Francis Hospital Research Articles

Abstract P72: The Obesity Paradox: Association Between Body Mass Index (BMI) and Disability After Stroke

Background: Present rise in the incidence of obesity has led to several opposing reports regarding the association between obesity and stroke outcomes. The objective of this study was to investigate a proposed paradoxical relationship between body mass index (BMI) and functional status in ischemic stroke patients at time of hospital discharge. Methods: Saint Francis Hospital Comprehensive Stroke Center patient databases were utilized in identifying 948 patients eligible for retrospective chart review over a period of 15 months. Subjects were divided into 4 groups according to BMI: underweight (BMI < 18.5 kg/m 2 ), normal weight (BMI 18.5-24.9 kg/m 2 ), overweight (BMI 25.0-29.9 kg/m 2 ), and obese (BMI ≥ 30.0 kg/m 2 ). Covariates, such as age, gender, prior to event modified Rankin scale (mRS), stroke recurrence, and smoking, were considered. Functional status and disability of stroke patients was scored via mRS at hospital discharge. Ordered logistic regression, Pearson’s chi-squared test, and Pearson’s r correlation were used for analysis to assess the association of BMI and functional status in ischemic strokes. Results: Of 948 eligible subjects, 49.9% were female and mean (SD) age was 69.4 (14.5) years. According to BMI, 22 (2.3%) were underweight, 247 (26.1%) normal weight, 319 (33.7%) overweight, and 360 (37.9%) obese. After adjusting for covariates, ischemic stroke patients with an increased BMI (OR, 0.98; 95% CI, 0.96-0.99) were not associated with increased disability risk upon discharge. Obese (16.2%) and overweight (14.1%) patients discharged with a mRS of 0 (back to baseline) or 1 more frequently compared to normal weight (6.1%) and underweight (0.21%) patients ( P <0.001). Furthermore, an inverse association between BMI status and disability was significantly evident ( r = -0.17, P < 0.001). Conclusion: Obese and overweight stroke patients discharge with a lower risk of disability than normal weight and underweight patients, supporting the existence of the “obesity paradox” in stroke. An inverse association between obesity status and functional outcome was identified and remained significant regardless of covariates.

281 Aspirin acceptance rate and perceived preeclampsia risk after the implementation of universal screening for preeclampsia

To determine the acceptance rate of low-dose aspirin (81 mg) after the implementation of universal screening for preeclampsia in the ultrasound unit using a questionnaire and assess the accuracy of the patient’s perception of risk. This is a retrospective cohort study of all women presenting for their first-trimester ultrasound at Saint Francis Hospital and Medical Center between December 1, 2017 and December 31, 2019. The women were screened for clinical risks of preeclampsia using a self-administered questionnaire developed from the United States Preventative Task Force (USPTF) risk-assessment recommendations. Those found to be at moderate or high risk for preeclampsia were recommended to take a low-dose aspirin (LDA). During their anatomy ultrasound, patients completed a follow-up questionnaire assessing aspirin compliance and perceived risk for developing preeclampsia. Descriptive statistics were used to calculate frequencies. Of 3,872 patients, 767 (19.8%) screened moderate or high risk for developing preeclampsia, 142 patients who had already been recommended by their obstetrician to take an LDA were excluded. The remaining 625 patients were recommended to take an LDA. 59.8% (374/625) subsequently completed the follow-up questionnaire. Of these, 93.8% (351/374) reported their perceived risk: 18.5% (65/351) reported no risk, 36.7% (129/351) low risk, 32.8% (115/351) moderate risk, and 12.0% (42/351) high risk. The acceptance rate of LDA was 77.3% (289/374). Only 25.6% (74/289) of those taking the aspirin accurately perceived their risk. When asked about the reason for taking the LDA, 70.1% (197/281) reported that LDA lowered their risk of preeclampsia or hypertension and 21.4% (60/281) reported it was recommended by their physician. A simple and quick intervention using a questionnaire in the ultrasound unit led to good acceptance of the LDA recommendation by patients found to be at moderate or high risk for developing preeclampsia even though only 1/4 of patients accurately perceived their risk for preeclampsia.

