction system; and (4) a session featuring outstanding authorities on aging and the elastin, collagen, and calcium of the vessel wall, all of which are frequently added to the artery wall during aging. The speakers were carefully selected from top scholars in England, Germany, Finland, France, Italy, Japan, and the United States. Professor W.H. Hauss, who pioneered the development of the Institute for Arteriosclerosis Research at the University of Munster, Germany, and is now in his 80s, opened the symposium and introduced four prominent officials in health, education, and other German government posts, who added their words of welcome. The first session was chaired by Professor G. Assmann, who is the current director of the Arteriosclerosis Research Institute in Munster, Germany. He gave the opening presentation on genetic determinants of life expectancy, a subject on which he is a world authority. He began his presentation with a brief description of the very large PROCAM study of more than 35 000 individuals, two thirds of whom are male, being carried out at the University of Munster Arteriosclerosis Institute in Westphalia. This long-term study of the natural history …

Surviving Autologous Bone Marrow Transplant

Melinda S. Weber, RN, BSN, OCN, an oncology clinical nurse in the nursing resources department at Christ Hospital in Jersey City, NJ, selected source items for this page.

Christ's Hospital of London, 1552-1598: "a passing deed of pity"

An examination of the circumstances surrounding the founding of this orphanage/school and how it functioned as a charitable institution until the advent of the first great Elizabethan poor law in 1598. The study draws heavily on the official records of the hospital, analyzing its administration and structure, fiscal situation, and describing the governors of the hospital and the children. Illustrated with charts and tables.

Influenza vaccination reduced the risk for influenza in elderly persons

TherapeuticsMay 1, 1995Influenza vaccination reduced the risk for influenza in elderly personsPeter A. GrossPeter A. GrossNew Jersey Medical School, Hackensack, New Jersey, USA (P.A.G.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/ACPJC-1995-122-3-065 SectionsAboutFull Text ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinkedInRedditEmail Source CitationGovaert TM, Thijs CT, Masurel N, et al. The efficacy of influenza vaccination in elderly individuals. A randomized double-blind placebo-controlled trial. JAMA. 1994 Dec 7;272:1661-5.References1 Hoskins TW, Davies JR, Smith AJ, Mille CL, Allchin A. Assessment of inactivated influenza—A vaccine after three outbreaks of influenza A at Christ's Hospital. Lancet. 1979;1:33-5. Google Scholar2 Foster DA, Talsma A, Furumoto-Dawson, A, et al. Influenza vaccine effectiveness in preventing hospitalization for pneumonia in the elderly. Am J Epidemiol. 1992;136:296-307. Google Scholar3 Fedson DS, Wajda A, Nichol JP, et al. Clinical effectiveness of influenza vaccination in Manitoba. JAMA. 1993;270:1956-61. Google Scholar4 Final results: Medicare influenza vaccination demonstration - selected states, 1988-1992. MMWR Morb Mortal Wkly Rep. 1993;42:601-4. Google Scholar5 Gross PA, Hermogenes A, Sacks HS, Lavandowski RA. The protective efficacy of influenza vaccine in the elderly: a meta-analysis. In: Abstracts of the 34th Interscience Conference on Antimicrobial Agents and Chemotherapy (October 7, 1994; Orlando, FL). Washington, D.C.: American Society for Microbiology; 1994:265 [Abstract 72]. Google Scholar6 Nichol KL, Margolis KL, Wuorenma J, Von Sternberg T. The efficacy and cost effectiveness of vaccination against influenza among elderly persons living in the community. N Engl J Med. 1994;331:778-84. Google Scholar7 Mullooly JP, Bennett MD, Hornbrook MC, et al. Influenza vaccination programs for elderly persons: cost-effectiveness in a health maintenance organization. Ann Intern Med. 1994;121:947-52. Google Scholar8 Margolis KL, Nichol KL, Poland GA, Pluhar RE. Frequency of adverse reactions to influenza vaccine in the elderly. A randomized, placebo-controlled trial. JAMA. 1990;264:1139-41. Google Scholar Author, Article, and Disclosure InformationAffiliations: New Jersey Medical School, Hackensack, New Jersey, USA (P.A.G.) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails May 1, 1995Volume 122, Issue 3Page: 65KeywordsComputed axial tomographyDiabetes mellitusElderlyHeartHospitalizationsLungsMedical servicesMedicareMorbidityObservational studiesPneumoniaSaline solutionsStaphylococcal infectionVaccines ePublished: 9 March 2020 Issue Published: May 1, 1995 Copyright & PermissionsCopyright © 1995 by American College of Physicians. All Rights Reserved.Loading ...

Nursing home-acquired pneumonia: outcomes from a clinical process improvement program.

