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Search Results: 1 - 10 of 483906 matches for " Robert A Cherry "
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Repeal of the Pennsylvania motorcycle helmet law: reflections on the ethical and political dynamics of public health reform
Robert A Cherry
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-202
Abstract: Prior to the repeal, and in the years that have followed, there has been intense debate and controversy regarding Pennsylvania's decision to repeal the law that required universal and mandatory use of motorcycle helmets for all riders. Proponents of the helmet repeal have argued in favor of individual rights and freedom, whereas advocates for mandatory helmet laws have voiced concerns over public health and safety based on available data.This commentary will discuss the policy-making process that led to Pennsylvania's repeal of the motorcycle helmet safety law from an ethical, political, and economic perspective.Just prior to the repeal of the Pennsylvania motorcycle helmet law in 2003, the National Highway Traffic Safety Administration (NHTSA) released a number of interesting findings that are worth mentioning: 1) there were 3,244 motorcycle deaths and 65,000 injuries in 2002 on US highways; 2) motorcyclists are 27 times more likely to die in motorcycle crash (MCC) per mile traveled than an occupant in an automobile; 3) head injury is the leading cause of death for MCC; 4) motorcycle helmets reduce the likelihood of death in a MCC by 37%; 5) the Crash Outcome Data Evaluation System (CODES) study demonstrated that motorcycle helmets are 67% effective in the prevention of traumatic brain injury and; 6) motorcycle helmet use saved $1.3 billion in 2002 and an additional $853 million could have been saved if helmets were worn in all MCC.In the face of such compelling data, why did Pennsylvania repeal its motorcycle helmet safety law? In 2002, there were 134 motorcycle-related crash fatalities. After the repeal of the law, this number increased to 205 in 2005. Is this an example of public policy gone awry?Anti-helmet advocates argued for the repeal of the Pennsylvania motorcycle helmet law for several reasons: 1) freedom of choice and individual rights, 2) the pleasure of riding without a helmet, and 3) helmet use increases the odds of spinal cord damage. In response, th
The Current Crisis in Emergency Care and the Impact on Disaster Preparedness
Robert A Cherry, Marcia Trainer
BMC Emergency Medicine , 2008, DOI: 10.1186/1471-227x-8-7
Abstract: After 9/11, federal plans, procedures and benchmarks were mandated to assure a unified, comprehensive disaster response, ranging from local to federal activation of resources. Nevertheless, insufficient federal funding has contributed to a long-standing counter-trend which has eroded emergency medical care. The causes are complex and multifactorial, but they have converged to present a severely overburdened system that regularly exceeds emergency capacity and capabilities. This constant acute overcrowding, felt in communities all across the country, indicates a nation at risk. Federal funding has not sufficiently prioritized the improvements necessary for an emergency care infrastructure that is critical for an all hazards response to disaster and terrorist emergencies.Currently, the nation is unable to meet presidential preparedness mandates for emergency and disaster care. Federal funding strategies must therefore be re-prioritized and targeted in a way that reasonably and consistently follows need.Many assumptions regarding the nation's need for disaster preparedness were reassessed after 9/11. Among them was a fuller appreciation of the fact that preparedness had to include public health and hospital personnel in its first responder definition. This significance was statutorily recognized with the Homeland Security Act (HSA) of 2002[1] which provided for the designation of a critical infrastructure protection program. This subsequently led to the Homeland Security Presidential Directive-7 (HSPD-7)[2] in 2003 which targeted emergency services as a critical infrastructure. The disaster of Hurricane Katrina in 2006 reaffirmed the need for this declaration. Among the lessons learned, it was determined that better planning and integration of emergency services at all levels of government – national, state, regional, and local – was essential for public health preparedness. Certain core questions must therefore be asked: What are our priorities? What assessments have
The Impact of Health Care Reform Initiatives on Ethical Conflict and Opportunities for Nurses to Improve Quality of Care While Enhancing Their Work Environments  [PDF]
Robert Cooper, Garry Frank, Cherry Shogren
Open Journal of Nursing (OJN) , 2014, DOI: 10.4236/ojn.2014.49068
Abstract:

Background: After more than a decade of the nursing profession contending that healthcare reform based almost exclusively on cost cutting was creating an array of serious ethical issues for nurses, healthcare organizations and other providers are now facing increasing demands primarily from payers to demonstrate improvement in both quality of care and patient experience along with continued cost reduction. Research Question: Have efforts by healthcare organizations to comply with these recently imposed requirements influenced the ethical environment faced by nurses and nurse leaders and if so, how? Materials and Methods: Data for assessing the current ethical environment was gathered with a close-ended survey mailed in October 2012 to a random sample of 3000 members of the American Organization of Nurse Executives. Results and Discussion: Statistical analysis of the data and comparison with the findings of a similar study conducted in 2000 indicated that along with five highly rated issues in the earlier study attributed largely to economic constraints imposed by healthcare organizations, the top-10 key ethical issues today included five issues primarily attributable to interprofessional conflict. Conclusion: Given the success of many ongoing efforts aimed at weakening these key sources of ethical conflict that have blocked many proposals to improve the quality of care, opportunities should arise for the nursing profession to more fully achieve its goals of improving the quality of care, safety and patient satisfaction and enhancing nurses’ work environments essential to that effort.