Włoski medyk Johannes Baptista Montanus (1489–1551) – jego działalność w Padwie, metody diagnostyczne i terapeutyczne oraz spuścizna naukowa

Italian Physician Johannes Baptista Montanus (1489–1551) – His Activity in Padua, Diagnostic and Therapeutic Methods, and Scientific Legacy Using the sources written by Johannes Baptista Montanus (1489–1551), by his students, and the existing historiography, the article aims to determine what role this Italian physician played in the development of diagnostic and therapeutic procedures, to what extent he is rightly considered the creator of clinical medicine, who were his mentors, and what were the methods of diagnosis and treatment he employed. Montanus was a professor at the University of Padua, and he has earned an ineffaceable place in the history of this university, where medicine was taught at a high level. At the same time, he worked as the head of St. Francis hospital. He was known for combining theoretical and practical knowledge in teaching at university. This method has become a permanent element of the teaching of medicine in Europe. He discussed the patient’s symptoms, then made a diagnosis, and recommended appropriate therapy directly at the patient’s bed, where the so-called consilia were held. This scheme of diagnostic and therapeutic procedure was named after him the ‘Collegium Montani’ and found many supporters among students who made notes while standing by the patient’s bed. The Consilia were later printed, and thus the treatments recommended and used by Montanus can be analyzed. Walenty Sierpiński of Lublin (also known as Valentinus Lublinus, b. 2nd half of the 16th century– d. before 1600) was among a large group of Montanus’s students. His merits include collecting, organizing and then publishing his master’s lectures. Considered to be Montanus’s most important work, Consultationum medicinalium Centuria prima, was published by Walenty of Lublin in Venice in 1554 (ex officina Erasmiana), and it contains one hundred pieces of medical advice given to one hundred patients. A few years later, a continuation of this work (Consultationum medicinalium Centuria secunda, ed. by Johannes Crato, Venice 1559) was published, containing further one hundred recommendations. Montanus was a promoter of physical examination as a method of obtaining knowledge about the patients’ health. He was regarded as a follower of Galen, Rhazes, and Avicenna and published critical studies on their treatment methods.

813: Postoperative Serotonin Syndrome

1N/A 2University of Connecticut Health Center, Hartford, CT 3N/A, Hartford, CT 4University of Connecticut Health Center, N/A 5Saint Francis Hospital, Hartford, CT

Prevalence and antifungal susceptibility of gastrointestinal candidiasis among diabetic patients: A cross-sectional study.

BackgroundGastrointestinal candidiasis is the most predominant opportunistic human mycosis, especially in diabetic patients. There is a global increase in antifungal resistance coupled with a rarity of information on antifungal susceptibility profiles in Uganda.ObjectiveThis study aimed to determine the occurrence and antifungal susceptibility of gastrointestinal candidiasis in diabetic patients.MethodsStool and fasting blood specimens were obtained from randomly sampled consenting patients with diabetes mellitus at St. Francis Hospital Nsambya in Kampala, Uganda to determine Candida infection, fasting blood glucose and glycated haemoglobin levels. Susceptibility testing was performed on Muller Hilton agar supplemented with 2% glucose and 0.2 µg of methylene blue, using the E-test diffusion method.ResultsAmong the 241 patients included in the analyses, the overall prevalence of gastrointestinal candidiasis was 15.4% (n = 37). Candida albicans (62.16%, n = 23) was the predominant species, followed by Candida glabrata (18.92%, n = 7), Candida tropicalis (8.11%, n = 3), Candida krusei (5.41%, n = 2) and Candida dublinensis (5.41%, n = 2). Resistance was observed with miconazole (48.65%), clotrimazole (18.92%) and fluconazole (8.11%). No resistance to itraconazole and nystatin was observed. Gastrointestinal candidiasis was associated with poor glucose control (p ≤ 0.001), prior use of antibiotics (p ≤ 0.001), antifungals (p ≤ 0.001) and corticosteroids (p ≤ 0.001) and was more common among female patients (p = 0.01).ConclusionOccurrence of gastrointestinal candidiasis was relatively low among our participants, and infection was associated with poor glucose control, female sex and use of antifungals, antibiotics and corticosteroids.

