Less chance of infection in preemie babies. Better chance at survival.
Most of us know someone who was a medical miracle at birth; a tiny baby born months early but through the marvel of modern medicine, survived. Now thanks to doctors at Intermountain Healthcare, there will be more of those little miracles.
They’ve made a discovery that could change endotracheal (end-oh-TRAKE-ee-al) treatment for premature babies and save more lives.
“Babies that have respiratory failure have to be attached to a breathing machine with a small tube,” says Doctor Robert D. Christensen, leader of the study. “One end goes in the baby’s mouth, the other attaches to the breathing machine. The tube tends to occasionally get plugged up by the secretions in the throat. So nurses and respiratory therapists take sterile saline, and put a few drops in, then suction out the secretions.”
But saline is not what you would normally find in a baby's trachea. The high salt concentration in saline can result in more infections in these fragile babies. So we invented a fluid that wouldn't cause any more harm to the proteins in a baby's airway.
“Basically what we did is have the pharmacy make a sterile solution that was more like the fluid that's normally in a baby's trachea.”
In the U.S., more than five hundred thousand babies are born prematurely each year and about half of those will require a respirator. The new fluid has been shown to have two positive outcomes on these babies: reducing the number of infections while on the respirator, and reducing the number of babies that are sent home with oxygen support.
Introducing a new "gold standard" in determining your risk for heart disease outcomes.
If there’s good news related to heart disease, it may be that there are tools out there to help determine who’s at risk for heart problems in time to prevent them.
And researchers from the Heart Institute at Intermountain Medical Center have devised a new tool that makes it more possible than ever. It’s called the Intermountain Risk Score--a measurement tool that looks at age and sex, and also adds the results of routine blood tests, something that hasn’t been included in the assessment system commonly used by physicians today.
In fact, the Heart Institute researchers compared their new tool with the Framingham Risk Score, which is currently the considered gold standard for measuring future coronary heart disease risk. The Framingham index looks at total cholesterol, HDL cholesterol, blood pressure, diabetes, age, and gender.
“Framingham does a good job of classifying groups of patients. But it’s not as good at indentifying an individual’s risk for disease,” says Benjamin Horne, PhD, director of cardiovascular and genetic epidemiology at the Heart Institute at Intermountain Medical Center, and the principal author of the study.
That’s where the Intermountain Risk Score can help—especially in combination with the Framingham index.
“Our research has shown that the Intermountain Risk Score really improves a doctor’s ability to measure patient risk. And it does it by including two simple and inexpensive tests: the complete blood count and metabolic profiles,” he says.
Researchers followed over 5,000 patients who were treated with angiography, or vascular imaging. By combining the patients’ Framingham Risk Score with their Intermountain Risk Score, researchers found that they were 30 percent more likely to correctly determine a woman’s risk, and 57 percent more likely to determine a man’s risk for a cardiovascular problem or death within 30 days of the angiography. The results remained substantially better than the Framingham score alone after one year.
“Adding the Intermountain Risk Score to the Framingham Risk Score substantially improves our ability to determine an individual’s risk of future coronary heart disease and associated problems,” says Dr. Horne.
Dr. Horne says that the goal at Intermountain Healthcare is to create an online risk score calculator to help clinicians around the world better assess their patients’ health.
What if treating a common heart condition could reduce the risk of Alzeheimer’s Disease and Stroke?
New findings by researchers from the Heart Institute at Intermountain Medical Center show that treating one of the most common heart rhythm disorders may significantly reduce the risk of stroke, Alzheimer’s disease and other forms of dementia, and death.
The disorder is called atrial fibrillation—and it is found in about 2.2 million Americans. During atrial fibrillation, the heart's two small upper chambers quiver instead of beating effectively. Blood isn't pumped completely out of them, so it may pool and clot. If a piece of a blood clot in the atria leaves the heart and becomes lodged in an artery in the brain, a stroke results.
A-Fib (as it’s called) can be treated with catheter ablation. This where a doctor inserts a thin, flexible tube into the heart (a catheter) and a special machine delivers energy through it and into tiny areas of the heart muscle that cause the abnormal heart rhythm. This energy “disconnects” the pathway of the abnormal rhythm.
Two new studies, conducted over 3 years, were led by Intermountain Healthcare cardiologists John D. Day, MD, and T. Jared Bunch, MD. They evaluated the long-term effects of ablation treatment on patients with A-fib and the likelihood of developing dementia, Alzheimer’s disease, stroke, and death. They show that patients treated with ablation are less likely to develop Alzheimer’s disease or other forms of dementia, and have a significantly reduced risk of stroke and death compared to A-fib patients who aren’t.
“With millions of people affected by atrial fibrillation, it is our hope that findings from studies like ours will help clinicians determine the best possible care and treatment options for patients,” says Dr. Day. “Our studies shed light on the positive outcomes of catheter ablation treatment not only to reduce atrial fibrillation, but also to help A-fib patients lower their risk of developing Alzheimer’s disease, suffering from a stroke or worse, loss of life.”
A method that reduces septic shock (a life-threatening blood infection) deaths by 80%.
Intermountain Medical Center and LDS Hospital have set a new national standard in reducing death from septic shock. By pioneering the implementation of stricter treatment guidelines, a patient’s chance of dying from sepsis and septic shock is reduced by an astounding 80%. The dramatic drop comes three years after Intermountain Healthcare made a goal of treating sepsis patients with a "bundle" of strategies by aggressively identifying patients with the potential for sepsis aggressively and treating them earlier and with more consistency.