Considerations in Dealing with Ethical Conflict Encountered in Healthcare Reform: Perceptions of Nurse Leaders  [PDF]
Robert Cooper, Garry Frank, Cherry Shogren
Open Journal of Nursing (OJN) , 2014, DOI: 10.4236/ojn.2014.410074
Abstract: With the nursing profession continuing to face an array of ethical issues, the article reports the findings of a survey of members of the American Organization of Nurse Executives conducted in 2012 to determine the extent to which nurse leaders at different organization levels perceive various factors in their personal, professional and organizational environments to be helpful in resolving ethical dilemmas. After their personal values, nurse leaders perceive factors related to their organization to be more helpful than those related to their profession, including, among others, the American Nurses Association Code of Ethics. The two highest rated business-related factors deal with the absence of pressure to compromise one’s own ethical standards which suggests that one way healthcare organizations can assist nurses and their leaders is by neither explicitly nor implicitly pressuring them to go against their own ethical values. Other key factors related to the organization include formal organizational factors such as the existence of an ethics committee or a person to whom unethical activity can be reported as well as more informal factors related to organizational climate such as the actions and responsiveness of one’s immediate boss, the ability to go beyond one’s boss if necessary, the organizational culture, management philosophy, and management’s communication of appropriate ethical behavior. Comparison of the findings of the 2012 survey with those of a similar study conducted in 2000 indicated the four factors perceived as most helpful in both studies were identical with the same rank order and the top-10 factors were identical with some differences in ranking. Further analysis indicated the relative degree of helpfulness of the 17 help factors common to both studies was perceived by responding nurse leaders as quite similar overall. The authors also discuss the implications for the profession and the healthcare industry today and in the future.
Resource utilization and outcomes of intoxicated drivers
Robert A Cherry, Pamela A Nichols, Theresa M Snavely, Lindsay J Camera, David T Mauger
Journal of Trauma Management & Outcomes , 2010, DOI: 10.1186/1752-2897-4-9
Abstract: Retrospective descriptive study (Jan 2002-June 2007) of our trauma registry and financial database comparing intoxicated drivers with blood alcohol levels (BAC) > 80 mg/dl (ETOH > 80) with drivers who had a BAC of 0 mg/dl (ETOH = 0). Drivers without a BAC drawn or who had levels ranging from 1 mg/dL to 80 mg/dL were excluded. Data was collected on demographic information (age, gender, injury severity score or ISS), outcome variables (mortality, complications, ICU and hospital LOS, ventilator days) and resource utilization (ED LOS, insurance, charges, costs, payments). Statistical analysis: p < 0.05 vs. ETOH > 80; stratified chi square.Out of 1732 drivers, the combined study group (n = 987) of 623 ETOH = 0 and 364 ETOH > 80 had a mean age of 38.8 ± 17.9, ISS of 18.0 ± 12.1, and 69.8%% male. There was no difference in ISS (p = 0.67) or complications (p = 0.38). There was a trend towards decreased mortality (p = 0.06). The ETOH = 0 group had more patients with a prolonged ICU LOS (≥ 5 days), ventilator days (≥ 8 days), and hospital LOS (> 14 days) when compared to the ETOH > 80 group (p < 0.05). The ETOH > 80 group tended to be self pay (4.9% vs. 0.7%, p < 0.5) and less likely to generate payment for hospital charges (p < 0.5). Hospital charges and costs were higher in the ETOH = 0 group (p < 0.5).The data suggests that intoxicated drivers may have better outcomes and a trend towards reduced mortality. They appeared to be less likely to have prolonged hospital LOS, ICU LOS, and ventilator days. We also observed that intoxicated drivers were more likely to be self-pay, less likely to have charges > $50K, and less likely to pay ≥ 90% of the charges. Further research using multivariable analysis is needed to determine if these apparent outcomes differences are driven by acute intoxication, and the tendency for endotracheal intubation and ICU admission, rather than injury severity.The prevalence of motor vehicle crashes remains a major public health concern and is a leadin
Intraoperative angioembolization in the management of pelvic-fracture related hemodynamic instability
Robert A Cherry, David C Goodspeed, Frank C Lynch, John Delgado, Spence J Reid
Journal of Trauma Management & Outcomes , 2011, DOI: 10.1186/1752-2897-5-6
