5 results on '"Nicole R. Guinn"'
Search Results
2. Blood Substitutes and Oxygen Therapeutics: A Review
- Author
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David R Lowery, Jonathan S. Jahr, Linda Shore-Lesserson, Nicole R. Guinn, and Aryeh Shander
- Subjects
Erythrocyte transfusion ,medicine.medical_specialty ,Blood transfusion ,Anemia ,medicine.medical_treatment ,Postoperative Hemorrhage ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,Blood Substitutes ,medicine ,Humans ,Blood Transfusion ,Intensive care medicine ,Clinical Trials as Topic ,Fluorocarbons ,business.industry ,medicine.disease ,Clinical trial ,Oxygen ,Anesthesiology and Pain Medicine ,Oxyhemoglobins ,Hemoglobin ,business ,030217 neurology & neurosurgery ,Allogeneic transfusion - Abstract
Despite the exhaustive search for an acceptable substitute to erythrocyte transfusion, neither chemical-based products such as perfluorocarbons nor hemoglobin-based oxygen carriers have succeeded in providing a reasonable alternative to allogeneic blood transfusion. However, there remain scenarios in which blood transfusion is not an option, due to patient's religious beliefs, inability to find adequately cross-matched erythrocytes, or in remote locations. In these situations, artificial oxygen carriers may provide a mortality benefit for patients with severe, life-threatening anemia. This article provides an up-to-date review of the history and development, clinical trials, new technology, and current standing of artificial oxygen carriers as an alternative to transfusion when blood is not an option.
- Published
- 2019
3. A Perioperative Medicine Model for Population Health: An Integrated Approach for an Evolving Clinical Science
- Author
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Sandhya Lagoo-Deendayalan, Thorsten M. Seyler, Nicole R. Guinn, Annemarie Thompson, Solomon Aronson, Padma Gulur, Tracy L. Setji, Paul E. Wischmeyer, Julie Westover, Mitchell T. Heflin, Madhav Swaminathan, Thomas J. Hopkins, and Ellen M. Flanagan
- Subjects
Service (business) ,Perioperative medicine ,Public economics ,Population Health ,business.industry ,Delivery of Health Care, Integrated ,media_common.quotation_subject ,Commodity ,Population health ,030204 cardiovascular system & hematology ,Payment ,Perioperative Care ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,030202 anesthesiology ,Multidisciplinary approach ,Patient-Centered Care ,Perfect competition ,Medicine ,Humans ,Quality (business) ,business ,media_common - Abstract
Health care delivery in the United States continues to balance on the tight rope that connects its transition from volume to value. Value in economic terms can be defined as the amount something exceeds its commodity price and is determined by extraordinary reputation, quality, and/or service, whereas its destruction can be a consequence of poor management, unfavorable policy, decreased demand, and/or increased competition. Going forward, payment for health care delivery will increasingly be based on services that contribute to improvements in individual and/or population health value, and funds to pay for health care delivery will become increasingly vulnerable to competitive market forces. Therefore, a sustainable population health strategy needs to be comprehensive and thus include perioperative medicine as an essential component of the complete cycle of patient-centered care. We describe a multidisciplinary integrated program to support perioperative medicine services that are integral to a comprehensive population health strategy.
