Doug Brunk

When Dr. David Lovinger was asked to join a team of physicians, administrators, and other staff of the University of Chicago Medical Center in providing input for the design of a new $700 million, 10-story hospital pavilion, he was eager to play a role.

“I know nothing specifically about architecture, but as a hospitalist, having ready access to certain things is really important, so being able to say, 'You need more work space for physicians, you need call rooms for physicians, you need to be able to access this, that, and the other thing'—the ergonomics of the workflow—I was in a good position to contribute,” said Dr. Lovinger, a hospitalist with the department of medicine at the University of Chicago. “We were working on things like what size the rooms should be, how they relate to the nursing station, and how they relate to call rooms and ancillary services.”

He and about 35 colleagues attended several dozen meetings with architects and designers working on medical-related phases of the project. In May 2008, the University of Chicago Medical Center Board of Trustees approved the 1.2-million-square-foot facility, which will be built about two blocks from the current downtown hospital location. Construction is scheduled to begin in 2009, and the building will open in 2012.

The pavilion will house programs that provide complex specialty care, including cancer, gastrointestinal disease, neuroscience, advanced surgery, and high-technology medical imaging. It will contain 240 private inpatient and intensive care beds, 24 operating rooms, 12 rooms for gastrointestinal and pulmonary procedures, 7 interventional radiology suites, and advanced diagnostic tools including high-resolution MRI and CT scanners.

Dr. Lovinger called the design “forward thinking,” unlike the design of many hospitals built in the previous century. “Facilities that are 20 or more years older were built in a different era, and medicine has changed,” he said. “There are infection control issues. There are a lot of patients in isolation, and patients are sicker. There is a lot more in the way of electronic medical records and computerized physician order entry and so much more information on the computer. There is so much more medical equipment and need to access more equipment.”

Flexibility is a key feature of the new pavilion. Rafael Viñoly Architects of New York and London, working with health care facility specialists Cannon Design of Grand Island, N.Y., designed a grid system consisting of 102 modular cubes on each floor—each one 31.5 feet across and 18 feet high. Each module can be reconfigured into an ICU, a radiology suite, or an operating room as needed.

“They were explicitly planning for a multiuse facility,” Dr. Lovinger said. “Twenty or 40 years ago that would have been a ridiculous idea. But now it makes complete sense.”

Nationwide, construction of hospitals and other health care facilities boomed until recently. According to “Construction Outlook 2008: Midyear Update” (McGraw-Hill Construction), construction of health care facilities reached an all-time high in 2006 at 110 million square feet. “The hospital segment provided much of the upward impetus, with very strong activity in 2005 and 2006,” wrote a team of analysts led by Robert A. Murray, the company's vice president of economic affairs. “However, an 18% retreat for hospital construction in 2007, after its middecade surge, was the reason why the overall health facilities category dropped 8% last year to 101 million square feet.”

In 2008, “it's forecast that both sides of the health care facilities category will lose momentum, as contracting retreats another 5% to 96 million square feet. In part, this is due to the continued pullback from the exceptional amount of construction that was achieved in 2006, and in part it reflects the tougher financing climate,” the analysts noted. Yearly construction averaged 92 million square feet during 2000–2004, compared with 79 million square feet in the 1990s.

The hospital pavilion marks the fourth major construction project at the University of Chicago in recent years. It will connect to Comer Children's Hospital, which opened in 2005. It will also be near the Gordon Center for Integrative Science, which opened in 2005, and adjacent to the Knapp Center for Biomedical Discovery, which is scheduled to open in 2009.

Dr. Lovinger praised the project management team for seeking input from physicians and other staff. “Getting your users involved is critically important,” he said. “If you don't get the people who 'work in the factory,' so to speak, involved, you're going to make a lot of mistakes and wind up having to do retrofitting. … I think the University of Chicago has done a great job in getting clinicians involved in this. They understand the importance of having that kind of input to having a good product. We're not a hindrance—we're critical to the process.”

The 102 modular cubes on each floor can be reconfigured into an ICU, a radiology suite, or an operating room as needed. University of Chicago Medical Center

When Dr. David Lovinger was asked to join a team of physicians, administrators, and other staff of the University of Chicago Medical Center in providing input for the design of a new $700 million, 10-story hospital pavilion, he was eager to play a role.

“I know nothing specifically about architecture, but as a hospitalist, having ready access to certain things is really important, so being able to say, 'You need more work space for physicians, you need call rooms for physicians, you need to be able to access this, that, and the other thing'—the ergonomics of the workflow—I was in a good position to contribute,” said Dr. Lovinger, a hospitalist with the department of medicine at the University of Chicago. “We were working on things like what size the rooms should be, how they relate to the nursing station, and how they relate to call rooms and ancillary services.”

He and about 35 colleagues attended several dozen meetings with architects and designers working on medical-related phases of the project. In May 2008, the University of Chicago Medical Center Board of Trustees approved the 1.2-million-square-foot facility, which will be built about two blocks from the current downtown hospital location. Construction is scheduled to begin in 2009, and the building will open in 2012.

The pavilion will house programs that provide complex specialty care, including cancer, gastrointestinal disease, neuroscience, advanced surgery, and high-technology medical imaging. It will contain 240 private inpatient and intensive care beds, 24 operating rooms, 12 rooms for gastrointestinal and pulmonary procedures, 7 interventional radiology suites, and advanced diagnostic tools including high-resolution MRI and CT scanners.

Dr. Lovinger called the design “forward thinking,” unlike the design of many hospitals built in the previous century. “Facilities that are 20 or more years older were built in a different era, and medicine has changed,” he said. “There are infection control issues. There are a lot of patients in isolation, and patients are sicker. There is a lot more in the way of electronic medical records and computerized physician order entry and so much more information on the computer. There is so much more medical equipment and need to access more equipment.”

Flexibility is a key feature of the new pavilion. Rafael Viñoly Architects of New York and London, working with health care facility specialists Cannon Design of Grand Island, N.Y., designed a grid system consisting of 102 modular cubes on each floor—each one 31.5 feet across and 18 feet high. Each module can be reconfigured into an ICU, a radiology suite, or an operating room as needed.

“They were explicitly planning for a multiuse facility,” Dr. Lovinger said. “Twenty or 40 years ago that would have been a ridiculous idea. But now it makes complete sense.”

Nationwide, construction of hospitals and other health care facilities boomed until recently. According to “Construction Outlook 2008: Midyear Update” (McGraw-Hill Construction), construction of health care facilities reached an all-time high in 2006 at 110 million square feet. “The hospital segment provided much of the upward impetus, with very strong activity in 2005 and 2006,” wrote a team of analysts led by Robert A. Murray, the company's vice president of economic affairs. “However, an 18% retreat for hospital construction in 2007, after its middecade surge, was the reason why the overall health facilities category dropped 8% last year to 101 million square feet.”

In 2008, “it's forecast that both sides of the health care facilities category will lose momentum, as contracting retreats another 5% to 96 million square feet. In part, this is due to the continued pullback from the exceptional amount of construction that was achieved in 2006, and in part it reflects the tougher financing climate,” the analysts noted. Yearly construction averaged 92 million square feet during 2000–2004, compared with 79 million square feet in the 1990s.

The hospital pavilion marks the fourth major construction project at the University of Chicago in recent years. It will connect to Comer Children's Hospital, which opened in 2005. It will also be near the Gordon Center for Integrative Science, which opened in 2005, and adjacent to the Knapp Center for Biomedical Discovery, which is scheduled to open in 2009.

Dr. Lovinger praised the project management team for seeking input from physicians and other staff. “Getting your users involved is critically important,” he said. “If you don't get the people who 'work in the factory,' so to speak, involved, you're going to make a lot of mistakes and wind up having to do retrofitting. … I think the University of Chicago has done a great job in getting clinicians involved in this. They understand the importance of having that kind of input to having a good product. We're not a hindrance—we're critical to the process.”

The 102 modular cubes on each floor can be reconfigured into an ICU, a radiology suite, or an operating room as needed. University of Chicago Medical Center

When Dr. David Lovinger was asked to join a team of physicians, administrators, and other staff of the University of Chicago Medical Center in providing input for the design of a new $700 million, 10-story hospital pavilion, he was eager to play a role.

“I know nothing specifically about architecture, but as a hospitalist, having ready access to certain things is really important, so being able to say, 'You need more work space for physicians, you need call rooms for physicians, you need to be able to access this, that, and the other thing'—the ergonomics of the workflow—I was in a good position to contribute,” said Dr. Lovinger, a hospitalist with the department of medicine at the University of Chicago. “We were working on things like what size the rooms should be, how they relate to the nursing station, and how they relate to call rooms and ancillary services.”

He and about 35 colleagues attended several dozen meetings with architects and designers working on medical-related phases of the project. In May 2008, the University of Chicago Medical Center Board of Trustees approved the 1.2-million-square-foot facility, which will be built about two blocks from the current downtown hospital location. Construction is scheduled to begin in 2009, and the building will open in 2012.

The pavilion will house programs that provide complex specialty care, including cancer, gastrointestinal disease, neuroscience, advanced surgery, and high-technology medical imaging. It will contain 240 private inpatient and intensive care beds, 24 operating rooms, 12 rooms for gastrointestinal and pulmonary procedures, 7 interventional radiology suites, and advanced diagnostic tools including high-resolution MRI and CT scanners.