At EHS Christ Hospital and Medical Center, an eight-step process improvement model was developed that incorporates continuous quality improvement concepts for monitoring, evaluating and improving patient care. Nursing home residents admitted with pneumonia were identified as the group having the most influence on mortality and costs associated with treatment of pneumonia at our hospital. A multidisciplinary team evaluated clinical resource use and patient care processes, and identified root causes of various influencing treatment. Clinical guidelines were created and outcomes were defined, resulting in significant improvement in the clinical management of these patients. Average length of stay decreased from 8.6 days in 1992 to 7.6 days in 1993, with a charge reduction of $1830 per patient. The methodologic framework of a process improvement program combines epidemiologic, clinical, and quality improvement sciences. This mix is essential in improving patient care and quantifying outcomes.

Enhancing hospital cash flow through improved medical records processing.

This article reviews a team-based effort to improve the performance of a key business process at Christ Hospital in Cincinnati. The quality improvement team reduced the time required to complete medical records following patient discharge. This effort had a major impact on the hospital's cash flow.

Editorial overview

The Christ Hospital Cardiovascular Research Center, Cincinnati, Ohio *National Center for Environmental Health, Centers for Disease Control, Atlanta, Georgia, USA

‘The genius of all arts’ and the use of instruments: Jonas-Moore (1617–1679) as a mathematician, Surveyor, and astronomer

Summary The use of mathematical and astronomical instruments played an important part in the development of Jonas Moore's career. Though debates about the nature of mathematics raised questions about the value of instruments, they remained essential to his work as a teacher, as Surveyor of the Fens and as Surveyor-General of the Ordnance. His confidence in them was most fully expressed in his equipping of the Royal Observatory and in his textbook for Christ's Hospital Mathematical School. His belief in the inseparability of mathematical practice from theory meant that, for him, instruments continued to offer a means of putting certain knowledge into practical effect.

258 Birth trauma: A five year review of incidence and associated perinatal factors

To determine the current incidence of clavicular fracture (CF), facial nerve injury (FNI) and brachial plexus injury (BPI) and identify the existence, if any, of associated perinatal factors with each injury.A case-controlled study design was selected and the study conducted for births between January 1, 1985 and January 1, 1990, at Christ Hospital and Medical Center, a tertiary care center with level III perinatal services in suburban Chicago. Among a population of 19,370 consecutive deliveries, we identified the occurrences of CP, FNI and BPI by database search, and maternal and neonatal chart reviews. A control group was randomly selected. Maternal, labor, delivery and neonatal variables were then compared between the birth trauma and control groups for each specific injury.The incidence per 1,000 live births and per 1,000 live-born cephalic singletons delivered vaginally for CF was 4.5 and 5.7; for FNI, 0.6 and 0.7; and for BPI, 0.9 and 1.1, respectively. To varying degrees, the data demonstrate that the occurrences of these injuries are associated significantly more often with prolonged gestation, epidural anesthesia, prolonged second stage of labor, oxytocin use, forceps delivery, shoulder dystocia, macrosomia, low Apgar scores and a previous maternal obstetric history of macrosomia when compared to controls. Other significantly associated variables include the presence of meconium in labor and neonatal hyperbilirubinemia. Despite the presence of multiple perinatal factors that are individually associated statistically with the injured groups, multiple logistic regression analysis predicted 44.2% of CF's, none of the FNIs and only 19% of the BPIs.While multiple perinatal variables are statistically associated with the specific birth injuries studied, the use of multiple logistic regression analysis shows that the ability to predict these injuries is markedly limited.

Implementing Focus Charting

Documentation is an issue of importance to nursing for many reasons. Quality patient care depends upon complete and accurate information among care givers, third party reimbursement is based on documented care, inefficient documentation systems and behaviors are costly to an institution in terms of salaries, overtime pay and dissatisfied nurses, and documentation is an essential component of institutional licensure and accreditation. The authors describe documentation issues that prompted Christ Hospital of Oak Lawn, Illinois to revise their documentation system, selection of Focus Charting, the educational process for a nursing staff of 1200, and a critique of the educational process. Clinical nurse specialists played a key role in each step of the project.

The prevalence of hepatitis B serologic markers in suburban paramedics: Denise J. Fligner, MD, Herbert N. Wigder, MD, and Phillip M. Harter, MD. Christ Hospital and Medical Center and Rush Medical College; Robert M. Fliegelman, DO, Christ Hospital and Medical Center and Rush Medical College; Mark Jewell, MPH, Christ Hospital and Medical Center, and Patt Perlman, RN, Christ Hospital and

The prevalence of hepatitis B serologic markers in suburban paramedics: Denise J. Fligner, MD, Herbert N. Wigder, MD, and Phillip M. Harter, MD. Christ Hospital and Medical Center and Rush Medical College; Robert M. Fliegelman, DO, Christ Hospital and Medical Center and Rush Medical College; Mark Jewell, MPH, Christ Hospital and Medical Center, and Patt Perlman, RN, Christ Hospital and

Phenacemide in Complex Partial Seizures

The anticonvulsant phenacemide (phenylacetylurea), discarded for 30 years because of serious toxicity, has been resurrected and used in the treatment of 13 children with refractory complex seizures at Loyola University, Maywood, and Christ Hospital, Oak Lawn, Illinois.

