Virginia Medical Research Articles

A multidisciplinary effort to decrease time from admission to chemotherapy on an inpatient oncology unit.

96 Background: Patients with established cancer diagnoses often experience delays in starting scheduled inpatient chemotherapy (CTX) after arrival on the University of Virginia (UVA) Medical Center oncology unit. These delays negatively impact hospital resource utilization. We formed a multidisciplinary team of physicians, nurses, and pharmacists to investigate these delays. We aim to decrease time-to-CTX (TTC) by 30% from baseline. Methods: From 340 planned inpatient CTX encounters in calendar year 2015, 100 were randomly reviewed to establish baseline retrospective data. The following were collected for each encounter: patient demographics; oncologic diagnosis; admitting team; CTX regimen and cycle; procedures and urinary parameters required prior to CTX start; times of lab orders and results, CTX signature and release, and start of intravenous fluid (IVF), premedications, and CTX; unit census data; available nursing staff; and length of stay. With guidance from ASCO’s Quality Training Program, we constructed a process map of the current state, an Ishikawa cause-and-effect diagram, a Pareto chart to assess causes of delays, and a priority matrix of potential interventions. XmR charts compared baseline and post-intervention data. Results: Baseline median TTC was 6.7 hours (range 1.5-105.3 h). Patients with pre-admission outpatient appointments started CTX 2.4 h earlier than those without appointments. Patients without urine parameters for treatment started CTX 3 h earlier than those with parameters. The Pareto chart indicated the longest delays occurred in pre-medicating patients, starting IVF, and signing CTX orders. In the first Plan-Do-Study-Act (PDSA) cycle, the CTX consent process was reformed. Post-intervention data showed no change in median TTC (7.2 h). Other PDSA cycles (setting patient arrival times and pre-admission pharmacy review of treatment plans) are ongoing; prospective data collection is pending. Conclusions: Retrospective data validate concerns that delays in starting inpatient CTX are longer than acceptable. They affect hospital length of stay, cost, and patient satisfaction. Our first PDSA cycle showed no change in TTC but additional interventions are ongoing.

Challenges and Solutions for Traumatic Brain Injury Management in a Resource-Limited Environment: Example of a Public Referral Hospital in Rwanda

Objectives: We evaluated treatment strategies for traumatic brain injury (TBI) management in both a high-income country (HIC) (University of Virginia Health System) and a low-income country setting (Kigali University Teaching Hospital). Methods: A review of the literature was performed to identify current strategies of TBI management in low and middle-income country (LMIC) settings. Additionally, personal communications with the neurosurgery and trauma teams at the University of Virginia (UVA) Medical Center and the Kigali University Teaching Hospital (KUTH) in Rwanda were employed. Results: At UVA, there are specific TBI treatment guidelines in place; however, these guidelines are somewhat resource intensive and might not be appropriate in a resource-limited setting. There are unpublished national neurosurgical guidelines that include sections on TBI management, but most physicians informally surveyed were unaware of the existence of these guidelines. Notably, a contextually relevant, institution-specific TBI guideline is in the process of being developed at KUTH. Conclusion: In an LMIC, such as Rwanda, interventions aimed at reducing the incidence of TBI, as well as predictive models to help allocate treatment resources, will likely help to improve outcomes in the short-term. Long-term improvement to provide outcomes similar to those seen in HIC will rely on increasing the supply of scarce resources, including trained neurosurgeons.

Preliminary experimental investigation of in vivo magnetic manipulation: results and potential application in hyperthermia.

The first in vivo experiments in support of a new technique for delivering stereotaxic hyperthermia have been conducted at the Experimental Surgery Facility of the University of Virginia's Medical Center. We call this technique the "Video Tumor Fighter." In each of twelve trials a single, small permanent magnet or train of small permanent magnets was implanted on the brain surface of adult canine models. In three of the trials, this "seed" (typically 6-mm diameter X 6-mm long) was moved by magnetic manipulation to different locations within the brain. In two other trials, the seed moved along the interface between the brain and the inner vault of the skull. The noncontact magnetic manipulation was accomplished by coupling the permanently magnetized seed to the large dc magnetic field gradient created by a water-cooled coil surrounding the animal's head. The seed's motions were monitored with x-ray fluoroscopy; its rate of movement was found to be approximately 0.8 mm s-1. The forces required to produce these motions were on the order of 0.07 N. We document here the instrumentation used in these trials, describe the experimental procedures employed, and discuss the technical aspects of the results.