Dr. Lovinger called the design “forward thinking,” unlike the design of many hospitals built in the previous century. “Facilities that are 20 or more years older were built in a different era, and medicine has changed,” he said. “There are infection control issues. There are a lot of patients in isolation, and patients are sicker. There is a lot more in the way of electronic medical records and computerized physician order entry and so much more information on the computer. There is so much more medical equipment and need to access more equipment.”

Flexibility is a key feature of the new pavilion. Rafael Viñoly Architects of New York and London, working with health care facility specialists Cannon Design of Grand Island, N.Y., designed a grid system consisting of 102 modular cubes on each floor—each one 31.5 feet across and 18 feet high. Each module can be reconfigured into an ICU, a radiology suite, or an operating room as needed.

“They were explicitly planning for a multiuse facility,” Dr. Lovinger said. “Twenty or 40 years ago that would have been a ridiculous idea. But now it makes complete sense.”

Nationwide, construction of hospitals and other health care facilities boomed until recently. According to “Construction Outlook 2008: Midyear Update” (McGraw-Hill Construction), construction of health care facilities reached an all-time high in 2006 at 110 million square feet. “The hospital segment provided much of the upward impetus, with very strong activity in 2005 and 2006,” wrote a team of analysts led by Robert A. Murray, the company's vice president of economic affairs. “However, an 18% retreat for hospital construction in 2007, after its middecade surge, was the reason why the overall health facilities category dropped 8% last year to 101 million square feet.”

In 2008, “it's forecast that both sides of the health care facilities category will lose momentum, as contracting retreats another 5% to 96 million square feet. In part, this is due to the continued pullback from the exceptional amount of construction that was achieved in 2006, and in part it reflects the tougher financing climate,” the analysts noted. Yearly construction averaged 92 million square feet during 2000–2004, compared with 79 million square feet in the 1990s.

The hospital pavilion marks the fourth major construction project at the University of Chicago in recent years. It will connect to Comer Children's Hospital, which opened in 2005. It will also be near the Gordon Center for Integrative Science, which opened in 2005, and adjacent to the Knapp Center for Biomedical Discovery, which is scheduled to open in 2009.

Dr. Lovinger praised the project management team for seeking input from physicians and other staff. “Getting your users involved is critically important,” he said. “If you don't get the people who 'work in the factory,' so to speak, involved, you're going to make a lot of mistakes and wind up having to do retrofitting. … I think the University of Chicago has done a great job in getting clinicians involved in this. They understand the importance of having that kind of input to having a good product. We're not a hindrance—we're critical to the process.”

The 102 modular cubes on each floor can be reconfigured into an ICU, a radiology suite, or an operating room as needed. University of Chicago Medical Center

SAN DIEGO — Postendovascular aneurysm repair surveillance, with color flow duplex ultrasound only, is a safe alternative to the current standard practice of follow-up CT with contrast, results from a single-center study showed.

After endovascular aneurysm repair (EVAR), “CT follow-up is associated with significant risk, including increased cost, contrast nephropathy, contrast allergy, and radiation exposure,” Dr. Rabih A. Chaer said at the Vascular Annual Meeting. “Alternative follow-up methods have been proposed, including color flow duplex ultrasound, MRI, and contrast-enhanced ultrasound. Of all these modalities, it's clear that simple color flow duplex ultrasound is the most readily available, the cheapest, and the least invasive.”

He and his associates in the division of vascular surgery at the University of Pittsburgh Medical Center studied 184 patients who were switched to color flow duplex ultrasound (CDU) surveillance in 2003 as an alternative to CT. Selective CT scanning was used only for new endoleaks or for patients who presented with an enlarging abdominal aortic aneurysm (AAA) sac. Only patients with at least 1 year of follow-up were included.

Criteria for switch to CDU included patients with a residual AAA sac of 4 cm or less anytime after the first year of follow-up, patients with a stable AAA sac size for 2 years, or patients with a stable type II endoleak for 2 years. The average CDU study duration was 20 minutes. The researchers used a GE Logiq 9 machine with a 3.5-MHz curve probe.

Of the 184 patients, 13 had an active stable type II endoleak, 23 had a prior endoleak that was treated or that resolved spontaneously. The mean follow-up on CDU was 24 months. Of the 184 grafts, 76 were Ancure, 58 were Zenith, 39 were Excluder, 7 were AneuRx, and 4 were Lifepath.

Dr. Chaer reported that there were three new endoleaks detected on CDU follow-up, all in patients who received an Ancure graft. Only one patient presented with sac enlargement. “One type II endoleak was detected, but this spontaneously resolved at 3 months,” he said. “There were two distal type I endoleaks that were treated with limb extension.”

CDU identified two patients (one with an Ancure and one with an AneruRx graft) who had an increase in their AAA sac size, yet no endoleak was detected. No endoleak was seen on CT scan, but when both patients underwent angiograms, a distal type I endoleak was detected in one patient.

There were no ruptures or graft occlusions observed during the follow-up period. Eight patients died. One was an aneurysm-related death following an Ancure explantation for infection that occurred 4 years post EVAR; two were related to malignancy, and five were related to acute myocardial infarctions.

The cumulative freedom from secondary intervention after the switch to CDU was 98% at 4 years.

In order to determine the applicability of the switch criteria for a full cohort of EVAR patients, the researchers examined 196 consecutive EVAR patients in 2004. Of these, 86 (44%) had been switched to CDU surveillance, whereas the remaining 110 were still followed with CT scan. At the 6-month follow-up, only 1.5% of patients followed with CT scan met the current criteria for the switch to CDU-only surveillance. But the proportion at 1, 2, and 3 years was 55%, 86%, and 97%, respectively.

“CDU-only surveillance is safe and can be initiated early after treatment on patients with a shrinking or a stable AAA sac,” he concluded. “Most patients treated with EVAR are eligible for this modality. After the 1 year follow-up, we do recommend that CT scanning should only be selectively utilized in patients treated with EVAR. This policy should result in cost-saving advantages and avoid the complications associated with CT.”

Dr. Chaer disclosed he had no relevant conflicts.

SAN DIEGO — Postendovascular aneurysm repair surveillance, with color flow duplex ultrasound only, is a safe alternative to the current standard practice of follow-up CT with contrast, results from a single-center study showed.

After endovascular aneurysm repair (EVAR), “CT follow-up is associated with significant risk, including increased cost, contrast nephropathy, contrast allergy, and radiation exposure,” Dr. Rabih A. Chaer said at the Vascular Annual Meeting. “Alternative follow-up methods have been proposed, including color flow duplex ultrasound, MRI, and contrast-enhanced ultrasound. Of all these modalities, it's clear that simple color flow duplex ultrasound is the most readily available, the cheapest, and the least invasive.”

He and his associates in the division of vascular surgery at the University of Pittsburgh Medical Center studied 184 patients who were switched to color flow duplex ultrasound (CDU) surveillance in 2003 as an alternative to CT. Selective CT scanning was used only for new endoleaks or for patients who presented with an enlarging abdominal aortic aneurysm (AAA) sac. Only patients with at least 1 year of follow-up were included.

Criteria for switch to CDU included patients with a residual AAA sac of 4 cm or less anytime after the first year of follow-up, patients with a stable AAA sac size for 2 years, or patients with a stable type II endoleak for 2 years. The average CDU study duration was 20 minutes. The researchers used a GE Logiq 9 machine with a 3.5-MHz curve probe.

Of the 184 patients, 13 had an active stable type II endoleak, 23 had a prior endoleak that was treated or that resolved spontaneously. The mean follow-up on CDU was 24 months. Of the 184 grafts, 76 were Ancure, 58 were Zenith, 39 were Excluder, 7 were AneuRx, and 4 were Lifepath.

Dr. Chaer reported that there were three new endoleaks detected on CDU follow-up, all in patients who received an Ancure graft. Only one patient presented with sac enlargement. “One type II endoleak was detected, but this spontaneously resolved at 3 months,” he said. “There were two distal type I endoleaks that were treated with limb extension.”

CDU identified two patients (one with an Ancure and one with an AneruRx graft) who had an increase in their AAA sac size, yet no endoleak was detected. No endoleak was seen on CT scan, but when both patients underwent angiograms, a distal type I endoleak was detected in one patient.

There were no ruptures or graft occlusions observed during the follow-up period. Eight patients died. One was an aneurysm-related death following an Ancure explantation for infection that occurred 4 years post EVAR; two were related to malignancy, and five were related to acute myocardial infarctions.

The cumulative freedom from secondary intervention after the switch to CDU was 98% at 4 years.

In order to determine the applicability of the switch criteria for a full cohort of EVAR patients, the researchers examined 196 consecutive EVAR patients in 2004. Of these, 86 (44%) had been switched to CDU surveillance, whereas the remaining 110 were still followed with CT scan. At the 6-month follow-up, only 1.5% of patients followed with CT scan met the current criteria for the switch to CDU-only surveillance. But the proportion at 1, 2, and 3 years was 55%, 86%, and 97%, respectively.

“CDU-only surveillance is safe and can be initiated early after treatment on patients with a shrinking or a stable AAA sac,” he concluded. “Most patients treated with EVAR are eligible for this modality. After the 1 year follow-up, we do recommend that CT scanning should only be selectively utilized in patients treated with EVAR. This policy should result in cost-saving advantages and avoid the complications associated with CT.”