Sepsis is a severe illness in which the bloodstream is overwhelmed by bacteria from an infection. Nearly 500,000 patients arrive in U.S. emergency departments each year with sepsis, which begins as an ordinary infection, such as pneumonia or a urinary tract infection.
"With sepsis, the infection affects the whole person, the whole body. Systems begin to shut down and organs fail," says Dr. Todd Allen, lead researcher and emergency medicine physician at Intermountain Medical Center and LDS Hospital. "Once that happens, the risk of death may be up to 50 percent or higher. Physicians have always struggled with sepsis, and once someone gets to the stage of septic shock, mortality rates are alarmingly high. But we've been able to reduce sepsis-related deaths to a ground-breaking, and remarkably low level.”
The "bundle" of strategies used by Intermountain include 11 elements that provide consistency in the early recognition and treatment of sepsis, including specialized blood testing, administration of antibiotics, fluids, and other medications, tight glucose control and protecting the lungs with a standardized ventilator strategy. The bundle was conceived in 2001 as part of a landmark study by another institution. In the years since then, hospital compliance across the country has been spotty, says Dr. Allen. "Intermountain is among the very first health systems to show huge improvements in a large hospital setting. We may lead the world in overall bundle compliance and survival rate.”
We’ve discovered a better way to manage contagious disease within hospitals.
Because hospitals deal with all kinds of health problems in one location, a big concern is keeping contagious disease from spreading from patient to patient. Researchers and specialists at Intermountain Healthcare have developed a tool that helps healthcare providers better manage patients with contagious diseases. It allows them to quickly and correctly determine whether a patient needs to be placed in isolation and if so, which type of isolation based on current CDC (Center for Disease Control and Prevention) guidelines.
Using either medical or common descriptions of the initial diagnosis, the caregiver can go to the hospital’s electronic medical record and get information on whether a person needs to be isolated and what type of isolation. Not only that, but the caregiver also receives information on what type of protective gear the provider needs to wear when treating the patient and the infective material and duration of precautions.
Without this information tool, a healthcare provider would need to pull documentation from a number of national sources to make this assessment. Dr. Scott Evans and Dr. Jacob Tripp worked with Intermountain Healthcare Infection Preventionists to develop this decision support tool.
Heart failure education improves long-term survival.
There is widespread evidence to show that heart failure medications and devices can improve survival, but results from a new study show that providing patient education is just as important. It can result in significantly improved survival rates, important especially since heart failure is the only major cardiovascular disorder on the rise.
Researchers at the Heart Institute at Intermountain Medical Center tracked more than 1,500 patients who were given specific discharge instructions about self-management using an educational program developed specifically for heart failure patients at Intermountain Healthcare. The MAWDS program (which stands for Medications, Activity, Weight, Diet and Symptoms) teaches patients the importance of taking and understanding their medications, staying physically active, tracking weight fluctuations on a daily basis, limiting sodium intake in their diet and monitoring for changes in their symptoms.
Patients who received documented MAWDS education while in the hospital between June 2002 and June 2004 had better one-year survival rates (84.1% vs. 81%) than those without documented discharge instructions. What our current study showed was that patients from the original study who had MAWDS education before discharge had better survival rates at five years after their initial hospitalization than those who didn’t receive the education. Even after controlling for age, gender, diagnosis, length of hospital stay, and severity of illness, results showed that the five-year survival rate for those who received discharge education was higher (57.1%) than for those without discharge education (49.6%).
“We developed and have implemented this program across Intermountain Healthcare,” says Kismet Rasmusson, FNP-BC, FAHA, a heart failure nurse practitioner and lead researcher of the study. “This data speaks to the importance of having a standardized, consistent educational message for patients with heart failure. We educate nurses at all of our hospitals to make sure they understand the necessity of this education. It’s our nurses who educate patients to engage their understanding about how to live with heart failure once they are discharged from the hospital.”
Less invasive valve replacement that’s changing heart treatment and saving lives.
There are many reasons why open-heart surgery may not be ideal for some patients. Age sometimes makes it difficult, and other times it’s a person’s health. In the past some people with valvular heart disease have been faced with the choice of foregoing necessary heart care or accepting high risk surgery and its associated complications. Aortic stenosis has robbed these people of not only their very lives, but also their ability to live independently and their quality of life.
Since May, 2009, physicians at the Heart Institute at Intermountain Medical Center have been testing the first aortic-valve replacement that doesn’t require invasive open heart surgery. Instead, physicians thread a thin, flexible catheter through a patient’s artery or make a small incision in the chest wall and then insert a balloon-expandable valve inside the previously nonfunctioning valve. The new valve functions immediately.
So far, heart experts at Intermountain Medical Center have placed the valve in 30 people with aortic stenosis, with ages ranging from 69 to 93. Results have exceeded expectations. “The ability to extend life saving technology and restore quality of life to almost all patients with aortic stenosis is gratifying” said Dr. Kent Jones, investigator of the Partner Trial at Intermountain Medical Center. Dr. Brian Whisenant who has partnered with Dr. Jones in the endeavor added “This is the most exciting advancement in the practice of medicine that I have observed in my career. The energy and commitment of many physicians representing various specialties has made this so successful.”
Patients have come from throughout the Intermountain West and as far away as New York to be part of this life-saving trial. Results of the recently published Partner Trial suggest that 20% more patients receiving a catheter delivered valve are alive at one year when compared to those treated medically.
Intermountain Healthcare Copyright © 2010, Intermountain Healthcare