Women\u2019s experiences following emergency Peripartum hysterectomy at St. Francis hospital Nsambya. A qualitative study

BackgroundEmergency peripartum hysterectomy (EPH) is a known remedy for saving women’s lives when faced with the challenging situation of severe post partum hemorrhage not responsive to conservative management. However, EPH by its nature is also a traumatic birth event that causes serious physical, emotional and psychological harm. Unfortunately at St. Francis Hospital Nsambya nothing much is known about these experiences since no study has been undertaken and these women are not routinely followed up. The purpose of this study was to explore these emotional experiences.MethodsThis was a qualitative phenomenological study carried out between August and December 2018. All those women who had undergone EPH between January 2015 and August 2018 were eligible to participate in the study. Purposive sampling was used. 18 women were interviewed before saturation was reached. All interviews were audio-recorded and then transcribed verbatim. Thematic analysis was used to analyze the data.ResultsThree major themes were identified as the main experiences of these women in this study and they were; Loss of Womanhood, Joy for being alive and Loss of marital safety.ConclusionWomen experience serious emotional consequences following EPH. We recommend routine follow-up to help appreciate these experiences and advise them on appropriate mitigating measures.

A Retrospective Study of Coinfection of SARS-CoV-2 and Streptococcus pneumoniae in 11 Hospitalized Patients with Severe COVID-19 Pneumonia at a Single Center.

BackgroundA lethal synergism between the influenza virus and Streptococcus pneumoniae has been identified. However, bacterial coinfection is considered relatively infrequent in hospitalized patients with COVID-19, and the co-prevalence of Streptococcus pneumoniae is low.Material/MethodsWe retrospectively analyzed the clinical characteristics and outcomes of patients subsequently admitted to AMITA Health Saint Francis Hospital between March 1 and June 30, 2020, with documented SARS-CoV-2 and S. pneumoniae coinfection.ResultsWe identified 11 patients with S. pneumoniae coinfection. The median age was 77 years (interquartile range [IQR], 74–82 years), 45.5% (5/11) were males, 54.5% (6/11) were white, and 90.9% (10/11) were long-term care facility (LTCF) residents. The median length of stay was 7 days (IQR, 6–8 days). Among 11 patients, 4 were discharged in stable condition and 7 had died, resulting in an inpatient mortality rate of 64%.ConclusionsAt our center, 11 patients with COVID-19 pneumonia who had confirmed infection with SARS-CoV-2 were diagnosed with Streptococcus pneumoniae infection while in hospital. All patients had pneumonia confirmed on imaging and a nonspecific increase in markers of inflammation. The in-hospital mortality rate of 64% (7 patients) was higher in this group than in previous reports. This study highlights the importance of monitoring bacterial coinfection in patients with viral lung infection due to SARS-CoV-2.

Prevalence and factors associated with overweight and obesity among patients with type 2 diabetes mellitus in Uganda—a descriptive retrospective study

ObjectivesTo assess the prevalence and risk factors of overweight and obesity among type 2 diabetes mellitus (T2DM) patients in Uganda.DesignRetrospective chart review.SettingThis study was conducted in the outpatient’s T2DM clinic...

Predictors of 30-day and 90-day mortality among hemorrhagic and ischemic stroke patients in urban Uganda: a prospective hospital-based cohort study