Dr. Chaer disclosed he had no relevant conflicts.

SAN DIEGO — Postendovascular aneurysm repair surveillance, with color flow duplex ultrasound only, is a safe alternative to the current standard practice of follow-up CT with contrast, results from a single-center study showed.

After endovascular aneurysm repair (EVAR), “CT follow-up is associated with significant risk, including increased cost, contrast nephropathy, contrast allergy, and radiation exposure,” Dr. Rabih A. Chaer said at the Vascular Annual Meeting. “Alternative follow-up methods have been proposed, including color flow duplex ultrasound, MRI, and contrast-enhanced ultrasound. Of all these modalities, it's clear that simple color flow duplex ultrasound is the most readily available, the cheapest, and the least invasive.”

He and his associates in the division of vascular surgery at the University of Pittsburgh Medical Center studied 184 patients who were switched to color flow duplex ultrasound (CDU) surveillance in 2003 as an alternative to CT. Selective CT scanning was used only for new endoleaks or for patients who presented with an enlarging abdominal aortic aneurysm (AAA) sac. Only patients with at least 1 year of follow-up were included.

Criteria for switch to CDU included patients with a residual AAA sac of 4 cm or less anytime after the first year of follow-up, patients with a stable AAA sac size for 2 years, or patients with a stable type II endoleak for 2 years. The average CDU study duration was 20 minutes. The researchers used a GE Logiq 9 machine with a 3.5-MHz curve probe.

Of the 184 patients, 13 had an active stable type II endoleak, 23 had a prior endoleak that was treated or that resolved spontaneously. The mean follow-up on CDU was 24 months. Of the 184 grafts, 76 were Ancure, 58 were Zenith, 39 were Excluder, 7 were AneuRx, and 4 were Lifepath.

Dr. Chaer reported that there were three new endoleaks detected on CDU follow-up, all in patients who received an Ancure graft. Only one patient presented with sac enlargement. “One type II endoleak was detected, but this spontaneously resolved at 3 months,” he said. “There were two distal type I endoleaks that were treated with limb extension.”

CDU identified two patients (one with an Ancure and one with an AneruRx graft) who had an increase in their AAA sac size, yet no endoleak was detected. No endoleak was seen on CT scan, but when both patients underwent angiograms, a distal type I endoleak was detected in one patient.

There were no ruptures or graft occlusions observed during the follow-up period. Eight patients died. One was an aneurysm-related death following an Ancure explantation for infection that occurred 4 years post EVAR; two were related to malignancy, and five were related to acute myocardial infarctions.

The cumulative freedom from secondary intervention after the switch to CDU was 98% at 4 years.

In order to determine the applicability of the switch criteria for a full cohort of EVAR patients, the researchers examined 196 consecutive EVAR patients in 2004. Of these, 86 (44%) had been switched to CDU surveillance, whereas the remaining 110 were still followed with CT scan. At the 6-month follow-up, only 1.5% of patients followed with CT scan met the current criteria for the switch to CDU-only surveillance. But the proportion at 1, 2, and 3 years was 55%, 86%, and 97%, respectively.

“CDU-only surveillance is safe and can be initiated early after treatment on patients with a shrinking or a stable AAA sac,” he concluded. “Most patients treated with EVAR are eligible for this modality. After the 1 year follow-up, we do recommend that CT scanning should only be selectively utilized in patients treated with EVAR. This policy should result in cost-saving advantages and avoid the complications associated with CT.”

Dr. Chaer disclosed he had no relevant conflicts.

SAN DIEGO — Use of Biobrane wound dressing in pediatric burn patients resulted in a short hospital stay and follow-up as an outpatient with few complications, results from a single-center study demonstrated.

Researchers reviewed the medical charts of 116 pediatric burn patients aged 0–18 years who received Biobrane wound dressing at the University Hospital trauma center in San Antonio, Tex., between 2002 and 2007.

Biobrane (Bertek Pharmaceuticals) is a synthetic nylon mesh that is bonded to silicone and coated with collagen peptides. It functions as an analogue to the dermis and its pores allow exudate to be drained. It has been shown to be a reasonable option in children, Dr. Cristiane M. Ueno said at the annual meeting of the Wound Healing Society.

The dressing "usually can be trimmed away after 1 week as the wound heals, decreasing the healing time when compared with some other dressings," Dr. Ueno of the University of Texas Health Science Center at San Antonio, said.

The average age of patients was 5 years, males outnumbered females 2:1, and more than two-thirds (68%) were Hispanic. Fifty-two percent of cases were scald injuries and 70% of the patients had second-degree burns.

Of the 116 patients who received Biobrane dressing, 58 had sustained burns to the upper extremity. More than two-thirds were admitted to the hospital for only 1–2 days for dressing care and instruction on care of the injury. Only seven complications occurred from the use of Biobrane, including one case of bacteremia, two cases of local infection, two cases of cellulitis, and two cases of fever, Dr. Ueno said at the meeting, held in conjunction with a symposium on advanced wound care.

The majority of patients needed only oral pain medications or mild conscious sedation, not general anesthesia, while undergoing debridement and Biobrane application and subsequent dressing changes. This, combined with the low risk of complications, suggests that the dressing could lower costs and reduce hospital stays in the pediatric burn population, said Dr. Ueno, who had no conflicts to disclose.

The child's burn is first cleaned with chlorhexidine and then bullae and nonviable tissue are removed (left). A Biobrane glove is then placed over the hand (right). Photos courtesy Dr. Cristiane M. Ueno

SAN DIEGO — Use of Biobrane wound dressing in pediatric burn patients resulted in a short hospital stay and follow-up as an outpatient with few complications, results from a single-center study demonstrated.

Researchers reviewed the medical charts of 116 pediatric burn patients aged 0–18 years who received Biobrane wound dressing at the University Hospital trauma center in San Antonio, Tex., between 2002 and 2007.

Biobrane (Bertek Pharmaceuticals) is a synthetic nylon mesh that is bonded to silicone and coated with collagen peptides. It functions as an analogue to the dermis and its pores allow exudate to be drained. It has been shown to be a reasonable option in children, Dr. Cristiane M. Ueno said at the annual meeting of the Wound Healing Society.

The dressing "usually can be trimmed away after 1 week as the wound heals, decreasing the healing time when compared with some other dressings," Dr. Ueno of the University of Texas Health Science Center at San Antonio, said.

The average age of patients was 5 years, males outnumbered females 2:1, and more than two-thirds (68%) were Hispanic. Fifty-two percent of cases were scald injuries and 70% of the patients had second-degree burns.

Of the 116 patients who received Biobrane dressing, 58 had sustained burns to the upper extremity. More than two-thirds were admitted to the hospital for only 1–2 days for dressing care and instruction on care of the injury. Only seven complications occurred from the use of Biobrane, including one case of bacteremia, two cases of local infection, two cases of cellulitis, and two cases of fever, Dr. Ueno said at the meeting, held in conjunction with a symposium on advanced wound care.

The majority of patients needed only oral pain medications or mild conscious sedation, not general anesthesia, while undergoing debridement and Biobrane application and subsequent dressing changes. This, combined with the low risk of complications, suggests that the dressing could lower costs and reduce hospital stays in the pediatric burn population, said Dr. Ueno, who had no conflicts to disclose.

The child's burn is first cleaned with chlorhexidine and then bullae and nonviable tissue are removed (left). A Biobrane glove is then placed over the hand (right). Photos courtesy Dr. Cristiane M. Ueno

SAN DIEGO — Use of Biobrane wound dressing in pediatric burn patients resulted in a short hospital stay and follow-up as an outpatient with few complications, results from a single-center study demonstrated.

Researchers reviewed the medical charts of 116 pediatric burn patients aged 0–18 years who received Biobrane wound dressing at the University Hospital trauma center in San Antonio, Tex., between 2002 and 2007.

Biobrane (Bertek Pharmaceuticals) is a synthetic nylon mesh that is bonded to silicone and coated with collagen peptides. It functions as an analogue to the dermis and its pores allow exudate to be drained. It has been shown to be a reasonable option in children, Dr. Cristiane M. Ueno said at the annual meeting of the Wound Healing Society.

The dressing "usually can be trimmed away after 1 week as the wound heals, decreasing the healing time when compared with some other dressings," Dr. Ueno of the University of Texas Health Science Center at San Antonio, said.

The average age of patients was 5 years, males outnumbered females 2:1, and more than two-thirds (68%) were Hispanic. Fifty-two percent of cases were scald injuries and 70% of the patients had second-degree burns.

Of the 116 patients who received Biobrane dressing, 58 had sustained burns to the upper extremity. More than two-thirds were admitted to the hospital for only 1–2 days for dressing care and instruction on care of the injury. Only seven complications occurred from the use of Biobrane, including one case of bacteremia, two cases of local infection, two cases of cellulitis, and two cases of fever, Dr. Ueno said at the meeting, held in conjunction with a symposium on advanced wound care.

The majority of patients needed only oral pain medications or mild conscious sedation, not general anesthesia, while undergoing debridement and Biobrane application and subsequent dressing changes. This, combined with the low risk of complications, suggests that the dressing could lower costs and reduce hospital stays in the pediatric burn population, said Dr. Ueno, who had no conflicts to disclose.

