Robert Packer Hospital Research Articles

The Guthrie Clinic Holds 7th Annual Research Day at Robert Packer Hospital in Sayre, PA

The Guthrie Clinic Holds 7th Annual Research Day at Robert Packer Hospital in Sayre, PA

The Guthrie Clinic Holds 6th Annual Research Day at Robert Packer Hospital in Sayre, PA

The Guthrie Clinic Holds 6th Annual Research Day at Robert Packer Hospital in Sayre, PA

The Role of Cholecystectomy in Hyperkinetic Gallbladder: A Retrospective Cohort Study in a Rural Hospital.

Background Biliary dyskinesia is a functional gallbladder disorder in which there is an absence of a structural or mechanical cause for biliary pain. A cholecystokinin-hepatobiliary iminodiacetic acid (CCK-HIDA) scan is typically performed during workup, and cholecystectomy is the accepted treatment for low ejection fraction (EF) (less than 33%, as defined by the literature). However, few studies have examined the role of cholecystectomy in hyperkinetic gallbladder (EF ≥80%). The aim of our study was to examine symptom resolution following minimally invasive cholecystectomy in patients with hyperkinetic gallbladder. Methodology A retrospective chart review was conducted at Robert Packer Hospital in Sayre, PA. Patients who underwent minimally invasive cholecystectomy for biliary colic with EF ≥80% and who were without cholelithiasis on preoperative imaging or on final pathology were included in this study. The main outcome was symptom resolution at the postoperative visit. Data collected included age, gender, EF, body mass index, symptoms with CCK infusion, and pathology. Results A total of 48 patients were included. The mean age of patients was 41.2 years (standard deviation = 14.4), and the median age of patients was 42.2 years, with a range of 17-71 years. The majority of patients were female (83.3%). Overall, 58.3% of patients had replication of symptoms with CCK infusion. The mean gallbladder EF was 87.3%, with a median of 87.0 and a range of 80-98. In total, 33 (68.8%) patients had chronic cholecystitis on final pathology reports. There was a 95.9% symptom resolution rate among our patients two weeks postoperatively. Conclusions The overwhelming majority of patients experienced symptom resolution prior to their two-week postoperative visit following minimally invasive cholecystectomy for hyperkinetic gallbladder. These results strongly suggest a role of surgical management in patients with high EF.

Fifth Annual Guthrie Research Day

The fifth annual Guthrie Research Day was held April 22, 2022, on the Robert Packer Hospital campus in Sayre, PA. The event showcases research and quality improvement projects from fellows and residents of Guthrie as well as medical students from Geisinger Commonwealth School of Medicine (GCSOM) and Lake Erie College of Osteopathic Medicine (LECOM). This year’s Research Day featured 13 oral presentations and 53 posters.

On the road to the OSHA voluntary protection program.

In 1998, representatives from the Employee Health Services, Safety and Security, Physical Therapy, Human Resources, and Legal Affairs Departments and the Risk Management Program at Robert Packer Hospital (RPH) in Sayre, PA began a project to create a "culture of safety." The journey would ultimately lead to application to the Occupational Safety and Health Administration Voluntary Protection Program (OSHA VPP). Four years later, because of the dedication and collaboration of many individuals, RPH received notification that its application for OSHA VPP participation was approved by the Assistant Secretary of Labor. This article describes that journey and provides other healthcare organizations with the information needed to begin their own journey to successful project implementation.

Guthrie Joint Camp: Improved Care At Lower Cost

The Problem: Review of operative procedures within the Guthrie Healthcare System revealed that major joint replacement (DRG 209) was not only decreasing in volume but becoming more expensive. The Goal: To review all aspects of care of patients needing major joint replacement for potenti al opportunities to streamline the experience while increasing quality, decreasing cost, and increasing patient satisfaction. The Solution/Results: To begin the review process, all physician staff, nursing and allied health staff and administration involved in any way in the care of patients needing joint replacement were stimulated to participate in a review of the current practices at Robert Packer Hospital and to compare them to best practices throughout the country. The Musculoskeletal Service Line Leader organized these efforts and initiated the review of DRG 209. As a result of this intense review, practice changes were determined and established using a multidisciplinary approach. It was through everyone's review of their portion of the DRG and a complete restructuring of the DRG 209 process that ‘Joint Camp’ evolved. Its premise is that joint replacement patients are not sick; therefore, a wellness approach was utilized. Initially, physicians eva luated their surgical practice. Through vendor negotiations, supply variances were eliminated and the organization was able to obtain significant cost savings. Next, the patient experience was changed through the use of a ‘coach,’ who helped the patient with rehabilitation during the hospital stay and after discharge. Also, a community setting was utilized for their reh abilitation process. This supportive, yet competitive environment increased their mobility at a faster rate than previously experienced, thus resulting in enhanced outcomes, a decreased length of stay, and a patient satisfaction score in the 99th percentile. Our case numbers have continued to increase, our patient satisfaction scores are continuously in the 99th percentile, the DRG has become profitable, and the quality has been enhanced through the use of the ‘coach.’ This successful Joint Camp program has now been started in Corning Hospital.