BackgroundWe report here on a prospective hospital-based cohort study that investigates predictors of 30-day and 90-day mortality and functional disability among Ugandan stroke patients.MethodsBetween December 2016 and March 2019, we enrolled consecutive hemorrhagic stroke and ischemic stroke patients at St Francis Hospital Nsambya, Kampala, Uganda. The primary outcome measure was mortality at 30 and 90 days. The modified Ranking Scale wasused to assess the level of disability and mortality after stroke. Stroke severity at admission was assessed using the National Institute of Health Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS). Examination included clinical neurological evaluation, laboratory tests and brain computed tomography (CT) scan. Kaplan-Meier curves and multivariate Cox proportional hazard model were used for unadjusted and adjusted analysis to predict mortality.ResultsWe enrolled 141 patients; 48 (34%) were male, mean age was 63.2 (+ 15.4) years old; 90 (64%) had ischemic and 51 (36%) had hemorrhagic stroke; 81 (57%) were elderly (≥ 60 years) patients. Overall mortality was 44 (31%); 31 (23%) patients died within the first 30 days post-stroke and, an additional 13 (14%) died within 90 days post-stroke. Mortality for hemorrhagic stroke was 19 (37.3%) and 25 (27.8%) for ischemic stroke. After adjusting for age and sex, a GCS score below < 9 (adjusted hazard ratio [aHR] =3.49, 95% CI: 1.39–8.75) was a significant predictor of 30-day mortality. GCS score < 9 (aHR =4.34 (95% CI: 1.85–10.2), stroke severity (NIHSS ≥21) (aHR = 2.63, 95% CI: (1.68–10.5) and haemorrhagic stroke type (aHR = 2.30, 95% CI: 1.13–4.66) were significant predictors of 90-day mortality. Shorter hospital stay of 7–13 days (aHR = 0.31, 95% CI: 0.11–0.93) and being married (aHR = 0.22 (95% CI: 0.06–0.84) had protective effects for 30 and 90-day mortality respectively.ConclusionMortality is high in the acute and sub-acute phase of stroke. Low levels of consciousness at admission, stroke severity, and hemorrhagic stroke were associated with increased higher mortality in this cohort of Ugandan stroke patients. Being married provided a protective effect for 90-day mortality. Given the high mortality during the acute phase, critically ill stroke patients would benefit from early interventions established as the post-stroke- standard of care in the country.

Prevalence, factors associated and treatment outcome of hyperbilirubinaemia in neonates admitted to St Francis hospital, Nsambya, Uganda: a descriptive study.

With targeted management of neonatal hyperbilirubinaemia in high-income countries, there has been a drastic drop in both the prevalence and mortality. On the contrary, over two-thirds of the global burden of neonatal hyperbilirubinaemia is in Sub-saharan Africa and South East Asia with a high mortality risk of 16-35%. Neonatal hyperbilirubinaemia is not a leading global cause of neonatal mortality, however leads to irreversible neurological damage and death when managed poorly. Three-quarters of the babies admitted to the national referral hospital in Uganda had significant hyperbilirubinaremia; 16.6% of these babies died. We aimed at determining the prevalence, treatment outcome and describing factors associated with hyperbilirubinaemia in neonates admitted to St Francis hospital, Nsambya. A cross sectional study was carried out. A total of 242 files of babies with a preliminary diagnosis of hyperbilirubinaemia were retrieved retrospectively. Relevant data was extracted from the files and analysed using STATA version 14.0. The prevalence of significant hyperbillirubinaemia was 22.7% (55/242). Seventy-seven percent of the babies admitted did not require treatment for hyperbilirubinaemia. No factors were found to be significantly associated with significant hyperbilirubinaemia. The case fatality for severe hyperbilirubinaemia was 20% (6/30); half of these babies had haemolytic disease of the newborn. Establishment of local guidelines will prevent unnecessary admissions and ensure timely treatment is administered. Longitudinal studies are required to discover factors associated with neonatal hyperbilirubinaemia in this region.