The child's burn is first cleaned with chlorhexidine and then bullae and nonviable tissue are removed (left). A Biobrane glove is then placed over the hand (right). Photos courtesy Dr. Cristiane M. Ueno

SAN DIEGO — Although fluid intake can be safely increased in nursing home residents who have, or are at risk for, pressure ulcers and do not routinely ingest the prescribed amount of fluid, levels of subcutaneous oxygen may remain low, results from a multicenter study demonstrated.

"In the nursing home population, hydration is a serious issue," Nancy A. Stotts, R.N., Ed.D., said at the annual meeting of the Wound Healing Society. "Some of the estimates are that up to half of all nursing home residents are underhydrated."

The investigators recorded routine fluid intake for 5 days in 64 residents of five nursing homes in Northern California. The residents were then randomized to receive, for 5 days, the target amount of fluid prescribed by their physician or the target amount plus 10 mL/kg of body weight, said Dr. Stotts, professor of nursing at the University of California, San Francisco.

They also evaluated levels of subcutaneous oxygen in all study participants for 3 days during treatment. Hypovolemia was defined as 45 mm Hg or less, or a less-than-20% increase in response to an oxygen challenge.

Patients' mean age was 79 years; most were female (38) and cognitively impaired (51). Mean baseline daily fluid intake was 1,374 cc for the group who received prescribed fluid, and 1,707 cc for those who were randomized to the extra fluid. After treatment, the mean daily fluid intake increased significantly for both groups: to 1,787 cc for the group who received prescribed fluid, and to 2,380 cc for those who received the extra fluid.

The mean level of subcutaneous oxygen, however, was 40 mm Hg for patients in the target prescribed group, and 36 mm Hg for patients in the group that received supplemental fluid. Subcutaneous oxygen levels less than 45 mm Hg indicate tissue hypoxia that may be caused by hypovolemia, Dr. Stotts said at the meeting, which was held in conjunction with a symposium on advanced wound care.

No cases of fluid overload or heart failure were observed.

Increased fluid intake "did not reverse the low subcutaneous oxygen, perhaps because of chronic underhydration and osmoreceptor reset," she said. "Further work needs to address the optimal dose and duration of fluid for older adults and other factors that contribute to the low subcutaneous oxygen."

The study was funded by the National Institutes of Health.

SAN DIEGO — Although fluid intake can be safely increased in nursing home residents who have, or are at risk for, pressure ulcers and do not routinely ingest the prescribed amount of fluid, levels of subcutaneous oxygen may remain low, results from a multicenter study demonstrated.

"In the nursing home population, hydration is a serious issue," Nancy A. Stotts, R.N., Ed.D., said at the annual meeting of the Wound Healing Society. "Some of the estimates are that up to half of all nursing home residents are underhydrated."

The investigators recorded routine fluid intake for 5 days in 64 residents of five nursing homes in Northern California. The residents were then randomized to receive, for 5 days, the target amount of fluid prescribed by their physician or the target amount plus 10 mL/kg of body weight, said Dr. Stotts, professor of nursing at the University of California, San Francisco.

They also evaluated levels of subcutaneous oxygen in all study participants for 3 days during treatment. Hypovolemia was defined as 45 mm Hg or less, or a less-than-20% increase in response to an oxygen challenge.

Patients' mean age was 79 years; most were female (38) and cognitively impaired (51). Mean baseline daily fluid intake was 1,374 cc for the group who received prescribed fluid, and 1,707 cc for those who were randomized to the extra fluid. After treatment, the mean daily fluid intake increased significantly for both groups: to 1,787 cc for the group who received prescribed fluid, and to 2,380 cc for those who received the extra fluid.

The mean level of subcutaneous oxygen, however, was 40 mm Hg for patients in the target prescribed group, and 36 mm Hg for patients in the group that received supplemental fluid. Subcutaneous oxygen levels less than 45 mm Hg indicate tissue hypoxia that may be caused by hypovolemia, Dr. Stotts said at the meeting, which was held in conjunction with a symposium on advanced wound care.

No cases of fluid overload or heart failure were observed.

Increased fluid intake "did not reverse the low subcutaneous oxygen, perhaps because of chronic underhydration and osmoreceptor reset," she said. "Further work needs to address the optimal dose and duration of fluid for older adults and other factors that contribute to the low subcutaneous oxygen."

The study was funded by the National Institutes of Health.

SAN DIEGO — Although fluid intake can be safely increased in nursing home residents who have, or are at risk for, pressure ulcers and do not routinely ingest the prescribed amount of fluid, levels of subcutaneous oxygen may remain low, results from a multicenter study demonstrated.

"In the nursing home population, hydration is a serious issue," Nancy A. Stotts, R.N., Ed.D., said at the annual meeting of the Wound Healing Society. "Some of the estimates are that up to half of all nursing home residents are underhydrated."

The investigators recorded routine fluid intake for 5 days in 64 residents of five nursing homes in Northern California. The residents were then randomized to receive, for 5 days, the target amount of fluid prescribed by their physician or the target amount plus 10 mL/kg of body weight, said Dr. Stotts, professor of nursing at the University of California, San Francisco.

They also evaluated levels of subcutaneous oxygen in all study participants for 3 days during treatment. Hypovolemia was defined as 45 mm Hg or less, or a less-than-20% increase in response to an oxygen challenge.

Patients' mean age was 79 years; most were female (38) and cognitively impaired (51). Mean baseline daily fluid intake was 1,374 cc for the group who received prescribed fluid, and 1,707 cc for those who were randomized to the extra fluid. After treatment, the mean daily fluid intake increased significantly for both groups: to 1,787 cc for the group who received prescribed fluid, and to 2,380 cc for those who received the extra fluid.

The mean level of subcutaneous oxygen, however, was 40 mm Hg for patients in the target prescribed group, and 36 mm Hg for patients in the group that received supplemental fluid. Subcutaneous oxygen levels less than 45 mm Hg indicate tissue hypoxia that may be caused by hypovolemia, Dr. Stotts said at the meeting, which was held in conjunction with a symposium on advanced wound care.

No cases of fluid overload or heart failure were observed.

Increased fluid intake "did not reverse the low subcutaneous oxygen, perhaps because of chronic underhydration and osmoreceptor reset," she said. "Further work needs to address the optimal dose and duration of fluid for older adults and other factors that contribute to the low subcutaneous oxygen."

The study was funded by the National Institutes of Health.

SAN DIEGO — High-voltage, pulsed electrical stimulation is an effective adjunct to multidisciplinary attempts at limb salvage in diabetic patients with complex lower extremity wounds, results from a small study demonstrated.

Of 45 wounds in 30 patients, 78% of the wounds healed in a mean of 14 weeks using the electrical stimulation system, Dr. Jeremy J. Burdge reported at the annual meeting of the Wound Healing Society.

"This is a preliminary study," said Dr. Burdge, a plastic and reconstructive surgeon who practices in Columbus, Ohio. "Further research is warranted."

He and his associates evaluated the efficacy of a high-voltage electrical stimulation system manufactured by MicroVas Technologies Inc. (Tulsa, Okla.) in patients who failed to improve despite multidisciplinary treatment approaches, including vascular evaluation and surgical intervention as indicated, aggressive off loading, bacterial infection control, and wound debridement.

"There is a variety of ways in which people speculate that high-voltage pulsed current has improved wound healing," Dr. Burdge said at the meeting, which was held in conjunction with a symposium on advanced wound care. "They fall into several groups of either increasing blood flow through promoting microcirculation, increasing wound healing through attraction of proliferating different cell types, or bacteria inhibition by this type of pulsed current."

More than half (57%) of the patients in the study were men; their mean age was 66 years. Comorbidities included neuropathy (84%), peripheral vascular disease (77%), cardiac disease (37%), and infection (33%). "This was a fairly high-risk group of patients," Dr. Burdge noted. "The mean hemoglobin A1c level was 8.2% and nine patients had undergone previous amputation."

The mean age of wounds was 25 weeks, and mean surface area was 7.8 cm

Emitter pads were placed over each wound. Stimulation was delivered for 45 minutes 2–3 times per week by a narrow pulsed current with a width of 80–100 microseconds at a frequency of 55 Hz. Pulses were delivered for 1.5 seconds, with a 1.5-second interval between pulses. The amplitude was individualized for each patient to maximize fused tetanic muscular contraction.

Dr. Burdge reported that the mean number of stimulation treatments per wound was 23 and that 35 (78%) of the wounds healed in a mean of 14 weeks.

Wound healing was defined as either complete epithelialization of the wound or closure with supplemental skin grafts.

Wounds in eight patients failed to heal. One required a metatarsal amputation, four had below-the-knee amputations, one had necrotic tissue and was lost to follow-up, and two patients are continuing further therapy.

At a mean follow-up of 40 weeks, 88% of wounds had no evidence of recurrence. "We did have four patients who had recurrent wounds," he said. "Two went on to complete healing. One had osteomyelitis and went on to a below-the-knee amputation."

Treatment is pending for the fourth wound that recurred.

Dr. Burdge had no conflicts to disclose.

A 3-month-old heel wound is seen in a 66-year-old male with diabetes and neuropathy.

