Froedtert Hospital Research Articles

Systemic Lupus–Induced Diffuse Alveolar Hemorrhage Treated With Extracorporeal Membrane Oxygenation

We report the case of a 28-year-old patient with systemic lupus erythematosus (SLE) with rapid onset of dyspnea and hemoptysis found to have diffuse alveolar hemorrhage (DAH) with refractory hypoxemia successfully treated with venovenous extracorporeal membrane oxygenation (ECMO). The discussion includes clinical presentation, diagnosis, management, outcome, and a review of the available adult literature on the use of ECMO in patients with DAH. Case report. Froedtert Hospital and the Medical College of Wisconsin. Data were collected from the patient's electronic medical record and the hospital radiology database. Diffuse alveolar hemorrhage secondary to SLE is quite rare. The adult literature on the utilization of ECMO for DAH is limited mostly to antineutrophil cytoplasmic antibody (ANCA)-associated alveolar hemorrhage and a few reports of nonvasculitis DAH. Bleeding has been a contraindication to ECMO due to the need for systemic anticoagulation. Our case, along with a review of the literature, indicates that ECMO with anticoagulation can be safely utilized in patients with DAH. To our knowledge, this is the first reported adult case of DAH due to SLE successfully treated with ECMO.

Dermoid Cyst

Medical College of Wisconsin, Froedtert Hospital, Milwaukee, WI. Received for publication April 27, 2012; accepted April 30, 201. The authors declare no conflict of interest. Reprints: Samir Prashant Shah, MD, Medical College of Wisconsin, Froedtert Hospital, 9200 W, Wisconsin Ave, Milwaukee, WI 53226 (e-mail: [email protected]).

Survey of opinions of mothers and teenage daughters on sexual behavior and contraception: descriptive study and literature review

BackgroundThe aim of this survey was to examine sexual behavior, use of contraception, and communication regarding these issues between mothers and their teenage daughters.MethodsThis descriptive cohort study included 314 pairs of women aged 15–24 years and their mothers, from an urban area in Israel. The participants completed questionnaires about sexual history and contraceptive usage. The main outcome measures were differences in sexual behavior and use of contraception between the two generations.ResultsSeventy-six percent of the daughters used effective contraception during their first intercourse versus only 29% of their mothers. Of the daughters, 48% had consulted their mothers regarding sexual relationships and use of contraception before beginning to use contraception. The vast majority of the mothers (96%) acknowledged that it was important to discuss these issues with their teenage daughters, but only 66% of them had actually spoken to their daughters about the subject. Daughters who did not discuss contraceptive matters with their mothers tended to be younger at the time of first sexual intercourse, to use the pill less often and the condom more often, and to have a slightly higher rate of elective abortions.ConclusionThis study contributes to our understanding of mother and daughter attitudes regarding contraception, intergenerational differences in this regard, and the importance of mother-daughter communication.

Warming Blanket Head Drapes and Trapped Anesthetic Gases: Understanding the Fire Risk

Polyethylene warming blanket head drapes are widely used to help surgical patients maintain normothermia. The OR quality management team at Froedtert Hospital, Milwaukee, Wisconsin, designed a quality improvement project using an intubation mannequin to determine whether a head drape used on an intubated patient would enhance the risk of ignition in the presence of an undetected anesthesia system gas leak. The team revealed several significant factors, including higher oxygen flow rate, the presence and application of the head drape, and not using the warming blanket blower, in the accumulation of oxidizers. Considerations for the surgical team when using the head drape include cutting a fenestration in the drape around the endotracheal tube or otherwise venting the drape, using the blanket blower, and having the anesthesia care provider frequently lift the head drape, thus minimizing the accumulation of trapped gases.

Hospital Response During the Red Dragon Drill

From March 2009 to June 2009, a series of drills involving a hypothetical radiological dispersal device (RDD) detonation were conducted in the metropolitan area of Milwaukee, Wisconsin. Named Red Dragon, the drill constituted the largest multi-agency RDD scenario attempted to date in the United States. Froedtert Hospital and the Children's Hospital of Wisconsin comprise the Level One trauma center that served as the site for triage, decontamination, and treatment of approximately 80 victims who participated in the exercise. Examined are hospital resources, plans, interaction with external agencies, communications, and lessons learned.