Sequential infection or immunization of ferrets with a series of influenza A (H3N2) strains (report to the Medical Research Council's Sub-Committee on influenza Vaccines (CDVIP/IV)).

Previous studies of boys at Christ's Hospital school have indicated that annual immunization with influenza virus vaccines did not significantly reduce the total incidence of influenza infection compared to unimmunized subjects. In view of the implications of this result, a similar study was conducted in ferrets to clarify these findings. Groups of ferrets were immunized or infected with a series of influenza A (H3N2) viruses over an 18-month period, and the immunity to subsequent live virus challenge was measured after each virus or vaccine exposure. The results indicated that live virus infection gave a more solid immunity than immunization with inactivated vaccine; and the serum haemagglutination-inhibiting antibody response was greater following immunization than following infection. In addition, differences in immunity could not be explained by measurements of cross-reacting and specific antibody, since the incidence of these antibodies was similar in both infected and immunized animals. The results do not suggest an explanation for the different levels of immunity induced following infection or immunization or the results obtained from the Christ's Hospital study. However, the relative contribution of various immune responses to virus or virus antigen is discussed, and it is suggested that the difference in immunity may lie in the ability of live virus infection to stimulate local antibody.

The Ceremony of the White Cock in Winchester

FOUR years ago a friend remarked that when he was a child of six or seven, in about 1929, he witnessed on two separate occasions a ceremony which took place above the Wharf Mill on the river Itchen in Winchester. One, or it might have been two white cocks were thrown into the river after their throats had been cut. As the corpses floated down the mill stream many onlookers shouted and applauded before dispersing. My friend has a very clear memory and can remember this incident in detail. His nurse, a girl in her teens, would take him out in the afternoon, having cleared up after the midday meal. So the ceremony probably did not take place before 3 p.m. He saw it twice, in successive years, and he thinks it was in August or September on each occasion. At this time there were two mill cottages still standing on the west side of the river, on what is now the riverside garden. My friend and his nurse were standing on the cutwater of the mill race of the Wharf Mill, looking up stream. On their right stood the Miller's Arms, on the east bank, on the plot of ground which is now public garden. The garden of the Miller's Arms lay up river and beside the bank, bounded on the north by the brick wall still standing which separated it from what are now the gardens of Chesil Terrace. On the occasions described a man appeared, apparently at the end of the garden of the Miller's Arms, with the white cocks or hens. My friend still remembers the fine white birds with bright red combs. It has since been pointed out that hens would not be in good condition at this time of year, and that fine combs suggest fine quality cocks, appropriate for sacrifice. Owing to the lapse of time and the movement of population since that time it has not been easy to obtain corroboration, but I have collected six separate and independent reports to support the memory of my friend who was a spectator. One was an actual witness and the others knew that the ceremony took place: (1) My friend's nurse, who confirms the event but can remember no details. (2) A friend, now deceased, who lived in Twyford. She told me that some twenty years ago she attended a meeting, probably of the Hampshire Field Club. As a result of something said at the meeting her neighbour told her of a ceremony roughly of the nature described, which she said used to take place on the river Itchen. (3) A friend tells me that her mother used to refer to a ceremony involving the sacrifice of a white cock, that used to take place on the river downstream from St. Swithun's Bridge. It is thought that she may have heard this in about 1922. (4) A pensioner who lived as a girl in Colebrook Street says that she knew about this ceremony, but she never saw it take place. (5) A pensioner living in Christ's Hospital, Winchester, lived as a young man in Twyford. When he was demobilised in 1919 in Winchester he knew that this event was going on. (6) Another pensioner lived in Winchester until 1930. She thinks that she heard about this, but she can remember no details. It is not known when this ceremony was discontinued-possibly some time in the 1930s. The fact that so few people now recall it is not surprising, for fifty years is a considerable time for memory, and people may not remember happenings which did not strike them as out of the ordinary. My friend can remember every detail, but the

Abingdon's ‘Right Goodly Crosse of Stone’

SummarySurviving records afford only a very incomplete impression of the appearance of the fine Gothic cross erected by the Fraternity of the Holy Cross in the market place at Abingdon in the 1440s and destroyed by Parliamentarian troops in 1644. An early seventeenth-century painting of the Abingdon cross at Christ's Hospital in the town shows it after it had been substantially altered during restoration in 1605, but its original appearance can be partially reconstructed from what is known of the Coventry cross, set up between 1541 and 1545, which was closely modelled on the Abingdon example, the most elaborate of its type built in the fifteenth century.