After 22 treatments and a supplemental skin graft, the wound was considered healed. Photos courtesy Dr. Jeremy J. Burdge

SAN DIEGO — High-voltage, pulsed electrical stimulation is an effective adjunct to multidisciplinary attempts at limb salvage in diabetic patients with complex lower extremity wounds, results from a small study demonstrated.

Of 45 wounds in 30 patients, 78% of the wounds healed in a mean of 14 weeks using the electrical stimulation system, Dr. Jeremy J. Burdge reported at the annual meeting of the Wound Healing Society.

"This is a preliminary study," said Dr. Burdge, a plastic and reconstructive surgeon who practices in Columbus, Ohio. "Further research is warranted."

He and his associates evaluated the efficacy of a high-voltage electrical stimulation system manufactured by MicroVas Technologies Inc. (Tulsa, Okla.) in patients who failed to improve despite multidisciplinary treatment approaches, including vascular evaluation and surgical intervention as indicated, aggressive off loading, bacterial infection control, and wound debridement.

"There is a variety of ways in which people speculate that high-voltage pulsed current has improved wound healing," Dr. Burdge said at the meeting, which was held in conjunction with a symposium on advanced wound care. "They fall into several groups of either increasing blood flow through promoting microcirculation, increasing wound healing through attraction of proliferating different cell types, or bacteria inhibition by this type of pulsed current."

More than half (57%) of the patients in the study were men; their mean age was 66 years. Comorbidities included neuropathy (84%), peripheral vascular disease (77%), cardiac disease (37%), and infection (33%). "This was a fairly high-risk group of patients," Dr. Burdge noted. "The mean hemoglobin A1c level was 8.2% and nine patients had undergone previous amputation."

The mean age of wounds was 25 weeks, and mean surface area was 7.8 cm

Emitter pads were placed over each wound. Stimulation was delivered for 45 minutes 2–3 times per week by a narrow pulsed current with a width of 80–100 microseconds at a frequency of 55 Hz. Pulses were delivered for 1.5 seconds, with a 1.5-second interval between pulses. The amplitude was individualized for each patient to maximize fused tetanic muscular contraction.

Dr. Burdge reported that the mean number of stimulation treatments per wound was 23 and that 35 (78%) of the wounds healed in a mean of 14 weeks.

Wound healing was defined as either complete epithelialization of the wound or closure with supplemental skin grafts.

Wounds in eight patients failed to heal. One required a metatarsal amputation, four had below-the-knee amputations, one had necrotic tissue and was lost to follow-up, and two patients are continuing further therapy.

At a mean follow-up of 40 weeks, 88% of wounds had no evidence of recurrence. "We did have four patients who had recurrent wounds," he said. "Two went on to complete healing. One had osteomyelitis and went on to a below-the-knee amputation."

Treatment is pending for the fourth wound that recurred.

Dr. Burdge had no conflicts to disclose.

A 3-month-old heel wound is seen in a 66-year-old male with diabetes and neuropathy.

After 22 treatments and a supplemental skin graft, the wound was considered healed. Photos courtesy Dr. Jeremy J. Burdge

SAN DIEGO — High-voltage, pulsed electrical stimulation is an effective adjunct to multidisciplinary attempts at limb salvage in diabetic patients with complex lower extremity wounds, results from a small study demonstrated.

Of 45 wounds in 30 patients, 78% of the wounds healed in a mean of 14 weeks using the electrical stimulation system, Dr. Jeremy J. Burdge reported at the annual meeting of the Wound Healing Society.

"This is a preliminary study," said Dr. Burdge, a plastic and reconstructive surgeon who practices in Columbus, Ohio. "Further research is warranted."

He and his associates evaluated the efficacy of a high-voltage electrical stimulation system manufactured by MicroVas Technologies Inc. (Tulsa, Okla.) in patients who failed to improve despite multidisciplinary treatment approaches, including vascular evaluation and surgical intervention as indicated, aggressive off loading, bacterial infection control, and wound debridement.

"There is a variety of ways in which people speculate that high-voltage pulsed current has improved wound healing," Dr. Burdge said at the meeting, which was held in conjunction with a symposium on advanced wound care. "They fall into several groups of either increasing blood flow through promoting microcirculation, increasing wound healing through attraction of proliferating different cell types, or bacteria inhibition by this type of pulsed current."

More than half (57%) of the patients in the study were men; their mean age was 66 years. Comorbidities included neuropathy (84%), peripheral vascular disease (77%), cardiac disease (37%), and infection (33%). "This was a fairly high-risk group of patients," Dr. Burdge noted. "The mean hemoglobin A1c level was 8.2% and nine patients had undergone previous amputation."

The mean age of wounds was 25 weeks, and mean surface area was 7.8 cm

Emitter pads were placed over each wound. Stimulation was delivered for 45 minutes 2–3 times per week by a narrow pulsed current with a width of 80–100 microseconds at a frequency of 55 Hz. Pulses were delivered for 1.5 seconds, with a 1.5-second interval between pulses. The amplitude was individualized for each patient to maximize fused tetanic muscular contraction.

Dr. Burdge reported that the mean number of stimulation treatments per wound was 23 and that 35 (78%) of the wounds healed in a mean of 14 weeks.

Wound healing was defined as either complete epithelialization of the wound or closure with supplemental skin grafts.

Wounds in eight patients failed to heal. One required a metatarsal amputation, four had below-the-knee amputations, one had necrotic tissue and was lost to follow-up, and two patients are continuing further therapy.

At a mean follow-up of 40 weeks, 88% of wounds had no evidence of recurrence. "We did have four patients who had recurrent wounds," he said. "Two went on to complete healing. One had osteomyelitis and went on to a below-the-knee amputation."

Treatment is pending for the fourth wound that recurred.

Dr. Burdge had no conflicts to disclose.

A 3-month-old heel wound is seen in a 66-year-old male with diabetes and neuropathy.

After 22 treatments and a supplemental skin graft, the wound was considered healed. Photos courtesy Dr. Jeremy J. Burdge

SAN DIEGO — A new absorbent silver barrier dressing may help prevent and manage complications of percutaneous endoscopic gastrostomy sites, according to the results of a small study.

In a poster presented at the annual meeting of the Wound Healing Society, researchers led by Kathy Leak, R.N., described use of Allevyn Ag dressing (Smith & Nephew) on percutaneous endoscopic gastrostomy (PEG) sites in five patients.

Before May 2008, the protocol for patients who required PEG sites was to apply a silver binding dressing to help reduce the risks and complications associated with PEG site management. That product, however, "has limitations with regard to its absorption capability, cannot be cut to shape, and does not have the capability of foam dressings in helping to reduce overgranulation," wrote Ms. Leak and her associates at Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Doncaster, England.

"Also, it requires daily dressing changes and a secondary foam dressing to absorb exudate, both of which are cost prohibitive," they noted.

The silver from the Allevyn Ag dressing is activated by fluid from the wound and then kills the bacteria. At the same time, excess fluid is managed by the dressing.

For the trial, Ms. Leak and her associates monitored five patients with PEG sites treated with Allevyn Ag for complications including erythema, overgranulation, high levels of exudate, soreness, and odor from the insertion site.

In all five cases, the product effectively managed exudate and odor, prevented excoriation to the surrounding skin, and provided enhanced comfort, compared with the previous treatment protocol, she said at the meeting, held in conjunction with a symposium on advanced wound care.

One study participant had been treated for cancer of the esophagus and presented with high levels of exudate that were starting to cause soreness and maceration of the peristomal area. He required a single application of Allevyn Ag, which he left in place for 4 days without incident.

Another study participant had a long-standing malabsorption problem and often developed abscesses around the stoma. After treatment with Allevyn Ag for 2 weeks with twice-daily dressing changes, the abscesses completely resolved.

"The dressing exceeded all our expectations on its speed of action to lower bacterial colonization and improve periskin conditions," Ms. Leak said in an interview, noting that, as of May 2008, patients at Doncaster and Bassetlaw Hospitals who have problematic PEG sites receive Allevyn Ag instead of the silver binding dressing.

Smith & Nephew supplied the Allevyn Ag used for the study. Ms. Leak has no financial interest in the company and reported no other relevant conflicts.

The new silver barrier dressing 'exceeded all our expectations on its speed of action.' MS. LEAK

High levels of exudate were starting to cause soreness and maceration.

The site is shown after a single 4-day application of the silver barrier dressing. Photos courtesy Kathy Leak, R.N.

SAN DIEGO — A new absorbent silver barrier dressing may help prevent and manage complications of percutaneous endoscopic gastrostomy sites, according to the results of a small study.

In a poster presented at the annual meeting of the Wound Healing Society, researchers led by Kathy Leak, R.N., described use of Allevyn Ag dressing (Smith & Nephew) on percutaneous endoscopic gastrostomy (PEG) sites in five patients.

Before May 2008, the protocol for patients who required PEG sites was to apply a silver binding dressing to help reduce the risks and complications associated with PEG site management. That product, however, "has limitations with regard to its absorption capability, cannot be cut to shape, and does not have the capability of foam dressings in helping to reduce overgranulation," wrote Ms. Leak and her associates at Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Doncaster, England.

"Also, it requires daily dressing changes and a secondary foam dressing to absorb exudate, both of which are cost prohibitive," they noted.