Abstract: We used portable digital subtraction fluoroscopy units for IAE in patients with severe pelvic hemorrhage and hemodynamic instability (5/03-4/09). Data was collected on demographics, injury severity, resource utilization, and outcomes at our Level 1 trauma center.There were 6,538 adult admissions with 912 having pelvic fractures and 65 of these undergoing pelvic angioembolization. Twelve hemodynamically compromised patients (10 males, 2 females) had intraoperative pelvic angiography (age: 22-79 years; mean 51.3 ± 17.4). Injury severity score (ISS) was 37.5 ± 8.4 (22-50). Mean emergency department (ED) length of stay (LOS) was 57.4 min ± 47.9 with 10 patients transported directly to the OR and 2 to the SICU prior to OR. Ten of 12 patients underwent exploratory laparotomy followed by angioembolization. Mortality was 50%. Among the 6 survivors (ISS 22 - 50), all had a pre-op CT scan, five had an initial base deficit <13, and four were transfused ≤ 6 units pre-incision/pre-procedure. Four of the 6 survivors had unilateral embolization. In contrast, all 6 non-survivors (ISS 29-41) required massive transfusion prior to OR (>6 units PRBCs) with 4 having a based deficit >13. Three of these patients bypassed CT and five underwent bilateral internal iliac embolization (BIIE).IAE for severe pelvic hemorrhage can be successfully performed concurrently with exploratory laparotomy, pelvic packing or other resuscitative procedures. Patients most likely to benefit have a base deficit <13, and do not require massive transfusion prior to IAE or suffer from a vertically unstable pelvis fracture.Angioembolization has long been used to control pelvic hemorrhage in hemodynamically compensated trauma patients. Mobile angiography has now been reported in the Emergency Department (ED) to facilitate immediate control of hemorrhage resulting from severe pelvic fractures [1,2]. The use of this approach in the operating room has not been widely described in the literature. In this case series re
Percutaneous retrieval of a biliary stent after migration and ileal perforation
Derek M Culnan, Bryan J Cicuto, Harjit Singh, Robert A Cherry
World Journal of Emergency Surgery , 2009, DOI: 10.1186/1749-7922-4-6
Abstract: Endoscopic biliary stent placement is a well established, safe and minimally invasive modality for the treatment of biliary diseases such as choledocholithiasis.[1,2] Over the past decade the use of this modality has increased in prevalence and utility. Despite the overall safety of this modality, on rare occasions these stents may migrate from the biliary tract.[3] A small percentage of those stents perforate the gut and require surgical intervention.[4,5] We present an unusual case of biliary stent migration with distal small bowel perforation and abscess formation which was successfully treated using interventional radiology techniques, including percutaneous drainage and fluoroscopic removal of the stent.A 76-year-old woman was admitted with cholecystitis and choledocholithiasis diagnosed via computed tomographic (CT) scan. Her past medical and surgical history was significant for paroxysmal atrial fibrillation, a right hemicolectomy and right oophorectomy for colon cancer, pulmonary embolism requiring inferior vena cava filter placement, endovascular abdominal aortic aneurysm repair, and a stroke resulting in vascular dementia. Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy was performed with removal of an impacted common bile duct stone and placement of an uncoated 10F plastic endostent, though the duct was radiographically clear. Four days later, after her liver function test normalized, she underwent a laparoscopic cholecystectomy during which an intra-peritoneal abscess was found surrounding a markedly inflamed and necrotic appearing gallbladder. The cholecystectomy was performed without complication and the abscess was drained adequately. The remainder of her post-operative course was unremarkable and she was discharged home on post-operative day five.Approximately nine weeks after her laparoscopic cholecystectomy she presented to the emergency department complaining of four days of feculent emesis, intermittent diffuse abdominal
Reduction of central venous catheter associated blood stream infections following implementation of a resident oversight and credentialing policy
Robert A Cherry, Cheri E West, Maria C Hamilton, Colleen M Rafferty, Christopher S Hollenbeak, Gregory M Caputo
Patient Safety in Surgery , 2011, DOI: 10.1186/1754-9493-5-15
