Stamford Hospital Research Articles

Prospective Evaluation of a Dynamic Acuity Score for Regularly Assessing a Critically Ill Patient's Risk of Mortality.

Predictive models developed for use in ICUs have been based on retrospectively collected data, which does not take into account the challenges associated with live, clinical data. This study sought to determine if a previously constructed predictive model of ICU mortality (ViSIG) is robust when using data collected prospectively in near real-time. Prospectively collected data were aggregated and transformed to evaluate a previously developed rolling predictor of ICU mortality. Five adult ICUs at Robert Wood Johnson-Barnabas University Hospital and one adult ICU at Stamford Hospital. One thousand eight hundred and ten admissions from August to December 2020. The ViSIG Score, comprised of severity weights for heart rate, respiratory rate, oxygen saturation, mean arterial pressure, mechanical ventilation, and values for OBS Medical's Visensia Index. This information was collected prospectively, whereas data on discharge disposition was collected retrospectively to measure the ViSIG Score's accuracy. The distribution of patients' maximum ViSIG Score was compared with ICU mortality rate, and cut points determined where changes in mortality probability were greatest. The ViSIG Score was validated on new admissions. The ViSIG Score was able to stratify patients into three groups: 0-37 (low risk), 38-58 (moderate risk), and 59-100 (high risk), with mortality of 1.7%, 12.0%, and 39.8%, respectively ( p < 0.001). The sensitivity and specificity of the model to predict mortality for the high-risk group were 51% and 91%. Performance on the validation dataset remained high. There were similar increases across risk groups for length of stay, estimated costs, and readmission. Using prospectively collected data, the ViSIG Score produced risk groups for mortality with good sensitivity and excellent specificity. A future study will evaluate making the ViSIG Score visible to clinicians to determine whether this metric can influence clinician behavior to reduce adverse outcomes.

Home Oxygen and Monitoring for COVID-19 Patients: A Multidisciplinary Team Approach.

During the initial COVID-19 pandemic peak, Stamford Hospital implemented a home oxygen program (HOP) to create a comprehensive, multi-disciplinary outpatient initiative without sacrificing a safe discharge. Primary care physicians monitored program participants, whose only indication for remaining admitted was an oxygen requirement. We retrospectively examined participant co-morbidities and outcomes, including death and readmission rates to evaluate HOP safety. A retrospective analysis of program participants discharged between April 2020-Janurary 2021 was performed. Variables included demographics, oxygen requirement, days enrolled in the HOP, and major comorbidities such as cardiovascular disease (CVD), diabetes (DM), hypertension (HTN), obesity, chronic kidney disease, malignancies and underlying chronic obstructive pulmonary disease (COPD). Among the 138 HOP participants, ages ranged from 23 to 96 (Mean 65.5), with 47.1% female and 52.9% male. The most represented ethnicity included White (48.6%), Hispanic (29.7%), and Black (15.2%). Patients' average time in the HOP was 19 days, requiring an average of 1.7 L/min of home oxygen. Thirteen patients (9.4%) were readmitted to the hospital with 2.9% secondary to worsening COVID-19 hypoxia, but no deaths occurred at home. A significant relationship was found between age and highest home oxygen need. Patients with COPD, HTN, and DM had significantly higher oxygen requirements (P-value <0.05). Increasing age, underlying COPD, HTN, and DM were associated with higher oxygen requirements in participants. Given limited availability of hospital beds, and no occurrences of death at home, Stamford Hospital HOP safely helped provide care for sicker patients and enhanced resource allocation.