The silver from the Allevyn Ag dressing is activated by fluid from the wound and then kills the bacteria. At the same time, excess fluid is managed by the dressing.

For the trial, Ms. Leak and her associates monitored five patients with PEG sites treated with Allevyn Ag for complications including erythema, overgranulation, high levels of exudate, soreness, and odor from the insertion site.

In all five cases, the product effectively managed exudate and odor, prevented excoriation to the surrounding skin, and provided enhanced comfort, compared with the previous treatment protocol, she said at the meeting, held in conjunction with a symposium on advanced wound care.

One study participant had been treated for cancer of the esophagus and presented with high levels of exudate that were starting to cause soreness and maceration of the peristomal area. He required a single application of Allevyn Ag, which he left in place for 4 days without incident.

Another study participant had a long-standing malabsorption problem and often developed abscesses around the stoma. After treatment with Allevyn Ag for 2 weeks with twice-daily dressing changes, the abscesses completely resolved.

"The dressing exceeded all our expectations on its speed of action to lower bacterial colonization and improve periskin conditions," Ms. Leak said in an interview, noting that, as of May 2008, patients at Doncaster and Bassetlaw Hospitals who have problematic PEG sites receive Allevyn Ag instead of the silver binding dressing.

Smith & Nephew supplied the Allevyn Ag used for the study. Ms. Leak has no financial interest in the company and reported no other relevant conflicts.

The new silver barrier dressing 'exceeded all our expectations on its speed of action.' MS. LEAK

High levels of exudate were starting to cause soreness and maceration.

The site is shown after a single 4-day application of the silver barrier dressing. Photos courtesy Kathy Leak, R.N.

SAN DIEGO — A new absorbent silver barrier dressing may help prevent and manage complications of percutaneous endoscopic gastrostomy sites, according to the results of a small study.

In a poster presented at the annual meeting of the Wound Healing Society, researchers led by Kathy Leak, R.N., described use of Allevyn Ag dressing (Smith & Nephew) on percutaneous endoscopic gastrostomy (PEG) sites in five patients.

Before May 2008, the protocol for patients who required PEG sites was to apply a silver binding dressing to help reduce the risks and complications associated with PEG site management. That product, however, "has limitations with regard to its absorption capability, cannot be cut to shape, and does not have the capability of foam dressings in helping to reduce overgranulation," wrote Ms. Leak and her associates at Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Doncaster, England.

"Also, it requires daily dressing changes and a secondary foam dressing to absorb exudate, both of which are cost prohibitive," they noted.

The silver from the Allevyn Ag dressing is activated by fluid from the wound and then kills the bacteria. At the same time, excess fluid is managed by the dressing.

For the trial, Ms. Leak and her associates monitored five patients with PEG sites treated with Allevyn Ag for complications including erythema, overgranulation, high levels of exudate, soreness, and odor from the insertion site.

In all five cases, the product effectively managed exudate and odor, prevented excoriation to the surrounding skin, and provided enhanced comfort, compared with the previous treatment protocol, she said at the meeting, held in conjunction with a symposium on advanced wound care.

One study participant had been treated for cancer of the esophagus and presented with high levels of exudate that were starting to cause soreness and maceration of the peristomal area. He required a single application of Allevyn Ag, which he left in place for 4 days without incident.

Another study participant had a long-standing malabsorption problem and often developed abscesses around the stoma. After treatment with Allevyn Ag for 2 weeks with twice-daily dressing changes, the abscesses completely resolved.

"The dressing exceeded all our expectations on its speed of action to lower bacterial colonization and improve periskin conditions," Ms. Leak said in an interview, noting that, as of May 2008, patients at Doncaster and Bassetlaw Hospitals who have problematic PEG sites receive Allevyn Ag instead of the silver binding dressing.

Smith & Nephew supplied the Allevyn Ag used for the study. Ms. Leak has no financial interest in the company and reported no other relevant conflicts.

The new silver barrier dressing 'exceeded all our expectations on its speed of action.' MS. LEAK

High levels of exudate were starting to cause soreness and maceration.

The site is shown after a single 4-day application of the silver barrier dressing. Photos courtesy Kathy Leak, R.N.

SAN DIEGO — WoundStat, a hemostatic agent approved in August 2007, is superior to other combat hemostatic agents used for combat and civilian trauma, results from a swine study demonstrated.

The product, marketed by TraumaCure Inc., consists of a pure granular smectite composite. In the study, it produced hemostasis in the face of high-pressure arterial bleeding within 3 minutes. WoundStat is currently used as a life-saving tool by the U.S. military in Afghanistan.

"The study protocol was to hold for 3 minutes, but in subsequent studies and observations, 2 minutes was more than sufficient for WoundStat to stop the hemorrhage," Robert F. Diegelmann, Ph.D., said at the annual meeting of the Wound Healing Society. It also would be simple for the victim or medic to apply.

Dr. Diegelmann, professor of biochemistry and molecular biology, anatomy, and emergency medicine at Virginia Commonwealth University, Richmond, led the research team that developed WoundStat at the university's reanimation engineering shock center.

He and his associates compared the performance of WoundStat with Z-Medica Corp.'s QuikClot zeolite granules and QuikClot zeolite Advance Clotting Sponge, HemCon Medical Technologies Inc.'s chitosan bandage, and the U.S. Army field gauze bandage in a lethal vascular injury model developed by the Army (J. Trauma 2007;63:276–84). The protocol involved creating a 6-mm arteriotomy in a vessel of 25 male swine. After 45 seconds of hemorrhage, five animals each were randomized to be treated with the Army field bandage (control group), QuikClot zeolite granules, the QuikClot zeolite Advance Clotting Sponge, the HemCon chitosan bandage, or WoundStat.

The application of WoundStat, a premixed composite available in 5.5-ounce packages, also involved the application of 200 mm Hg pressure over the product in the wound for 3 minutes.

In all swine, fluid resuscitation began at the time each product was applied, with 500 mL of Hextend, followed by lactated Ringer's solution at 100 mL/min to achieve and maintain a mean arterial blood pressure of 65 mm Hg. The study's primary end points were survival, survival time, posttreatment blood loss, and amount of resuscitation fluid required.

All swine in the WoundStat group survived to 180 minutes and required only a single application, Dr. Diegelmann said at the meeting, held in conjunction with a symposium on advanced wound care. One animal in the HemCon chitosan bandage group survived, but none of the animals in the other groups survived.

He reported that survival and survival times for animals in the WoundStat group were significantly greater, compared with those in all other groups. In addition, posttreatment blood loss and lost-resuscitation fluid volume were significantly less for animals in the WoundStat group, compared with all other groups.

Dr. Diegelmann disclosed that he is a paid consultant for TraumaCure Inc.

The interaction of whole blood and WoundStat resulted in the aggregated red cells and formation of fibrin matrix seen in this scanning electron micrograph (3,300X) of a sample fixed during a span of 1 minute after the addition of the blood. Courtesy Dr. Robert F. Diegelmann

SAN DIEGO — WoundStat, a hemostatic agent approved in August 2007, is superior to other combat hemostatic agents used for combat and civilian trauma, results from a swine study demonstrated.

The product, marketed by TraumaCure Inc., consists of a pure granular smectite composite. In the study, it produced hemostasis in the face of high-pressure arterial bleeding within 3 minutes. WoundStat is currently used as a life-saving tool by the U.S. military in Afghanistan.

"The study protocol was to hold for 3 minutes, but in subsequent studies and observations, 2 minutes was more than sufficient for WoundStat to stop the hemorrhage," Robert F. Diegelmann, Ph.D., said at the annual meeting of the Wound Healing Society. It also would be simple for the victim or medic to apply.

Dr. Diegelmann, professor of biochemistry and molecular biology, anatomy, and emergency medicine at Virginia Commonwealth University, Richmond, led the research team that developed WoundStat at the university's reanimation engineering shock center.

He and his associates compared the performance of WoundStat with Z-Medica Corp.'s QuikClot zeolite granules and QuikClot zeolite Advance Clotting Sponge, HemCon Medical Technologies Inc.'s chitosan bandage, and the U.S. Army field gauze bandage in a lethal vascular injury model developed by the Army (J. Trauma 2007;63:276–84). The protocol involved creating a 6-mm arteriotomy in a vessel of 25 male swine. After 45 seconds of hemorrhage, five animals each were randomized to be treated with the Army field bandage (control group), QuikClot zeolite granules, the QuikClot zeolite Advance Clotting Sponge, the HemCon chitosan bandage, or WoundStat.

The application of WoundStat, a premixed composite available in 5.5-ounce packages, also involved the application of 200 mm Hg pressure over the product in the wound for 3 minutes.

In all swine, fluid resuscitation began at the time each product was applied, with 500 mL of Hextend, followed by lactated Ringer's solution at 100 mL/min to achieve and maintain a mean arterial blood pressure of 65 mm Hg. The study's primary end points were survival, survival time, posttreatment blood loss, and amount of resuscitation fluid required.

All swine in the WoundStat group survived to 180 minutes and required only a single application, Dr. Diegelmann said at the meeting, held in conjunction with a symposium on advanced wound care. One animal in the HemCon chitosan bandage group survived, but none of the animals in the other groups survived.