Accuracy of a Dual Test for Detection of HIV1 and Syphilis at an Urban Hospital in Kampala- A cross-sectional study

Background: Dual rapid point of care test kits for multiple infections such as HIV and syphilis can greatly improve the screening and detection of such infections in vulnerable groups. Methodology: A cross sectional study was conducted at St. Francis Hospital Nsambya ante natal clinic between 16th March and 3rd May 2015. All pregnant women attending the clinic for the first time were screened and eligible participants enrolled in the study after informed consent. Data was collected using structured questionnaire; whole blood was collected from participants by venapuncture. Data was entered into Epi data version 3.1 analysed with IBM SPSS version 16. Results: A total of 549 were screened for the study and 476 (86.7%) were tested for HIV and syphilis. Fifty two had already tested for HIV and syphilis and 21 left the clinic without being tested. Of those tested 9 had inconsistent data and 5 did not have confirmatory results due to mis- identification. Only 462 (84%) results were available for analysis. The sensitivity and specificity for ASTEL HIV and syphilis was 79% and 77% respectively. The PPV and NPV for ASTEL kit for HIV and Syphilis was 99%, 92 and 99, 93% respectively. The sensitivity /specificity/PPV and NPV for Determine HIV were 74%/100%/99% and 89% 38%/98%/96% and 92% for syphilis. The prevalence of HIV in the study was 4%, C.I 2-6% while that of syphilis was 6 %, C.I 4-8%. Conclusion: The sensitivity of the ASTEL kit for HIV and syphilis was lower than that given by the manufacturers and other laboratory based studies but was better than that of the routine Determine tests. The low prevalence of HIV and syphilis in this study population may have resulted in a higher proportion of false negatives hence affecting the positive and negative predictive values

Quality of life and Associated Factors among Children aged 5 to 18 years with Diabetes Mellitus at St. Francis Hospital Nsambya and Mulago National Referral Hospital

Background: This study aimed to determine the quality of life and describe associated factors among children aged 5-18 years with diabetes Mellitus at St. Francis Hospital Nsambya and Mulago National Referral Hospital. Methods: An explanatory sequential study design was used between November 2018 and March 2019. Univariate analysis together with bivariate logistic regression analysis was used to determine quality of life and identify association between the quality of life at a p-value ˂ 0.05 respectively. Factors found to have a p-value ˂ 0.25 were included in the Multivariate logistic regression. A backward method was then applied to determine the best model that predicts quality of life among children. Data was analysed using STATA version 14. Data on the perception of quality of life of children with diabetes mellitus from the perspective of the children, caregivers and health workers was used to obtain qualitative results. Results: 115 children were recruited from the paediatric diabetic clinics. A low quality of life with a mean score of 77 ±15.58 was reported with a mean age of 13 ± 3.9. Factors associated with quality of life included: age groups of 8-12 and 13-18 years, primary education, secondary education, tertiary education, a single parent, living with relatives and primary care giver being a relative other than the biological parents. Conclusion: A sub-optimal quality of life was observed among children with type 1 diabetes mellitus. The factors associated with good quality of life included; age between 5- 7 years, a child living with biological parents, a child being in primary school and higher parental level of education. Recommendation: Community health education and sensitization should be more focused towards the adolescent patients, single mothers, guardians and benefactors of children with diabetes mellitus. There is greater need for healthcare support in schools to mitigate the stigma experienced by these children.

Predictors of loss to follow up among patients with type 2 diabetes mellitus attending a private not for profit urban diabetes clinic in Uganda \u2013 a descriptive retrospective study

BackgroundAlthough the prevalence of type 2 diabetes mellitus is increasing in Uganda, data on loss to follow up (LTFU) of patients in care is scanty. We aimed to estimate proportions of patients LTFU and document associated factors among patients attending a private not for profit urban diabetes clinic in Uganda.MethodsWe conducted a descriptive retrospective study between March and May 2017. We reviewed 1818 out-patient medical records of adults diagnosed with type 2 diabetes mellitus registered between July 2003 and September 2016 at St. Francis Hospital - Nsambya Diabetes clinic in Uganda. Data was extracted on: patients’ registration dates, demographics, socioeconomic status, smoking, glycaemic control, type of treatment, diabetes mellitus complications and last follow-up clinic visit. LTFU was defined as missing collecting medication for six months or more from the date of last clinic visit, excluding situations of death or referral to another clinic. We used Kaplan-Meier technique to estimate time to defaulting medical care after initial registration, log-rank test to test the significance of observed differences between groups. Cox proportional hazards regression model was used to determine predictors of patients’ LTFU rates in hazard ratios (HRs).ResultsBetween July 2003 and September 2016, one thousand eight hundred eighteen patients with type 2 diabetes mellitus were followed for 4847.1 person-years. Majority of patients were female 1066/1818 (59%) and 1317/1818 (72%) had poor glycaemic control. Over the 13 years, 1690/1818 (93%) patients were LTFU, giving a LTFU rate of 34.9 patients per 100 person-years (95%CI: 33.2–36.6). LTFU was significantly higher among males, younger patients (< 45 years), smokers, patients on dual therapy, lower socioeconomic status, and those with diabetes complications like neuropathy and nephropathy.ConclusionWe found high proportions of patients LTFU in this diabetes clinic which warrants intervention studies targeting the identified risk factors and strengthening follow up of patients.