1232. Mupirocin Susceptibility of Staphylococcus aureus (SA), 2022: Is It Time for Change in MRSA Decolonization?

Abstract Background Nasal decolonization with mupirocin has been a commonly used strategy for the prevention of surgical site infections (SSIs) due to SA. We recently noted an increase in SSIs due to SA despite the use of mupirocin, including a case of post-operative mupirocin-resistant MRSA infection despite intranasal mupirocin. We therefore evaluated the mupirocin susceptibility of SA at Stamford Hospital to determine the optimal regimen for decolonization. Methods SA isolates were recovered from clinical and screening samples received in the microbiology laboratory from 8/1/2020 to 2/28/2022. Mupirocin susceptibility was determined using e-tests and a standardized inoculum on Mueller-Hinton agar. Isolates were categorized as “susceptible” (MuS) with minimum inhibitory concentrations (MIC) ≤4 mcg/ml or resistant (MuR) with MIC values ≥8mcg/ml. Resistant strains were further divided into low-level resistance, with MIC values from 8 to 256 mcg/ml, and high-level resistance, with MIC values &amp;gt;256/ml. SA isolates were identified and tested for susceptibility by usual Clinical Laboratory Standards Institute (CLSI) criteria. Results 223 unique SA isolates from 218 patients were tested. Patients ranged in age from newborn to 94 years. Twenty-four SA isolates (10.8%) were resistant to mupirocin (20 MRSA and 4 MSSA). Of the 24 MuR strains, 19 (79.2%) isolates demonstrated high-level resistance. MRSA strains were more likely to be resistant (22.5% were MuR) than MSSA strains (3.0% were MuR) (p&amp;lt; 0.001). MuR strains did not differ from MuS strains with respect to patient age, sex, race, site of isolation, infected versus colonized, community-acquired versus hospital-acquired or inpatient/out-patient location. Conclusion Preventing surgical site infections is challenging. Decolonization with mupirocin nasal ointment has been a common component of preoperative optimization. However, the emergence of resistance would render mupirocin suboptimal and other regimens might be preferred. In our study, less than 80% of MRSA strains were MuS. These findings are concerning and have led us to reevaluate our current decolonization strategy. In patients colonized with MRSA at high risk for infection (e.g. total joint replacement), intranasal povidone iodine may be preferable to mupirocin. Disclosures All Authors: No reported disclosures.

Augmentation of a Hospital Incident Command System to Support Continued Waves of the COVID-19 Pandemic.

Stamford Hospital (SH) is a 305 bed Level II Trauma center located in Fairfield County, the epicenter of the coronavirus disease 2019 (COVID-19) pandemic in Connecticut. The COVID-19 pandemic was a fast paced, rapidly evolving crisis, presenting our leadership team with unique challenges related to resource availability, patient care, and staff safety. The existing Hospital Incident Command System (HICS) was activated in March 2020 to coordinate our operational emergency management planning, response, and recovery capability for this unplanned event. Although HICS lays the groundwork for hospital preparations and protocol implementation, it is not designed to withstand prolonged crisis circumstances. Given the conditions that the COVID-19 pandemic presented, the possibility for future waves became an impending reality, prompting the need for a long-term solution. To establish guidelines that promoted balance between necessary preparations in the case of additional surges of the pandemic and concurrent resumption then maintenance of routine hospital operations, the SH COVID-19 Playbook was created. The Playbook, presented here, is arranged in accordance with the evidence-based 4 S's (Space, Staff, Systems, and Stuff) strategic critical care planning framework, to address surge capacity management within our hospital's four main patient care areas and additional supportive services. Through feedback from frontline caregivers and leaders within SH, the Playbook captures our experience, best practices, and insight acquired during the first wave of the pandemic. Established with the intentions of equipping leadership and staff globally, guidelines are presented to aid in the navigation of future pandemic surges and successfully care for COVID-19 patients, ensure staff safety, allow for normal services to operate, and provide optimal communication and support for the community, patients, and staff.

Implementing a Neurohospitalist Program Improves Stroke Care Metrics and Patient Satisfaction Scores.

Compare the differences in health outcomes and patient satisfaction between a neurohospitalist model of care and a community-based neurologists model at a single community-based teaching hospital among in-patients diagnosed with a cerebrovascular accident (CVA). Data was collected from the Stamford Hospital's electronic medical records system. An assessment of patient health outcomes and satisfaction scores was conducted, comparing both discrete and continuous variables between the two time periods. An omnibus P-value of 0.05 (P < 0.05) was considered statistically significant. The sample consisted of 341 patients between the two periods, pre-period n = 168 (49.3%) post-period n = 173 (50.7%). Door to lab and door to tPA times decreased significantly between pre- and post-periods (P = 0.003 and P = 0.002, respectively) as did the number of MRIs (P < 0.001). In addition, statistically significant increases were found between pre-period and post-period percentages, all increasing over time: stroke education (P < 0.001), discharged on anticoagulant medication (P < 0.001), and discharged on anti-thrombolytic medication (P = 0.019). Patient satisfaction scores demonstrated mean gain across both periods for five of six items. Two items "Doctor's Concern of my Questions/Worries" and "Skill of Doctors" demonstrated statistical significance (P = 0.020 and P = 0.029, respectively). The introduction of a neurohospitalist service at a community-based teaching hospital improved patient health outcomes on time to intervention, stroke education, discharge medications as well as patient satisfaction. Therefore, it may be beneficial for hospitals to implement a neurohospitalist model of care for their patients presenting with CVA.