He reported that survival and survival times for animals in the WoundStat group were significantly greater, compared with those in all other groups. In addition, posttreatment blood loss and lost-resuscitation fluid volume were significantly less for animals in the WoundStat group, compared with all other groups.

Dr. Diegelmann disclosed that he is a paid consultant for TraumaCure Inc.

The interaction of whole blood and WoundStat resulted in the aggregated red cells and formation of fibrin matrix seen in this scanning electron micrograph (3,300X) of a sample fixed during a span of 1 minute after the addition of the blood. Courtesy Dr. Robert F. Diegelmann

SAN DIEGO — WoundStat, a hemostatic agent approved in August 2007, is superior to other combat hemostatic agents used for combat and civilian trauma, results from a swine study demonstrated.

The product, marketed by TraumaCure Inc., consists of a pure granular smectite composite. In the study, it produced hemostasis in the face of high-pressure arterial bleeding within 3 minutes. WoundStat is currently used as a life-saving tool by the U.S. military in Afghanistan.

"The study protocol was to hold for 3 minutes, but in subsequent studies and observations, 2 minutes was more than sufficient for WoundStat to stop the hemorrhage," Robert F. Diegelmann, Ph.D., said at the annual meeting of the Wound Healing Society. It also would be simple for the victim or medic to apply.

Dr. Diegelmann, professor of biochemistry and molecular biology, anatomy, and emergency medicine at Virginia Commonwealth University, Richmond, led the research team that developed WoundStat at the university's reanimation engineering shock center.

He and his associates compared the performance of WoundStat with Z-Medica Corp.'s QuikClot zeolite granules and QuikClot zeolite Advance Clotting Sponge, HemCon Medical Technologies Inc.'s chitosan bandage, and the U.S. Army field gauze bandage in a lethal vascular injury model developed by the Army (J. Trauma 2007;63:276–84). The protocol involved creating a 6-mm arteriotomy in a vessel of 25 male swine. After 45 seconds of hemorrhage, five animals each were randomized to be treated with the Army field bandage (control group), QuikClot zeolite granules, the QuikClot zeolite Advance Clotting Sponge, the HemCon chitosan bandage, or WoundStat.

The application of WoundStat, a premixed composite available in 5.5-ounce packages, also involved the application of 200 mm Hg pressure over the product in the wound for 3 minutes.

In all swine, fluid resuscitation began at the time each product was applied, with 500 mL of Hextend, followed by lactated Ringer's solution at 100 mL/min to achieve and maintain a mean arterial blood pressure of 65 mm Hg. The study's primary end points were survival, survival time, posttreatment blood loss, and amount of resuscitation fluid required.

All swine in the WoundStat group survived to 180 minutes and required only a single application, Dr. Diegelmann said at the meeting, held in conjunction with a symposium on advanced wound care. One animal in the HemCon chitosan bandage group survived, but none of the animals in the other groups survived.

He reported that survival and survival times for animals in the WoundStat group were significantly greater, compared with those in all other groups. In addition, posttreatment blood loss and lost-resuscitation fluid volume were significantly less for animals in the WoundStat group, compared with all other groups.

Dr. Diegelmann disclosed that he is a paid consultant for TraumaCure Inc.

The interaction of whole blood and WoundStat resulted in the aggregated red cells and formation of fibrin matrix seen in this scanning electron micrograph (3,300X) of a sample fixed during a span of 1 minute after the addition of the blood. Courtesy Dr. Robert F. Diegelmann

Finding time for renewal is no easy task for full-time physician Dr. Shaun J. Gillis, a married mother of three children, aged 9, 6, and 3.

That's why she looks forward to her 2-hour dance rehearsals every Thursday night, which she began 3 years ago as an outlet for exercise and stress release.

Dancing “is almost like yoga for my mind or meditation—it's a chance to step away from what I do every day, all day,” said 39-year-old Dr. Gillis, who practices ob.gyn. in Bozeman, Mont. “I'm not mom, and I'm not the doctor. I'm just dancing, minding what my feet are doing. It's relaxing mentally, a chance to step away.”

A Montana native, Dr. Gillis starting dancing competitively as a freshman in high school and went on to join the dance company at Montana State University in Bozeman, where she specialized in lyrical and tap dancing.

Her dancing days were put on hold when she enrolled into medical school at the University of Washington, Seattle. “It was very sad,” she recalled. “With medical school and residency, I was too busy.”

When she relocated back to Bozeman she joined Tanya's Dance Co. in Belgrade, Mont. (www.tanyasdanceco.com

Tap dancing “has become my new favorite. But I also like lyrical dance; it's more expressionistic,” said Dr. Gillis. She's also adept at clogging, which she described as “an American version of Irish folk dancing. It's all about the footwork. There is not a lot of arm movement or upper body motion, but the steps are quite different from Irish folk dancing.”

She also admires the work of the Alvin Ailey American Dance Theater, a New York City-based company that tours extensively.

Tanya's Dance Co.—whose members range in age from 18 to their early 50s—competes with other dance groups in Montana during March and April and stages a local performance in June. Right before the curtain went up at last year's performance someone's child yelled out “Go Mom,” which caused the dancers to erupt with laughter, she recalled.

In the spring of 2007, Dr. Gillis and her teammates received the honor of having the No. 1 tap routine in a statewide competition. Such events represent a chance “to take an individual talent and turn it into a team sport because we compete as a team,” she said. “The judges score you on costumes, makeup, and hair—so everything needs to be very uniform.”

She said she enjoys such camaraderie with other women from all walks of life. “I interact with people that I would never interact with on a daily basis,” she said. “Nobody else in my group is a physician or in the medical profession.”

Dr. Gillis initially worried what her patients would think about their doctor performing dance routines in public, but she is over that now, and explained that many of her patients showered her with support and encouragement.

In fact, some members of the dance team are her patients. “This is a small town, so it happens,” she said.

Her goal is to keep building her skills and to keep dancing as long as she is physically able.

“There are some incredibly difficult tap moves that I watch my teacher do and I'm just in awe,” she said.

Adding that, “I'm constantly striving to see if I can get my feet to move like that or learn a complicated series of steps. It's challenging.”

Dr. Gillis noted that it saddens her to think she went 10 years without dancing, “because it was such a joy to get back into. Being a physician you have to maintain balance and things that you enjoy outside of medicine.”

Dr. Shaun J. Gillis described clogging as an “American version of Irish folk dancing. It's all about the footwork.” Courtesy Dr. Shaun J. Gillis

Finding time for renewal is no easy task for full-time physician Dr. Shaun J. Gillis, a married mother of three children, aged 9, 6, and 3.

That's why she looks forward to her 2-hour dance rehearsals every Thursday night, which she began 3 years ago as an outlet for exercise and stress release.

Dancing “is almost like yoga for my mind or meditation—it's a chance to step away from what I do every day, all day,” said 39-year-old Dr. Gillis, who practices ob.gyn. in Bozeman, Mont. “I'm not mom, and I'm not the doctor. I'm just dancing, minding what my feet are doing. It's relaxing mentally, a chance to step away.”

A Montana native, Dr. Gillis starting dancing competitively as a freshman in high school and went on to join the dance company at Montana State University in Bozeman, where she specialized in lyrical and tap dancing.

Her dancing days were put on hold when she enrolled into medical school at the University of Washington, Seattle. “It was very sad,” she recalled. “With medical school and residency, I was too busy.”

When she relocated back to Bozeman she joined Tanya's Dance Co. in Belgrade, Mont. (www.tanyasdanceco.com

Tap dancing “has become my new favorite. But I also like lyrical dance; it's more expressionistic,” said Dr. Gillis. She's also adept at clogging, which she described as “an American version of Irish folk dancing. It's all about the footwork. There is not a lot of arm movement or upper body motion, but the steps are quite different from Irish folk dancing.”

She also admires the work of the Alvin Ailey American Dance Theater, a New York City-based company that tours extensively.

Tanya's Dance Co.—whose members range in age from 18 to their early 50s—competes with other dance groups in Montana during March and April and stages a local performance in June. Right before the curtain went up at last year's performance someone's child yelled out “Go Mom,” which caused the dancers to erupt with laughter, she recalled.

In the spring of 2007, Dr. Gillis and her teammates received the honor of having the No. 1 tap routine in a statewide competition. Such events represent a chance “to take an individual talent and turn it into a team sport because we compete as a team,” she said. “The judges score you on costumes, makeup, and hair—so everything needs to be very uniform.”

She said she enjoys such camaraderie with other women from all walks of life. “I interact with people that I would never interact with on a daily basis,” she said. “Nobody else in my group is a physician or in the medical profession.”

Dr. Gillis initially worried what her patients would think about their doctor performing dance routines in public, but she is over that now, and explained that many of her patients showered her with support and encouragement.

In fact, some members of the dance team are her patients. “This is a small town, so it happens,” she said.

Her goal is to keep building her skills and to keep dancing as long as she is physically able.

“There are some incredibly difficult tap moves that I watch my teacher do and I'm just in awe,” she said.

Adding that, “I'm constantly striving to see if I can get my feet to move like that or learn a complicated series of steps. It's challenging.”

Dr. Gillis noted that it saddens her to think she went 10 years without dancing, “because it was such a joy to get back into. Being a physician you have to maintain balance and things that you enjoy outside of medicine.”