Abstract: This is a retrospective analysis of prospectively collected data at an academic medical center with four adult ICUs and a pediatric ICU. All patients undergoing non-tunneled CVC placement were included in the study. Data was collected on CLABSI, line days, and serious adverse events in the year prior to and following policy implementation on 9/01/08.A total of 813 supervised central lines were self-reported by residents in four departments. Statistical analysis was performed using paired Wilcoxon signed rank tests. There were reductions in median CLABSI rate (3.52 vs. 2.26; p = 0.015), number of CLBSI per month (16.0 to 10.0; p = 0.012), and line days (4495 vs. 4193; p = 0.019). No serious adverse events reported to the Pennsylvania Patient Safety Authority.Implementation of a new CVC resident oversight and credentialing policy has been significantly associated with an institution-wide reduction in the rate of CLABSI per 1,000 central line days and total central line days. No serious adverse events were reported. Similar resident oversight policies may benefit other teaching institutions, and support concurrent organizational efforts to reduce hospital acquired infections.Hospital acquired infections are a growing public health concern because of their impact on morbidity and mortality and their potential preventability. Central venous catheters (CVC) account for about 90 percent of catheter-related bloodstream infections (BSIs) [1]. As a result, there are somewhere between 500 and 4,000 patient deaths each year in the U.S. related to central line associated blood stream infections (CLABSI), with the cost per BSI estimated at $33,039 [2]. Reducing the rate of CLABSI became an organizational quality and patient safety goal in order to reduce morbidity, mortality, and health care-related costs.The use of meticulous technique and evidence-based guidelines by experienced physicians has led to reductions in CLABSI at many facilities. One effective way to reduce these typ
Crisis of Public Utility Deregulation and the Unrecognized Welfare State
Barbara A. Cherry
Computer Science , 2001,
Abstract: Successful achievement of public policies requires satisfaction of conditions affecting political feasibility for policy adoption and maintenance as well as economic viability of the desired activity or enterprise. This paper discusses the difficulties of satisfying these joint constraints given the legacy of the common law doctrines of "just price" and "businesses affected with a public interest." In this regard, it is helpful to view traditional public utility regulation as a form of welfare state regulation, as it suffers from similar political problems from policy retrenchment. The retrenchment problems are examined in the context of the electricity crisis in California as well as the passage and implementation of the Telecommunications Act of 1996. As expected, retrenchment from low residential retail rates - the most universalistic benefit for customers - faces the greatest political resistance. The societal trade-offs between monopoly and competition must be reexamined in light of the greater instability and political difficulties under a deregulatory regime.
Action for Rehabilitation from Neurological Injury (ARNI): A pragmatic study of functional training for stroke survivors  [PDF]
Cherry Kilbride, Meriel Norris, Nicola Theis, Amir A. Mohagheghi
Open Journal of Therapy and Rehabilitation (OJTR) , 2013, DOI: 10.4236/ojtr.2013.12008
Abstract: This study evaluated the effectiveness of a twelve-week community-based functional training on measures of impairment, activity and participation in a group of stroke survivors. Isometric strength of the knee musculature, Centre-Of-Pressure (COP) based measures of balance, Berg Balance Scale (BBS), 10 m walk test, and the Subjective Index of Physical and Social Out come (SIPSO), were recorded at baseline, post-intervention, and after twelve weeks (follow-up). Exercise instructors delivered training once a week in a group format at a community centre. Significant improvement was noted in the BBS (p < 0.002), and 10 m walk speed (p = 0.03) post intervention which remained unchanged at follow-up. Total SIPSO score improved significantly post-intervention (p = 0.044). No other significant differences and no adverse effects were observed. It is possible that functional training provided more opportunity for the improvement of dynamic aspects of balance control that could be captured by the BBS but not with the traditional measures of balance using COP data. Results also suggest positive effects on the level of participation, and lack of association between measures of impairment and activity. Community based functional training could be effective and used to extend access to rehabilitation services beyond the acute and sub-acute stages after stroke.
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