The Tale of Two Collapsing Glomerulopathies Associated with COVID-19 in Stamford Hospital

The Tale of Two Collapsing Glomerulopathies Associated with COVID-19 in Stamford Hospital

A steroidal impact

Stamford Hospital Family Medicine Residency Program, Stamford, CT The author declares no conflicts of interest.

Ten Eleven things to facilitate participation of underrepresented groups in headache medicine research.

FEATURE ARTICLE Ten Eleven things to facilitate participation of underrepresented groups in headache medicine research Olivia Begasse de Dhaem MD, Corresponding Author Olivia Begasse de Dhaem MD begassededhaem@gmail.com Department of Neurology, Stamford Hospital, Columbia University, Stamford, CT, USA Correspondence Olivia Begasse de Dhaem, Department of Neurology, Stamford Hospital, Columbia University, Stamford, CT, USA. Email: begassededhaem@gmail.comSearch for more papers by this authorJessica Kiarashi MD, Jessica Kiarashi MD Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USASearch for more papers by this authorCynthia E. Armand MD, Cynthia E. Armand MD Department of Neurology, Albert Einstein College of Medicine, Montefiore Headache Center, Bronx, NY, USASearch for more papers by this authorLarry Charleston IV MD, MSc, FAHS, Larry Charleston IV MD, MSc, FAHS orcid.org/0000-0002-7708-5394 Department of Neurology and Ophthalmology, Michigan State University College of Human Medicine, East Lansing, MI, USASearch for more papers by this authorChristina L. Szperka MD, MSCE, FAHS, Christina L. Szperka MD, MSCE, FAHS orcid.org/0000-0003-4786-8889 Department of Neurology, Children's Hospital of Philadelphia & Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USASearch for more papers by this authorYeonsoo S. Lee BS, Yeonsoo S. Lee BS Department of Medicine, Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USASearch for more papers by this authorThilinie Rajapakse MD, Thilinie Rajapakse MD Department of Neurology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, CanadaSearch for more papers by this authorElizabeth K. Seng PhD, Elizabeth K. Seng PhD orcid.org/0000-0002-8938-4949 Department of Psychology, Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA Department of Psychology, Albert Einstein College of Medicine, Bronx, NY, USASearch for more papers by this authorJuliana H. VanderPluym MD, Juliana H. VanderPluym MD Department of Neurology, Mayo Clinic, Scottsdale, AZ, USASearch for more papers by this authorAmaal J. Starling MD, Amaal J. Starling MD Department of Neurology, Mayo Clinic, Scottsdale, AZ, USASearch for more papers by this author Olivia Begasse de Dhaem MD, Corresponding Author Olivia Begasse de Dhaem MD begassededhaem@gmail.com Department of Neurology, Stamford Hospital, Columbia University, Stamford, CT, USA Correspondence Olivia Begasse de Dhaem, Department of Neurology, Stamford Hospital, Columbia University, Stamford, CT, USA. Email: begassededhaem@gmail.comSearch for more papers by this authorJessica Kiarashi MD, Jessica Kiarashi MD Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USASearch for more papers by this authorCynthia E. Armand MD, Cynthia E. Armand MD Department of Neurology, Albert Einstein College of Medicine, Montefiore Headache Center, Bronx, NY, USASearch for more papers by this authorLarry Charleston IV MD, MSc, FAHS, Larry Charleston IV MD, MSc, FAHS orcid.org/0000-0002-7708-5394 Department of Neurology and Ophthalmology, Michigan State University College of Human Medicine, East Lansing, MI, USASearch for more papers by this authorChristina L. Szperka MD, MSCE, FAHS, Christina L. Szperka MD, MSCE, FAHS orcid.org/0000-0003-4786-8889 Department of Neurology, Children's Hospital of Philadelphia & Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USASearch for more papers by this authorYeonsoo S. Lee BS, Yeonsoo S. Lee BS Department of Medicine, Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USASearch for more papers by this authorThilinie Rajapakse MD, Thilinie Rajapakse MD Department of Neurology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, CanadaSearch for more papers by this authorElizabeth K. Seng PhD, Elizabeth K. Seng PhD orcid.org/0000-0002-8938-4949 Department of Psychology, Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA Department of Psychology, Albert Einstein College of Medicine, Bronx, NY, USASearch for more papers by this authorJuliana H. VanderPluym MD, Juliana H. VanderPluym MD Department of Neurology, Mayo Clinic, Scottsdale, AZ, USASearch for more papers by this authorAmaal J. Starling MD, Amaal J. Starling MD Department of Neurology, Mayo Clinic, Scottsdale, AZ, USASearch for more papers by this author First published: 14 June 2021 https://doi.org/10.1111/head.14124Citations: 2 Funding information: Dr. Szperka receives salary support from the NIH NINDS, Grant/Award number: K23NS102521 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume61, Issue6June 2021Pages 951-960 This article also appears in:Diversity, Equity, and Inclusion in Headache Care RelatedInformation