The Comparative Effects of Fresh-Water and Marine Teleost Pituitary on the Water Balance of Frogs

MINTON, SHERMAN A. 1953. Variation in venom samples from copperheads (Agkistrodon contortrix mokeson) and timber rattlesnakes (Crotalus horridus horridus). COPEIA, 1953 (4): 212-15. PARRISH, HENRY M., AND C. B. PALLARD. 1957. The effects of repeated poisonous snakebites in man: A report of twelve cases. Bull Ayer Clinical Laboratory, in press. PARRISH, HENRY M., HARRY F. WATT, AND JAMES D. ARNOLD. 1957. Human allergy resulting from North American snake venoms: A report of two cases. Journal Florida Medical Assn., in press. WATT, HARRY F., HENRY M. PARRISH, AND C. B. POLLARD. 1956. Repeated poisonous snakeI TON, SHERMAN A. 1953. Variation in venom ples from copperheads (Agkistrodon conrtrix mokeson) and timber rattlesnakes rotalus horridus horridus). COPEIA, 1953 (4): bites in the same patient: An unusual case report. North Carolina Med. Jour., 17: 17479. WooD, JOHN T., WILLIAM W. HOBACK, AND THOMAS W. GREEN. 1955. Treatment of snake venom poisoning with ACTH and Cortisone. Virginia Medical Monthly, 82: 13035.

Primary tuberculosis of the tonsils: Report of a case complicated by extension to the pharynx and soft palate: Preston, H. G. Virginia Medical Monthly, 1933, 60, 10

Primary tuberculosis of the tonsils: Report of a case complicated by extension to the pharynx and soft palate: Preston, H. G. Virginia Medical Monthly, 1933, 60, 10

Eclampsia and its conservative treatment: Bear: Virginia Medical Monthly, 1921, xlvii, 487–491

Eclampsia and its conservative treatment: Bear: Virginia Medical Monthly, 1921, xlvii, 487–491

Report of a case of secondary hemorrhage following tonsillotomy—Measles.—Clarence Porter Jones, M. D., Newport News, Va.—Virginia Medical Semi‐Monthly. October, 1902

Report of a case of secondary hemorrhage following tonsillotomy—Measles.—Clarence Porter Jones, M. D., Newport News, Va.—<i>Virginia Medical Semi‐Monthly.</i> October, 1902

A case of severe mastoid neuralgia—John Dunn, (Richmond, Va.)—The Virginia Medical Semi‐Monthly, April 12, 1901

A case of severe mastoid neuralgia—John Dunn, (Richmond, Va.)—<i>The Virginia Medical Semi‐Monthly</i>, April 12, 1901

Poisoning by Acetanilid and Bismuth.

Brodnax, La., April 13, 1896. To the Editor: —I note in the Medical Brief , April, 1896, an article taken from your splendid journal, written by Dr. C. W. Rook, in which he gives the details of these cases of poisoning, one death, from the use of equal parts of acetanelid and bismuth subnitrate. The infants were two and four days old. Without a doubt acetanilid is a powerful drug and should be used with care, but I think the doctor has hardly followed the formula given in the Virginia Medical Monthly . I think it is about as follows: acetanilid and boric acid equal parts. (This powder is named by Dr. Burgess of Tennessee, boralid.) When used on tender skins, as infants, the formula recommended is a bulk of bismuth subnitrate equal to both the others, viz., boric acid and acetanilid each 1 part, bismuth subnitrate 2 parts. It will, no

Poisoning by Acetanilid.

Quincy, Ill, Jan. 19, 1896. <h3>To the Editor:</h3> —In ourJournalof Jan. 18, 1896, page 144, reference is made to a report in the<i>Virginia Medical Monthly</i>, by Dr. Ben. H. Broadnax, on the use of acetanilid. Having recently had in my own practice two cases of acetanilid poisoning, one terminating fatally, I can not, therefore, indorse Dr. Brodnax's recommendation for the use of this drug, particularly in new-born infants. A few weeks ago I prescribed for a babe of four days, suffering with ah erythematous inflammation of the skin of the nates, thighs and groins, a powder composed of equal parts of subnitrate of bismuth and acetanilid. During that afternoon and night the powder was dusted upon the inflamed areas three or four times. On the following morning the babe was found deeply cyanosed, and died a few hours later. Before realizing that acetanilid was the cause of