Determining Patient Characteristics Leading to Worse Outcomes with Long Term Milrinone Therapy

Background Milrinone is an inotrope used in patients with end-stage heart failure awaiting mechanical support, heart transplant or as palliative therapy. Numerous studies have evaluated adverse events and mortality associated with milrinone use, which have shown to be associated with higher mortality rates and arrhythmias. Despite the homogeneous prevalence of these adverse effects, the association of their development with the duration of treatment remains debatable. Additionally, emerging smaller studies have described relative safety of long term milrinone use. In light of such discrepancy, no specific factors have been identified to account for the difference in onset and prevalence of milrinone associated deleterious effects. We sought to determine underlying patient characteristics that would influence worse outcomes with milrinone Methods We conducted a single-center retrospective study reviewing all patients on outpatient milrinone therapy at St. Francis Hospital with a mean follow up of 36 months. Results In total, 10 patients were identified of which 4 patients were deceased. These 4 patients were on milrinone for a mean of 11.5 months. The attributes of the survivors compared to deceased showed: age at start of therapy 67.5 vs 79; female gender 66% vs 33%; non-ischemic cardiomyopathy 33% vs 50%; atrial fibrillation/flutter 50% vs 25%; hyperlipidemia 66% vs 50%; anemia 83% vs 75%; presence of CRT 66% vs 25% and ICD 16% vs 0%; sodium 136 vs 140mEq; chloride 101.5 vs 104.5mEq; potassium 4.07 vs 4.23mEq; and creatinine 1.3 vs 1.8 mg/dL. Conversely, deceased patients were more likely to have diabetes (50% vs 16%), hypertension (100% vs 83%), chronic kidney disease (75% vs 66%), peripheral vascular disease (25% vs 0%), coronary artery disease (75% vs 33%), higher pulmonary artery pressures (54 vs 50.5mmHg) and history of coronary intervention with primary coronary angioplasty or coronary bypass surgery (50% vs 16%). Conclusion Males were more likely to have died if they were placed on milrinone at a later age. Ischemic risk factors appear to be more deleterious. These trends exhibit potential patient characteristics that may predict worse outcomes on long term milrinone. Larger studies are needed to assess statistical significance of these findings.

Wanda Błeńska and the program of leprosy treatment in Uganda

Wanda Błeńska (1911-2014), a Polish physician, established a leprosy treatment center in the village of Buluba in Uganda in 1951, which lasted until 1993. Through her efforts, the village for lepers in Buluba, established in 1934, which had previously been a place of isolation conducted by the Little Sisters of St. Francis in Uganda, became such an important leprosy treatment and research center that eventually the facility was able to cooperate with similar centers in India and South Africa. It then became affiliated with research institutes in London and Amsterdam; the Borstel Research Institute near Hamburg, Germany; and the World Health Organization. Błeńska developed a working relationship with the government of Uganda and contributed to changes in the government provision of health care for lepers by creating a network of leprosy treatment stations throughout the country. Through her efforts, public health education and leprosy prophylaxis became available for thousands of people, effectively changing the national attitude toward this disease. In 1994, one of the buildings of the St. Francis hospital complex in Buluba was named in her honor (The Wanda Blenska Training Centre).