586 Decreased fetal movement and anterior placentation: a case control study

Decreased fetal movement (DFM) is a common obstetrical complaint, with an incidence of up to 16% of pregnancies. DFM is often attributed to anterior placentation, however, there is limited data to support this belief. There are no case control studies or studies performed in the United States which address this relationship. This was a case control study of patients who presented to Stamford Hospital with DFM from January 2017 to December 2017. The control group included patients who presented for delivery during this time. Exclusion criteria included presentation prior to 24 weeks gestational age, multi-fetal gestation, and intrauterine fetal demise. Variables collected were placentation, age, parity, gestational age, fetal presentation, BMI, and presence of hypertensive or diabetic disorder. Cohorts were matched by BMI and parity. Discrete variables were analyzed with chi-square statistics and continuous variables were analyzed with independent t-test. Propensity score matching was conducted using the nearest neighbor matching criteria in ‘R.’ Logistic regression was used to calculate adjusted odds ratios. 123 patients presented with DFM and 127 control patients were identified. 112 patients were matched in each group. In the DFM group, 56 (58.3%) had an anterior placenta, compared with 33 (35.1%) in the control group (p=0.001). Patients that presented with DFM were 2.9 times as likely to have an anterior placenta (CI 1.5-5.5). Average maternal age in the DFM group was 30.7 years, compared with 32.7 years in the control group (p=0.005). Patients that presented with DFM were not at an increased odds of presenting with non-vertex presentation (CI 0.10-1.2). There was also no increased odds of hypertensive or diabetic disorder in the DFM group (CI 0.24-2.95; CI 0.30-2.03). Our study supports that patients who present for decreased fetal movement compared with matched controls are at an increased odds of having an anterior placenta. These patients are also younger. There is no increased odds of non-vertex presentation or of having a hypertensive or diabetic disorder.

Opioid Use After Cesarean Delivery in a Community Hospital Setting [25E

INTRODUCTION: The opioid epidemic is a serious public health concern that currently affects approximately 2 million Americans. Since cesarean sections are one of the most common surgeries performed in the United States, there have been many studies looking at opioid prescription practices. Prescribing patterns of opioids after cesarean vary widely and there is little information regarding normative patterns of practitioners. This study aims to assess our opioid prescribing practices after cesarean delivery at our hospital. METHODS: This is a prospective cohort study including women between the ages of 18–50 years old who underwent cesarean section. Data was collected through chart review and phone call follow-up after hospital discharge to determine the amount of opioid and oral NSAID medication used during both inpatient stay and after discharge, the number of narcotic pills leftover if applicable, pain score and activity level. RESULTS: 59 patients were included, 13 were lost to follow-up, and 1 declined participation. 50% of participants had leftover pills, 38% percent never filled a prescription, and 12% percent consumed all pills. One patient required an additional narcotic prescription. Of the six different OB GYN practices, the number of narcotic pills prescribed ranged from 6 to 30 tablets. CONCLUSION: Narcotic use in the hospital can predict narcotic use at home in the first one to two weeks postoperatively. Most patients had unused narcotic pills. Prescribing practices at Stamford Hospital are highly varied among practitioners. Data from our study will help to standardize prescriptions for postoperative pain management after cesarean delivery.