- Published
- 2017
4. Outcomes in Patients Undergoing Cardiac Surgery Who Decline Transfusion and Received Erythropoietin Compared to Patients Who Did Not: A Matched Cohort Study
- Author
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Mary Cooter, Frederick W. Lombard, Lorent Duce, Sharon L. McCartney, and Nicole R. Guinn
- Subjects
Male ,Risk ,medicine.medical_specialty ,Blood transfusion ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Severity of Illness Index ,Treatment Refusal ,03 medical and health sciences ,0302 clinical medicine ,Matched cohort ,hemic and lymphatic diseases ,Internal medicine ,Severity of illness ,medicine ,Humans ,In patient ,Blood Transfusion ,030212 general & internal medicine ,Cardiac Surgical Procedures ,Erythropoietin ,Jehovah's Witnesses ,Aged ,Retrospective Studies ,business.industry ,Retrospective cohort study ,Anemia ,Length of Stay ,Middle Aged ,Patient Discharge ,Cardiac surgery ,Surgery ,Anesthesiology and Pain Medicine ,Increased risk ,Treatment Outcome ,Preoperative Period ,Hematinics ,Female ,business ,Algorithms ,medicine.drug - Abstract
Erythropoiesis-stimulating agents, such as erythropoietin (EPO), can be used to treat preoperative anemia. Some studies suggest an increased risk of mortality and thrombotic events, and use in cardiovascular surgery remains off-label. This study compares outcomes in cardiac surgery patients declining blood transfusion who received EPO with a matched cohort who did not.After institutional review board approval, we conducted a retrospective review of all patients who decline blood transfusion who underwent cardiac surgery and received EPO between January 1, 2004, and June 15, 2015, at a single institution. Control patients who did not receive EPO and were not transfused allogeneic red blood cells perioperatively were identified during the same period. Two controls were matched to each EPO patient using an optimal matching algorithm based on age, date of surgery, gender, operative procedure, and surgeon. The European System for Cardiac Operative Risk Evaluation (EuroSCORE) and baseline characteristics remaining unbalanced in the matched cohorts were controlled for in assessing patient outcomes. The primary outcome was a composite of mortality and thrombotic events, and secondary outcomes included change in hemoglobin (Hb) from baseline to discharge, acute kidney injury (AKI), sternal wound infection, atrial fibrillation, time to extubation, intensive care unit, and hospital length of stay (LOS).Fifty-three patients who decline transfusion and received EPO were compared to 106 optimally matched control patients who did not receive EPO or red blood cell transfusion in the perioperative period. The median additive EuroSCORE was similar between the EPO and control group [6 (4, 9) vs 5 (3, 7), respectively; P = .39]. There was no difference in the primary outcome (P = .12) and mortality was zero in both groups. The EPO group had a higher mean preoperative Hb (13.91 g/dL vs 13.31; P = .02) and a smaller change in Hb from baseline (-2.65 vs -3.60; P = .001). The incidence of AKI (47.17% vs 41.51%; P = .49) was similar and there was no significant difference in all other outcomes, including time to extubation, hospital LOS, or intensive care unit LOS.In this retrospective matched cohort study of patients declining transfusion and receiving EPO matched to control patients, there were no clinically meaningful differences in the outcomes.
- Published
- 2017
5. Local anesthetics and mode of delivery: bupivacaine versus ropivacaine versus levobupivacaine
- Author
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Yaakov Beilin, Jeffrey Zahn, Sabera Hossain, Howard H. Bernstein, Carol A. Bodian, and Nicole R. Guinn
- Subjects
medicine.medical_specialty ,Time Factors ,medicine.drug_class ,Gestational Age ,Labor Stage, Second ,Pregnancy ,medicine ,Humans ,Ropivacaine ,Anesthetics, Local ,Levobupivacaine ,Pain Measurement ,Bupivacaine ,Labor Pain ,business.industry ,Local anesthetic ,Cesarean Section ,Delivery, Obstetric ,Amides ,Surgery ,Analgesia, Epidural ,Analgesics, Opioid ,Fentanyl ,Parity ,Anesthesiology and Pain Medicine ,Mode of delivery ,Anesthesia ,Analgesia, Obstetrical ,Drug Therapy, Combination ,Female ,business ,Labor Stage, First ,medicine.drug - Abstract
The influence of the labor epidural local anesthetic (LA) on mode of delivery has not been adequately studied. In this study, we sought to determine if there is a difference in mode of delivery among parturients who receive epidural bupivacaine, ropivacaine, or levobupivacaine.Nulliparous women at term requesting labor analgesia with a cervical dilation5 cm were randomized to receive epidural bupivacaine, ropivacaine, or levobupivacaine. Analgesia was initiated with a bolus of 15 mL of 0.0625% of the assigned LA with fentanyl 2 microg/mL. Analgesia was maintained with an infusion of the same solution at 10 mL/h. The primary endpoint was the operative delivery rate (instrumental assisted vaginal delivery plus cesarean delivery).Ninety-eight women received bupivacaine, 90 ropivacaine, and 34 levobupivacaine (before it was removed from the US market). There was no significant difference in the operative delivery rate (bupivacaine = 46%, ropivacaine = 39%, and levobupivacaine = 32%, P = 0.35) among groups. There was less motor block in the levobupivacaine group when compared with the ropivacaine and bupivacaine groups, P0.05. There was no significant difference in the duration of the first or second stage of labor, the total dose of LA received per hour of labor, or neonatal outcome among groups.Bupivacaine, ropivacaine, and levobupivacaine all confer adequate labor epidural analgesia, with no significant influence on mode of delivery, duration of labor, or neonatal outcome.
- Published
- 2007
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