Experience With Stereotactic Guided Core Biopsy Using the New Mammotome Technology at Robert Packer Hospital

The Mammotome biopsy needle has improved diagnostic accuracy and reduced complications of core needle breast biopsy.

It’s Deja Vu All Over Again

The title of this editorial comes from the statement made by Yogi Berra many years ago and used by Carol Camp in her discussion of bacterial antigen testing. In her article, she discusses bacterial antigen testing and her experience at Robert Packer Hospital. Unfortunately, the original bloom of enthusiasm has been replaced with cynicism because, as she demonstrates in her review, the lack of sufficient accuracy has severely limited the use of bacterial antigen testing. Many diagnostic tests, as well as therapeutic interventions, are brought forward with a great hope and expectation that they will be able to improve our ability to accurately diagnose patients earlier as well as treat them more successfully. Dr. Ayerdi and his surgical colleagues describe the evolution of carotid endarterectomy in the treatment of atherosclerotic carotid disease. In their excellent review, they show how the technique itself has evolved and gone through periods of wide acceptance with subsequent periods of disillusionment. Carotid endarterectomy went through a period when many patients who were having the procedure were not appropriate candidates. With further study and experience, as outlined by Ayerdi and his colleagues, the indications for carotid endarterectomy have been better refined and the procedure applied more appropriately. In the November 12, 1998 issue of the New England Journal of Medicine, H.J.M. Barnett et. al. (N.E.J.M. 1998;339:1415-25) confirm that patients symptomatic with carotid stenosis of 70% or more are markedly improved with endarterectomy, which persists for more than five years. Patients with moderate stenosis (50-69%) benefit, but less than those with stenosis at 70 percent or more, whereas those with stenosis of less than 50% did not benefit from endarterectomy. J.V. Tu, et.al., in the same issue, (N.E.J.M. 1998;339:1441-7) review the status of endarterectomy in the 90’s, without as extensive historical review as Ayerdi, et al., but with an analysis of referral patterns.

Sequel to the Symbiosis of the Guthrie Medical Center and the Lehigh Valley Railroad

One of the few advantages of having to have lived to a respectable old age is that one can sit back and meditate on events that have been recorded a couple of decades ago. In 1976, the author gave birth to a discourse on the influence of the Lehigh Valley Railroad on the organization and early growth of the Robert Packer Hospital. 1 By 1976, the Lehigh Valley Railroad had ceased to function as a transportation company, but the Hospital was experiencing a lusty growth.

Dedication of the Paul Gerry Dialysis Center at Robert Packer Hospital

Dedication of the Paul Gerry Dialysis Center at Robert Packer Hospital

Trauma critical pathways: a care delivery system that works.

Continuous performance improvement in care a patient receives is of paramount importance to Robert Packer Hospital, a regional, accredited trauma center in rural Pennsylvania. In fall 1991, a care delivery system known as case management was introduced as a mode for achieving this continuous performance improvement goal. The staff members' experience with the initial development and use of a trauma critical pathway was first published in the November 1993 issue of Critical Care Nursing Quarterly. Now, 3 years later, case management has proven to be a viable means to accomplish the continuous performance improvement goal by enhancing the quality of care for trauma patients and their families throughout hospitalization. This article reviews the outcomes over the past 3 years as a result of case management and the use of trauma critical pathways.

Mynah Birds and the Robert Packer Hospital

Mynah Birds and the Robert Packer Hospital

Pulmonary Emboli in Trauma Patients at Robert Packer Hospital Trauma Center

Pulmonary emboli are a source of significant morbidity and mortality in the trauma population. The incidence at Robert Packer Hospital is 0.23% with a mortality rate of 50%. A retrospective analysis over the last six years found eight out of 3450 trauma patients with documented pulmonary emboli. The purpose of this study was to identify those risk factors associated with the development of pulmonary embolism in trauma patients.