Implementation of Pre-cesarean Checklist for Labor Arrest and Failed Induction [16P

INTRODUCTION: National and Stamford Hospital cesarean delivery (CD) rates, at 32% and 40.4% respectively, remain high. A large contributor to the primary CD rate is labor arrest, including failed induction of labor (IOL). Use of new guidelines for diagnosing these conditions have been shown to decrease the CD rate. This study aims to assess adherence to new definitions and the impact of a pre-cesarean checklist at our institution. METHODS: A retrospective chart review for primary CD in nulliparous, singleton, term, vertex (NSTV) pregnancies performed for labor arrest, including failed IOL, from January 2018 to August 2019. In January 2019 a paper pre-cesarean checklist, adapted from a previously published checklist was introduced to labor and delivery to allow physicians to review labor arrest criteria. Calculated primary CD rates for labor arrest pre and post implementation were compared using chi square analysis. RESULTS: The primary cesarean delivery (pCD) rate in NSTV pregnancies for labor arrest was 14.1% in 2018 and 12.5% in 2019 (P=.5). Of the 55 pCD for labor arrest in 2019, 17 (30.9%) filled out the pre-cesarean checklist. Only 18 (32.79%) met criteria for labor arrest/failed IOL. CONCLUSION: At our institution, CD in NSTV pregnancies for labor arrest or failed IOL do not meet contemporary definitions. Introduction of a paper pre-cesarean checklist to evaluate labor arrest has not affected the CD rate. However, use of the checklist was limited, thus there remains significant room for a decrease in the cesarean rate if adherence can be improved.

Does the ratio between icu admission blood glucose and chronic glycemia predict ICU mortality?

Introduction: A small emerging literature has suggested that preadmission glycemia, reflected by HgbA1c level obtained at onset of critical illness, modulates the relationship between glycemia during critical illness and mortality. Objective: To evaluate the relationship of the quotient of admission blood glucose (BG) and estimated preadmission averate glucose (eAG) – the glycemia ratio (GR) – to mortality in a two-center cohort of critically ill patients, and to compare this metric to the relationship of admission BG to mortality. Methods: This is a retrospective investigation of prospectively collected data including patients admitted to the mixed medical-surgical intensive care units of Stamford Hospital (Stamford, CT USA, “S”) and Erasme Medical Center (Brussels, Belgium, “E”). eAG was derived using the Nathan formula (eAG = [(HgbA1c*28.7)-46.7]. Mortality, defined as status at hospital discharge, was calculated for admission BG < 80; 80-139; 140-179 and > 180 mg/dL and for GR < 0.7; 0.7-1.3; 1.3-2.0 and > 2.0. Results: The investigation included 6,054 patients (S=4,387; E=1,367) admitted between 2011-2018 (S) and 2016-2018 (E) who had HgbA1c values available at admission. The median (IQR) age was 66 (52-78) and 58.7% were men. Patients had medical (73.4%), surgical (21.3%) and trauma (5.3%) diagnoses, with median (IQR) APACHE II score 15 (10-21). The median (IQR) HgbA1c was 5.7% (5.3-6.2) and 23.2% had known diabetes mellitus. Mortality was 19.6%, 11.9%, 15.3% and 18.2% for patients with admission BG <80, 80-139, 140-179 and > 180 mg/dL and 16.5%, 12.2%, 15.9% and 28.6% for patients with GR < 0.7, 0.7-1.3, 1.3-2.0 and > 2.0. Conclusions. In this two-center heterogeneous cohort of critically ill patients the glycemic ratio, incorporating preadmission glycemia, had a more robust relationship to mortality than did admission BG alone. These data support the paradigm of a personalised approach to glycemic control in ICU populations.

In The Safety Net: A Tale Of Ticking Clocks And Tricky Diagnoses

Narrative Matters Health AffairsVol. 32, No. 8: Health IT, Payment & Practice Reforms In The Safety Net: A Tale Of Ticking Clocks And Tricky DiagnosesMaria Maldonado Affiliations Maria Maldonado ( [email protected] ) is the program director of the internal medicine residency program at Stamford Hospital, in Connecticut, and a clinical associate professor of medicine in the College of Physicians and Surgeons at Columbia University, in New York City. PUBLISHED:August 2013No Accesshttps://doi.org/10.1377/hlthaff.2013.0146AboutSectionsView articleView Full TextView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions View articleAbstractIn a time-crunched clinic, a physician and her resident battle the clock to uncover a potentially fatal diagnosis.TOPICSClinicsCancerCommunity health centersPharmaceuticalsPrimary careCancer patientsMagnetic resonance imagingPatient safetyPatient-centered medical homesSafety net hospitals Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 1 History Published online 1 August 2013 Information Project HOPE—The People-to-People Health Foundation, Inc. PDF downloadCited byGroup Medical Visits as Participatory Care in Community Health Centers19 May 2018 | Qualitative Health Research, Vol. 28, No. 7