Effect of Maternal Exhaustion on Breastfeeding Exclusivity

The current rate of exclusive breastfeeding at Bon Secours St. Francis Hospital is 68.3%, with 910 newborns out of 1,332 eligible newborns being exclusively breastfeed over a 6-month period. The general assumption by staff was that a lactation consultant nurse could improve, during the night shifts, breastfeeding exclusivity until the patient was discharged. Data were gathered over a 6-month period on 1,332 births. The mother–baby unit manager was a key stakeholder who used the eight-step plan–do–check–act (PDCA) methodology to solve this problem. The unit manager selected to investigate the subset of 44 mothers who attempted breastfeeding but failed and identified that exhaustion, pain, or unknown reasons were causes. The unit manager worked with front-line staff to develop a root cause analysis using the categories of man, method, material, machine. and environment and identified five important causes of the exhaustion that new mothers experienced:•Care providers were operating on their own schedules, which resulted in 31 planned encounters with the mother during the first 24-hr postbirth.•The hospital did not have mandatory quiet hours or a process to limit visitors.•The patient rooms are side by side with no sound protection.•Staff lacked the awareness of their noise level and how it related to the mother’s exhaustion and lower breastfeeding rates.•Badge swipes for supply, medical, and linen (any locked door) on the unit created loud beeps and mechanical sounds throughout the unit any time a locked door was accessed. Since March 2018, breastfeeding exclusivity rates have remained above 70% and patient satisfaction scores have improved. The hospital also was surveyed for Baby-Friendly hospital designation in August 2018 and is awaiting results. The staff was not familiar with the eight-step PCDA process, and, in the beginning, they believed that the solution was to add lactation support at night. There were additional opportunities that could have been taken advantage of with these improvements by working with internal marketing to promote the initiative and exploring the potential to partner with physician practices to focus on women’s care from prenatal planning to postpartum care.

Patient‐Specific Hemodynamic Analysis of Coronary Arteries

In cases of severe cardiac stenosis, the selection of treatment options including angioplasty, stent insertion, and bypass surgery are based on cardiac diagnosis provided by electrocardiograms, stress tests, and angiograms. Although these diagnostic tools are all vital, it is still difficult to determine the true extent to which normal blood flow has been compromised. To date, a clear guideline for aggressive intervention does not exist, as stenosis characteristics can vary greatly between patients. Plaque composition, compressibility, and shape are all factors that can modify a patient's risk of incurring a life‐threatening cardiac event in the near future. Our work aims to establish a streamlined computational model that can provide accurate estimation of dynamic shear stress and tensile strain on a plaque based on a patient's specific geometry. Together with flow information provided by 4D cardiac MRI, information from the computational model will allow a cardiologist to make better informed decisions regarding therapeutic options for patient cardiac health.The goal of this undergraduate research project was to determine the most effective method for 3D reconstruction and segmentation of the heart and coronary arteries from patient‐specific CTA (computed tomography angiography) data. The resulting 3D geometry will be imported into COMSOL, a computational fluid dynamics software, for hemodynamics and stress‐strain analysis.Patients' CTA data was provided by the Cardiac Imaging Department of the St. Francis Hospital (with IRB approval). A set of 2097 images were imported into a 3D reconstruction software, 3D Slicer (http://www.slicer.org), and visualized in sagittal, axial, and coronal views. By scanning through images in each plane, major components of the heart (i.e., atria, ventricles, aorta, coronary arteries) were identified manually. 3D reconstruction and segmentation were accomplished using a seeding procedure in which each part of the heart was carefully selected and identified as an individual component. 3D Slicer then generated a 3D‐reconstructed geometry of the heart from seeds. Proper seeding allowed different components of the heart to be visualized individually in the 3D viewer, enabling isolation of the coronary arteries from the whole heart model.Preliminary results showed a 3D model of the whole heart from CTA data with the left main coronary isolated. Manual segmentation was found to be challenging because coronary artery branches are embedded within the cardiac muscle. It was demonstrated to be efficient to refine seeds for coronary artery identification and segmentation by carefully examining the 3D model and performing several iterations of correction. The coronary artery geometry generated in 3D Slicer is then processed by a Vascular Modeling Tool Kit (VMTK, an open source software) to generate the proper geometries (in .stl format) needed for COMSOL, for hemodynamics modeling and analysis.As methods for reconstruction and segmentation are further refined, computational modeling will be used as a high throughput tool to generate useful information on stress/strain conditions within the coronary arteries, moving toward our goal of streamlined personalized cardiac treatment.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Small-incision lenticule extraction for the correction of myopic astigmatism