IT & informatics in translational research: a case study

IT & informatics in translational research: a case study

Death with functioning kidney transplant: an obituarial analysis

BackgroundDeath with a functioning kidney graft (DWFG) is now a major cause of graft loss after renal transplantation, occurring in up to 40% of cases. Its occurrence provides insight into the medical care of subjects with a functioning kidney transplant. In this study, we used the time to DWFG as an endpoint, to test whether improved medical care has contributed to better kidney transplant outcomes.MethodsWe used single-center data from the Milwaukee Regional Medical Center and Froedtert Hospital, on kidney-only transplants from 1969 through 2005. A total of 3,157 kidney transplants were done at our center during this time. There were 714 deaths with functioning kidney. We also recorded the major causes of DWFG over the time period from 1969 through 2005 divided into 3 epochs. The data were analyzed as a serial collection of yearly obituaries.ResultsThe time to DWFG has increased to 10 years despite a 20-year increase in the mean age of transplant recipients over the same time period.ConclusionsBetter pre-transplant evaluation, improved treatments for hypertension and hyperlipidemia, improved management of acute myocardial infarction, superior immunosuppressive protocols and better prophylaxis and treatment of infectious diseases have all likely contributed to this trend.

MEG-Clinic: a comprehensive software application to optimize the workflow of clinical MEG data.

Event Abstract Back to Event MEG-Clinic: a comprehensive software application to optimize the workflow of clinical MEG data. Elizabeth Bock1* and Sylvain Baillet2 1 Medical College of Wisconsin, United States 2 Medical College of Wisconsin, Froedtert Hospital, United States As the use of MEG becomes more prevalent in the clinical setting, the need for an optimized workflow has become imperative. A comprehensive solution will relieve the reliance on the scientist and physician and move the majority of the workload to automated algorithms and a trained technician. The solution will include a user interface that will guide a technician through the entire workflow, while automating steps to reduce the time to reporting. The current workflow includes data acquisition, data conditioning, data analysis and report generation. MEG-Clinic has been developed as an integrated solution using Java and Matlab. This application manages the patient workflow by organizing and displaying those files associated with each patient, while providing a “wrapper” to several existing software packages that provide for data conditioning and analysis. MEG-Clinic lays out the workflow, step by step. As the technician completes each step, either by launching a manual process or reviewing the results of an automated process, new data are available for analysis and the next steps can be completed. MEG-Clinic is currently being developed for the Elekta-Neuromag System but could be extended to other MEG systems using appropriate file format conversion. Supported software packages include MaxFilter, MNE, Brainvisa, Brainstorm and Prism. Appropriate functions from these packages are called from MEG-Clinic when needed. If the process is automated (MEG-Clinic runs the process in the background and provides an output), the technician will be required to review the outputs. MEG-Clinic automates several steps of data conditioning, including MaxFilter (signal-space separation), artifact removal (ECG, EOG, etc), data averaging for functional protocols and Elekta FDA Source Analysis. In addition to this data conditioning, MEG-Clinic currently interacts with Brainstorm for final analysis and Prism for final reporting. The ongoing development will include integration of additional analysis programs. Conference: Biomag 2010 - 17th International Conference on Biomagnetism , Dubrovnik, Croatia, 28 Mar - 1 Apr, 2010. Presentation Type: Poster Presentation Topic: MEG: Clinical applications Citation: Bock E and Baillet S (2010). MEG-Clinic: a comprehensive software application to optimize the workflow of clinical MEG data.. Front. Neurosci. Conference Abstract: Biomag 2010 - 17th International Conference on Biomagnetism . doi: 10.3389/conf.fnins.2010.06.00279 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 01 Apr 2010; Published Online: 01 Apr 2010. * Correspondence: Elizabeth Bock, Medical College of Wisconsin, Milwaukee, United States, ebock@mcw.edu Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Elizabeth Bock Sylvain Baillet Google Elizabeth Bock Sylvain Baillet Google Scholar Elizabeth Bock Sylvain Baillet PubMed Elizabeth Bock Sylvain Baillet Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Interview with William Petasnick, FACHE, President and Chief Executive Officer, Froedtert Hospital and Froedtert & Community Health System, and 2008 Chair, American Hospital Association