554: The effect of postgraduate training level on the accuracy of clinically estimated fetal weights

accuracy of clinically estimated fetal weights Jamil ElFarra, Susanne Matias-Gomes, Tracy Shevell, Hani Tamim, Paul Bobby Stamford Hospital, Department of Obstetrics and Gynecology, Stamford, CT, American University of Beirut Medical Center, Epidemiology and Biostatistics, Department of Internal Medicine, Beirut, Lebanon OBJECTIVE: To evaluate the effect of postgraduate training level on the accuracy of fetal weight assessment in a cohort of obstetrics and gynecology residents. STUDY DESIGN: A prospective observational study was performed over a 6-month period in 2011. Consecutive cases at 37-42 weeks’ gestation presenting in labor, with premature rupture of membranes, for labor induction or for scheduled cesarean section were studied. The estimated fetal weight (EFW) recorded on admission and the examining resident’s postgraduate year (PGY) were recorded. Comparison was made between the birthweight and EFW. Estimation error was calculated by dividing the absolute value of the EFW-birthweight difference by the birthweight. The association between year of residency and estimation error was analyzed using ANOVA. The sensitivity of clinical exam for detection of large-for-gestational age (LGA) newborns ( 3999g) was compared for each PGY cohort using chi-square test. RESULTS: 600 EFW assessments were recorded by 12 OBGYN residents with 3 residents at each year of training (PGY I-IV). Average maternal age, BMI, parity and gestational age were comparable among the four groups, as were the indications for admission. Overall, mean percent error in estimated fetal weight was 8.0% standard deviation (SD) was 7.6. Mean (SD) percent errors were were 8.3 (7.1), 8.4 (7.7), 8.3 (8.8), and 6.7(6.8) for the PGY I, II, III, and IV cohorts, respectively, with P 0.1on ANOVA. In 70% of cases, clinical estimation fell within 10% of birthweight. 83 newborns were LGA at birth (13.8% incidence). Only 18.1% of these cases were identified by clinical assessment on admission. No differences in detection rate were identified between residents at different PGY levels (p 0.1). CONCLUSION: Higher postgraduate training level does not improve the accuracy of clinical estimation of fetal weights. Clinical assessment appears to provide a reliable estimation of birthweight in the majority of cases.

Enhancing the Patient's Experience Through the Total Joint Replacement Continuum of Care

The use of a Total Joint Replacement Pathway provides nurses with a process that guides their professional practice. The pathway begins during the preadmission phase and follows the patients throughout their hospital stay. Relationship-based care is demonstrated by the interdisciplinary care that includes the patient and healthcare team. The goal of this article is to describe the continuum of care for total joint replacement patients at Stamford Hospital from preadmission to discharge. A preoperative class is offered weekly to all patients who are scheduled for elective surgery. Approximately 90% of patients attend the preoperative classes. This article provides a framework for guiding the clinical care of total joint replacement patients. Implementation of this framework will ultimately improve patient care and nursing practice in any surgical setting. Pain management and patient education are 2 core components of nursing practice vital to the success of the Joint Replacement Program and facilitate care of these patients through the continuum.

Warren Howard Redding

The sudden death at age 58 of Warren Howard Redding, associate specialist in charge of the minor injuries unit at Stamford Hospital, has saddened the community and his loving family....

Glucose Measurement of Intensive Care Unit Patient Plasma Samples Using a Fixed-Wavelength Mid-Infrared Spectroscopy System