To report the outcomes of small-incision lenticule extraction (SMILE) in myopic eyes with astigmatism of 1.0 to 3.0 diopters (D). Center for Refractive Surgery, Eye Department, St. Francis Hospital, Muenster, Germany. Retrospective case series. Inclusion criteria were myopia of -0.5 D or more, astigmatism between -1.0 D and 3.0 D, and decimal corrected distance visual acuity (CDVA) of 1.0 or better. The study comprised 206 eyes. Preoperatively, the mean attempted spherical equivalent (SE) correction was -5.45±2.37 D (range -1.25 to -11.38 D) and the mean cylinder was -1.52±0.57 D (range -1.0 to -3.0 D). Three months postoperatively, the mean SE refraction was -0.07±0.38 D (range -1.25 to +1.00 D) and the mean cylinder was -0.32±0.29 D (range 0.0 to -1.5 D). The mean decimal uncorrected distance visual acuity (UDVA) was 1.13, the mean efficacy index was 0.87, and the mean safety index was 1.00. The UDVA was the same as or better than the CDVA in 67% of cases. The angle of error was ±5 degrees in 67% and ±15 degrees in 94% of cases, and the residual astigmatism was 0.5 D or less in 88% and 1.0 D or less in all patients. Small-incision lenticule extraction for the correction of myopic astigmatism was safe and effective, with outcomes comparable to those reported for laser insitu keratomileusis using modern eye-tracking systems.

Cervical Collar Placement Algorithm for Triage Nurses

You are the triage nurse in the emergency department. It is a busy night, and you have a waiting room full of patients. A 35-year-old woman arrives; she is walking slowly and reports a motor vehicle crash in which her car was hit from behind. Air bags deployed, and the patient reports a neck pain level of 6 on a 10-point scale. The patient is alert and oriented. She extricated herself from her vehicle and was found sitting on the curb. She declined transport on scene. You know it will be a while before the provider sees the patient. Do you place a cervical collar on her? Melissa Irwin is Emergency Services and Cardiopulmonary Manager, CHI-Franciscan: St Elizabeth Hospital, Enumclaw, WA. Andi L. Foley, Member, ENA Washington State Council, is ED Clinical Nurse Specialist, CHI-Franciscan: St Francis Hospital, Federal Way, WA.

Confirmation of Zika virus infection through hospital-based sentinel surveillance of acute febrile illness in Uganda, &nbsp;2014-2017.

Zika virus (ZIKV), transmitted by Aedes species mosquitoes, was first isolated in Uganda in 1947. From February 2014 to October 2017, the Uganda Virus Research Institute, in collaboration with the US Centers for Diseases Control and Prevention, conducted arbovirus surveillance in acute febrile illness (AFI) patients at St Francis hospital in Nkonkonjeru. Three hundred and eighty-four serum samples were collected and tested for IgM antibodies to yellow fever virus (YFV), West Nile virus (WNV), dengue virus (DENV), chikungunya virus (CHIKV) and ZIKV. Of the 384 samples, 5 were positive for ZIKV IgM. Of these five, three were confirmed by plaque reduction neutralization test (PRNT) to be ZIKV infections. Of the remaining two, one was determined to be a non-specific flavivirus infection and one was confirmed to be alphavirus-positive by reverse transcriptase polymerase chain reaction (RT-PCR). This study provides the first evidence of laboratory-confirmed ZIKV infection in Uganda in five decades, and emphasizes the need to enhance sentinel surveillance.