Interview with William Petasnick, FACHE, President and Chief Executive Officer, Froedtert Hospital and Froedtert & Community Health System, and 2008 Chair, American Hospital Association

RESEARCH REVIEW

Katheryne Tifuh Amba, BSN, RN, is a graduate student at the Marquette University College of Nursing and is employed as Critical Care Staff Nurse in the Surgical Intensive Care Unit, Froedtert Hospital, Milwaukee, Wisconsin. Corresponding Author: Katheryne Tifuh Amba, BSN, RN, Surgical Intensive Care Unit, Froedtert Hospital, 9200 W Wisconsin Ave, Milwaukee, WI 53226 ([email protected] or [email protected]).

Improving Communication and Documentation Concerning Preliminary and Final Radiology Reports

The communication and documentation of radiology preliminary and final interpretations for the identification of discrepancies failed to evolve with radiology's transition away from film. Processes should facilitate documentation and distribution of preliminary findings to multiple practitioners in real time and should provide timely communication and documentation of additional findings. The evolution of the electronic medical record and digital radiology images provided an opportunity to establish effective, safe, and efficient methods of communication and documentation. Froedtert Hospital (Milwaukee, WI) used the Six Sigma process to improve communication and documentation of radiologic findings. Root causes of problems were determined, hypotheses were tested, and new processes were piloted and implemented. Froedtert Hospital improved its process for documenting and communicating preliminary and final interpretations and identifying discrepancies.

Administration of IV immunosuppressive agents and the drawing of their levels: A how to guide for nurses

Topic: To show the importance of dedicating a line to administer immunosuppressive drugs (ISD) to ensure proper dosing for the BMT patient. Purpose/Background/Rationale: Early in 2005, Froedtert Hospital (FH) experienced several patients who had continuously high ISD levels without showing signs of toxicity or decreasing lab values after dose reduction. At this point, it was decided the nurses needed to draw both a peripheral level and level from the central venous catheter (CVL) in order to see if the 2 levels correlated. Up until this point, it had been our policy to draw all levels from the CVL only. In all of the patients where dual labs were drawn, the CVL level was significantly higher than the level drawn peripherally. This discrepancy has many negative consequences including poor immunosuppression for the BMT patient, possible increase in the rate of GVHD, unnecessary changes in drug dosages and inaccurate lab data. This poster will describe the nursing interventions taken to correct this problem showing that dedicating a line is an important part of insuring accurate lab and dosing levels when it is not possible to draw a peripheral level. Intervention: Nurse interviews and audits showed significant variance in the knowledge of the ISD policy. Once initial data was collected policy changes included the drawing of peripheral levels only with continued line dedication. Staff was reeducated on proper procedure and documentation. Procedure reminders were placed in areas of patient care. Evaluation: Dual labs are again being drawn to see if post education data shows an increased correlation between peripheral and CVL values. Preliminary results show that there has been a significant improvement. Discussion: This presentation will demonstrate that continuity in nursing practice will insure the proper dosing of the BMT patient unable to receive a peripheral blood draw. Topic: To show the importance of dedicating a line to administer immunosuppressive drugs (ISD) to ensure proper dosing for the BMT patient. Purpose/Background/Rationale: Early in 2005, Froedtert Hospital (FH) experienced several patients who had continuously high ISD levels without showing signs of toxicity or decreasing lab values after dose reduction. At this point, it was decided the nurses needed to draw both a peripheral level and level from the central venous catheter (CVL) in order to see if the 2 levels correlated. Up until this point, it had been our policy to draw all levels from the CVL only. In all of the patients where dual labs were drawn, the CVL level was significantly higher than the level drawn peripherally. This discrepancy has many negative consequences including poor immunosuppression for the BMT patient, possible increase in the rate of GVHD, unnecessary changes in drug dosages and inaccurate lab data. This poster will describe the nursing interventions taken to correct this problem showing that dedicating a line is an important part of insuring accurate lab and dosing levels when it is not possible to draw a peripheral level. Intervention: Nurse interviews and audits showed significant variance in the knowledge of the ISD policy. Once initial data was collected policy changes included the drawing of peripheral levels only with continued line dedication. Staff was reeducated on proper procedure and documentation. Procedure reminders were placed in areas of patient care. Evaluation: Dual labs are again being drawn to see if post education data shows an increased correlation between peripheral and CVL values. Preliminary results show that there has been a significant improvement. Discussion: This presentation will demonstrate that continuity in nursing practice will insure the proper dosing of the BMT patient unable to receive a peripheral blood draw.