Glycemic control is a rapidly developing field in intensive care medicine with the aim of reducing mortality, morbidity, and cost. Current intensive care unit (ICU) glucose measurement technologies are susceptible to interference from medications, volume expanders, and other substances present in critically ill patients. We hypothesized that a fixed-wavelength mid-infrared (mid-IR) spectroscopy system would be accurate for measuring glucose levels of ICU patients. This is a prospective investigation of plasma samples from two different institutions treating a heterogeneous population of ICU patients. The first 292 samples were collected from 86 patients admitted to Stamford Hospital, and the next 352 samples were collected from 75 patients from three ICUs at the University of Maryland. Plasma samples were measured on a Fourier-transform infrared or a proprietary spectrometer, with a glucose prediction algorithm to correct for spectral interference, which were compared with reference measurements taken using a YSI 2300 glucose analyzer. Glucose values ranged from 24 to 343 mg/dl. Numerous medications and injury/disease states were observed in the patient populations, with metoprolol, fentanyl, and multiple organ failure the most prevalent. Despite these interferents, there was a high correlation (r ≥ 0.94) and low standard error (≤12.8 mg/dl) between the predicted glucose values and those of the YSI 2300 STAT Plus reference instrument in the three studies. A total of 95.1% of the 644 values in the three studies met International Organization for Standardization 15197 criteria. These results suggest that a fixed-wavelength mid-IR spectrometer can measure glucose accurately in the plasma of ICU patients.

Re: Screening for Prostate Cancer: A Review of the Evidence for the U.S. Preventive Services Task Force

Oregon Health and Science University, Portland, Oregon, Agency for Healthcare Research and Quality, Rockville and Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, Stamford Hospital Center for Integrative Medicine and Wellness, Stamford, Connecticut, and Georgetown University School of Medicine, Washington, D. C.

Mild hypoglycemia is strongly associated with increased intensive care unit length of stay

BackgroundHypoglycemia is associated with increased mortality in critically ill patients. The impact of hypoglycemia on resource utilization has not been investigated. The objective of this investigation was to evaluate the association of hypoglycemia, defined as a blood glucose concentration (BG) < 70 mg/dL, and intensive care unit (ICU) length of stay (LOS) in three different cohorts of critically ill patients.MethodsThis is a retrospective investigation of prospectively collected data, including patients from two large observational cohorts: 3,263 patients admitted to Stamford Hospital (ST) and 2,063 patients admitted to three institutions in The Netherlands (NL) as well as 914 patients from the GLUCONTROL trial (GL), a multicenter prospective randomized controlled trial of intensive insulin therapy.ResultsPatients with hypoglycemia were more likely to be diabetic, had higher APACHE II scores, and higher mortality than did patients without hypoglycemia. Patients with hypoglycemia had longer ICU LOS (median [interquartile range]) in ST (3.0 [1.4-7.1] vs. 1.2 [0.8-2.3] days, P < 0.0001), NL (5.2 [2.6-10.3] vs. 2.0 [1.3-3.2] days, P < 0.0001), and GL (9 [5-17] vs. 5 [3-9] days, P < 0.0001). For the entire cohort of 6,240 patients ICU LOS was 1.8 (1.0-3.3) days for those without hypoglycemia and 3.0 (1.5-6.7) days for those with a single episode of hypoglycemia (P < 0.0001). This was a consistent finding even when patients were stratified by severity of illness or survivor status. There was a strong positive correlation between the number of episodes of hypoglycemia and ICU LOS among all three cohorts.ConclusionsThis multicenter international investigation demonstrated that hypoglycemia was consistently associated with significantly higher ICU LOS in heterogeneous cohorts of critically ill patients, independently of severity of illness and survivor status. More effective methods to prevent hypoglycemia in these patients may positively impact their cost of care.

Hope VI Fairfield Court Neighborhood: 2011 Evaluation for the Stamford Housing Authority, aka Charter Oak Communities, Stamford, Connecticut

During the ten-year period that occurs between available Census data for the Fairfield Court HUD project Baseline (1999) and data in this report (2009), the nation in general, and Stamford in particular, experienced a strong housing bubble, evidenced by new construction and strong increases in market value and assessed value, even in the less well-to-do HOPE VI neighborhood. In this decade when all areas developed into more diverse communities, HOPE VI residents in Tract 215 experienced, in aggregate, upward movement in their Median Income, even though poverty also increased by 1% across the decade (using American Community Survey data). For residents in Tract 214, on the western side of Stamford, median income declined by 25% although poverty also declined, if only by a single percent over the decade – while maintaining low vacancy rates in an area where almost 75% of housing units are rented.The area continues to support light manufacturing and warehousing, retail, a few major office buildings, Stamford Hospital and adjoining doctors’ offices, a motel and restaurants and standard services. In aggregate, the proportions for business types are generally the same at the end of this period as at the starting timeframe.