Small Cell Lung Carcinoma: A Retrospective Analysis of 54 Cases of Limited Stage Disease

A retrospective study of patients with limited stage small cell lung carcinoma (SCLC) treated from December 1980 to April 1991, was performed. The objective of the study was to identify patient factors that had an impact on survival. Patients with limited disease were identified using the tumor registry of the Robert Packer Hospital. Their records were reviewed for symptoms, tumor location, TNM (tumor, node, metastasis) staging, modality of therapy, survival, and cause of death. Fifty-four patients fulfilled the inclusion criteria. The average survival for the entire group was 19 months. Patients in whom the only manifestation of disease was an abnormal chest X-ray had a mean survival of 32 months. However, asymptomatic stage III patients did not show any survival advantage. In patients with more than three symptoms, average survival reached 12 months. Dyspnea, weight loss, and hoarseness were associated with short survival. Patients who had peripheral tumors had better overall survival regardless of the stage of disease. Extent of disease correlated with survival since 57% of stage I patients were long term survivors (36 or more months) while only 6.5% of stage III patients were. Surgery was the most successful mode of therapy for patients with stage I disease. In patients with stage III SCLC, the combination of chemotherapy and radiation provided the best survival.

For the record: the origin of the rapid serial sheet-film changer.

The early development of angiography and angiocardiography, and especially the equipment for the rapid automatic serialization of X-ray exposures, was chronologically described in detail by Dr. Wendell Scott in his Carmen Lecture delivered to the Radiological Society of North America (RSNA) in December 1950 [1]. Radiologic publications of the 1940s were saturated with articles describing homemade, and a few commercial, rapid filming devices, all of which were cassette or roll-film changers. None of these units satisfied the ultimate needs for the developing art of rapid serial angiography. Up to the time of Scott’s lecture, no mention had been made of instruments transporting only sheet film. In January 1951 , my preceptor, Dr. Paul Perry, then chairman of the Department of Radiology at Robert Packer Hospital and Guthrie Clinic in Sayre, PA, granted me 4 months’ leave from the terminal portion of my residency to visit major centers of radiology in the United States. Two weeks of this experience during January 1 951 was spent at the University of Michigan in Ann Arbor. Most of that visit was spent with Dr. Melvin Figley, reviewing his experiences with the roll-film changer he had developed along with Drs. Thompson and Hodges [2]. During an interval return to Sayre, I discussed the state of the art of serial angiography with Dr. Perry, who agreed to the use of departmental research funds to proceed with the development of a unit designed to more closely satisfy the optimal requirements of a rapid serial changer. Mr. Harold Reynolds, Chief Developmental Engineer at Ingersoll Rand Company in Athens, PA, was invited to participate in this project. He quickly recognized the inherent limitations of transporting the mass of relatively heavy cassettes in the cassette changer units, and the film handling and processing problems of the large roll-film units. His suggestion was to move the lightest mass possible, namely the sheet film. After many discussions of the problem and some innovative suggestions by me, on February 7, 1 951, Reynolds completed drawings of the prototype unit we had envisioned. This instrument was fabricated by Reynolds, a superb machinist, in his home workshop. The unit was completed in the summer of 1951 and put into clinical use at the Robert Packer Hospital. A description of the sheet-film changer (named the Serialograph) was not published until early 1953 [3]. Later that year, it was shown as a scientific exhibit at the 39th annual meeting of the RSNA in Chicago. At that meeting, the instrument was reviewed by interested representatives from most of the American manufacturers and, in addition, in great detail by engineers from the Elema-Schonander Company of Solna, Sweden. The Elema-Schonander representatives drew our attention to the fact that they had developed a sheetfilm unit in 1952 based on strikingly similar design principles. Thirty years later, in 1983, I reviewed the Swedish contributions with the help of Mr. L. Stolpe, then president of Elema-Schonander in Elk Grove, IL. Mr. Stolpe obtained information and documents from Mr. Georg Fredzell, the previous long-term director of research and

Thoughts of One of the First Sewell Patients at Robert Packer Hospital

Thoughts of One of the First Sewell Patients at Robert Packer Hospital

Heart Surgery Continues at Robert Packer Hospital

Heart Surgery Continues at Robert Packer Hospital

ABOUT ORGAN AND TISSUE DONATION

Clinical Coordinator Department of Nursing Education and Research Robert Packer Hospital, Guthrie Healthcare System Sayre, Pennsylvania

Abstracts of Articles Published in Other Journals By Guthrie and Robert Packer Hospital Physicians

Abstracts of Articles Published in Other Journals By Guthrie and Robert Packer Hospital Physicians

Using a quality improvement team to reduce patient falls.

Preventing falls among hospitalized patients continues to be a major concern of nurses, as evidenced by the volume of literature on this subject during the past 10 years. Yet, preventing falls, like preventing medication errors, has been a difficult and chronic issue for most nursing departments. Carolyn Corbett and Barbara Pennypacker describe how the nursing staff at Robert Packer Hospital in Sayre, PA, finally has experienced success by applying the systematic methods and principles of continuous quality improvement and establishing a fall prevention process.