Resource Review

Katrina Ceci, BS, RN,BC, CEN, is Graduate Student of MS-Nursing Education Program, Cardinal Stritch University, Staff Nurse at the Wisconsin Heart Hospital, and Educator at Froedtert Hospital, Milwaukee, Wisconsin.

The monkeypox virus outbreak: Reflections from the frontlines

The day began as a rather typical Friday morning on May 30, 2003. The infection control practitioners were reviewing their telephone messages and preparing for the weekly staff meeting with both the hospital epidemiologist and the Chairman of the Froedtert Hospital Infection Control Committee, who was engaged in a discussion with one of our staff emergency department (ED) physicians about a veterinarian who was seeking treatment in the ED for a skin lesion and swollen lymph nodes. The veterinarian had a history of recent exposure to an ill pet prairie dog. At the time, little did we know that a series of events would set into motion a full scale epidemiologic investigation encompassing our own hospital in addition to local, state, and federal health agencies, entirely because of a smallpox-like virus that had never been seen before in the Western hemisphere.1

Beth Lanham on Six Sigma in healthcare. Interview by Luc R. Pelletier.

Beth Lanham, BSN RN, is a Six Sigma Coordinator in the department of quality management, staff development and safety, at Froedtert Hospital in Milwaukee, WI. Ms. Lanham received her bachelor's degree from Otterbein College in Westerville, OH and has an extensive clinical and management background in critical care nursing. In April 2000, Ms. Lanham completed the Six Sigma Black Belt training program through the American Society for Quality. She is currently working as a Six Sigma Black Belt and is actively involved with numerous committees and projects aimed at reducing medical errors and enhancing patient safety. Ms. Lanham has presented Six Sigma initiatives at the International Quality Congress sponsored by the American Society for Quality, the University Healthcare Consortium National Conference, the International Quality and Productivity Center National Conference on Six Sigma for Healthcare Providers, and the American Hospital Association Patient Safety Leadership Fellowship Retreat. Six Sigma projects at Froedtert Hospital are aimed at reducing errors associated with patient controlled analgesia pumps, continuous intravenous infusions, narcotic sedation in postoperative patients, insulin therapy, and handling of laboratory specimens. Six Sigma has also been applied toward reducing falls on a rehabilitation unit.

INTRA- AND INTER-RATER RELIABILITY OF HAND-HELD DYNAMOMETRY IN PATIENTS HAVING CARDIOPULMONARY COMPROMISE.

1Department of Physical Therapy, Marquette University and 2Curative Rehabilitation Services at Froedtert Hospital, Milwaukee, WI. Funded by the Hazel Mae Mayer Trust for Emphysema Research.

Information on wheels--library outreach.

Information on Wheels is an outreach service of the Medical College of Wisconsin Libraries. A mobile cart loaded with professional books and journals is taken weekly to the hospital unit and outpatient clinic of the Milwaukee County Hospital and Froedtert Hospital. The targeted audience is primarily nurses since their job demands usually allow little time flexibility, and they make up the largest percentage of hospital health care professionals. After one year of service, a survey was undertaken to determine the usefulness of the service. The results were very positive. One comment repeated was, "This is an excellent service because it provides easy access to pertinent information to people who are sometimes too busy or don't think to go to the library."