Dr. Shaun J. Gillis described clogging as an “American version of Irish folk dancing. It's all about the footwork.” Courtesy Dr. Shaun J. Gillis

Finding time for renewal is no easy task for full-time physician Dr. Shaun J. Gillis, a married mother of three children, aged 9, 6, and 3.

That's why she looks forward to her 2-hour dance rehearsals every Thursday night, which she began 3 years ago as an outlet for exercise and stress release.

Dancing “is almost like yoga for my mind or meditation—it's a chance to step away from what I do every day, all day,” said 39-year-old Dr. Gillis, who practices ob.gyn. in Bozeman, Mont. “I'm not mom, and I'm not the doctor. I'm just dancing, minding what my feet are doing. It's relaxing mentally, a chance to step away.”

A Montana native, Dr. Gillis starting dancing competitively as a freshman in high school and went on to join the dance company at Montana State University in Bozeman, where she specialized in lyrical and tap dancing.

Her dancing days were put on hold when she enrolled into medical school at the University of Washington, Seattle. “It was very sad,” she recalled. “With medical school and residency, I was too busy.”

When she relocated back to Bozeman she joined Tanya's Dance Co. in Belgrade, Mont. (www.tanyasdanceco.com

Tap dancing “has become my new favorite. But I also like lyrical dance; it's more expressionistic,” said Dr. Gillis. She's also adept at clogging, which she described as “an American version of Irish folk dancing. It's all about the footwork. There is not a lot of arm movement or upper body motion, but the steps are quite different from Irish folk dancing.”

She also admires the work of the Alvin Ailey American Dance Theater, a New York City-based company that tours extensively.

Tanya's Dance Co.—whose members range in age from 18 to their early 50s—competes with other dance groups in Montana during March and April and stages a local performance in June. Right before the curtain went up at last year's performance someone's child yelled out “Go Mom,” which caused the dancers to erupt with laughter, she recalled.

In the spring of 2007, Dr. Gillis and her teammates received the honor of having the No. 1 tap routine in a statewide competition. Such events represent a chance “to take an individual talent and turn it into a team sport because we compete as a team,” she said. “The judges score you on costumes, makeup, and hair—so everything needs to be very uniform.”

She said she enjoys such camaraderie with other women from all walks of life. “I interact with people that I would never interact with on a daily basis,” she said. “Nobody else in my group is a physician or in the medical profession.”

Dr. Gillis initially worried what her patients would think about their doctor performing dance routines in public, but she is over that now, and explained that many of her patients showered her with support and encouragement.

In fact, some members of the dance team are her patients. “This is a small town, so it happens,” she said.

Her goal is to keep building her skills and to keep dancing as long as she is physically able.

“There are some incredibly difficult tap moves that I watch my teacher do and I'm just in awe,” she said.

Adding that, “I'm constantly striving to see if I can get my feet to move like that or learn a complicated series of steps. It's challenging.”

Dr. Gillis noted that it saddens her to think she went 10 years without dancing, “because it was such a joy to get back into. Being a physician you have to maintain balance and things that you enjoy outside of medicine.”

Dr. Shaun J. Gillis described clogging as an “American version of Irish folk dancing. It's all about the footwork.” Courtesy Dr. Shaun J. Gillis

Finding time for renewal is no easy task for full-time physician Shaun J. Gillis, a married mother of three children, aged 9, 6, and 3.

That's why she looks forward to her 2-hour dance rehearsals every Thursday night, which she began 3 years ago as an outlet for exercise and stress release.

Dancing “is almost like yoga for my mind or meditation—it's a chance to step away from what I do every day, all day,” said 39-year-old Dr. Gillis, who practices ob.gyn. in Bozeman, Mont. “I'm not mom, and I'm not the doctor. I'm just dancing, minding what my feet are doing. It's relaxing mentally, a chance to step away.”

A Montana native, Dr. Gillis starting dancing competitively as a freshman in high school and went on to join the dance company at Montana State University in Bozeman, where she specialized in lyrical and tap dancing. Her dancing days were put on hold when she enrolled into medical school at the University of Washington, Seattle. “It was very sad,” she recalled. “With medical school and residency, I was too busy.”

When she relocated back to Bozeman, she joined Tanya's Dance Co. in Belgrade, Mont. (www.tanyasdanceco.com

Tap dancing “has become my new favorite. But I also like lyrical dance; it's more expressionistic,” Dr. Gillis said. She's also adept at clogging, which she described as “an American version of Irish folk dancing. It's all about the footwork. There is not a lot of arm movement or upper body motion, but the steps are quite different from Irish folk dancing.”

She also admires the work of the Alvin Ailey American Dance Theater, a New York City-based company that does extensive touring.

Tanya's Dance Co.—whose members range in age from 18 to their early 50s—competes with other dance groups in Montana during March and April and stages a local performance in June. Right before the curtain went up at last year's performance someone's child yelled out, “Go, Mom!” which caused the dancers to erupt with laughter, she recalled.

In the spring of 2007, Dr. Gillis and her teammates received the honor of having the No. 1 tap routine in a statewide competition. Such events represent a chance “to take an individual talent and turn it into a team sport because we compete as a team,” she said. “The judges score you on costumes, makeup, and hair—so everything needs to be very uniform.”

She said she enjoys such camaraderie with other women from all walks of life. “I interact with people that I would never interact with on a daily basis,” she said. “Nobody else in my group is a physician or in the medical profession.”

Dr. Gillis initially worried what her patients would think about their doctor performing dance routines in public, but she is over that now, and explained that many of her patients showered her with support and encouragement. In fact, some members of the dance team are her patients. “This is a small town, so it happens,” she said.

Her goal is to keep building her skills and to keep dancing as long as she is physically able. “There are some incredibly difficult tap moves that I watch my teacher do and I'm just in awe,” she said. “I'm constantly striving to see if I can get my feet to move like that or learn a complicated series of steps. It's challenging,” she added.

Dr. Gillis noted that it saddens her to think she went 10 years without dancing, “because it was such a joy to get back into. Being a physician you have to maintain balance and things that you enjoy outside of medicine.”

Dr. Shaun J. Gillis calls clogging “an American version of Irish folk dancing. It's all about the footwork." Courtesy Dr. Shaun J. Gillis

Finding time for renewal is no easy task for full-time physician Shaun J. Gillis, a married mother of three children, aged 9, 6, and 3.

That's why she looks forward to her 2-hour dance rehearsals every Thursday night, which she began 3 years ago as an outlet for exercise and stress release.

Dancing “is almost like yoga for my mind or meditation—it's a chance to step away from what I do every day, all day,” said 39-year-old Dr. Gillis, who practices ob.gyn. in Bozeman, Mont. “I'm not mom, and I'm not the doctor. I'm just dancing, minding what my feet are doing. It's relaxing mentally, a chance to step away.”

A Montana native, Dr. Gillis starting dancing competitively as a freshman in high school and went on to join the dance company at Montana State University in Bozeman, where she specialized in lyrical and tap dancing. Her dancing days were put on hold when she enrolled into medical school at the University of Washington, Seattle. “It was very sad,” she recalled. “With medical school and residency, I was too busy.”

When she relocated back to Bozeman, she joined Tanya's Dance Co. in Belgrade, Mont. (www.tanyasdanceco.com

Tap dancing “has become my new favorite. But I also like lyrical dance; it's more expressionistic,” Dr. Gillis said. She's also adept at clogging, which she described as “an American version of Irish folk dancing. It's all about the footwork. There is not a lot of arm movement or upper body motion, but the steps are quite different from Irish folk dancing.”

She also admires the work of the Alvin Ailey American Dance Theater, a New York City-based company that does extensive touring.

Tanya's Dance Co.—whose members range in age from 18 to their early 50s—competes with other dance groups in Montana during March and April and stages a local performance in June. Right before the curtain went up at last year's performance someone's child yelled out, “Go, Mom!” which caused the dancers to erupt with laughter, she recalled.

In the spring of 2007, Dr. Gillis and her teammates received the honor of having the No. 1 tap routine in a statewide competition. Such events represent a chance “to take an individual talent and turn it into a team sport because we compete as a team,” she said. “The judges score you on costumes, makeup, and hair—so everything needs to be very uniform.”

She said she enjoys such camaraderie with other women from all walks of life. “I interact with people that I would never interact with on a daily basis,” she said. “Nobody else in my group is a physician or in the medical profession.”

Dr. Gillis initially worried what her patients would think about their doctor performing dance routines in public, but she is over that now, and explained that many of her patients showered her with support and encouragement. In fact, some members of the dance team are her patients. “This is a small town, so it happens,” she said.

Her goal is to keep building her skills and to keep dancing as long as she is physically able. “There are some incredibly difficult tap moves that I watch my teacher do and I'm just in awe,” she said. “I'm constantly striving to see if I can get my feet to move like that or learn a complicated series of steps. It's challenging,” she added.

Dr. Gillis noted that it saddens her to think she went 10 years without dancing, “because it was such a joy to get back into. Being a physician you have to maintain balance and things that you enjoy outside of medicine.”

Dr. Shaun J. Gillis calls clogging “an American version of Irish folk dancing. It's all about the footwork." Courtesy Dr. Shaun J. Gillis

Finding time for renewal is no easy task for full-time physician Shaun J. Gillis, a married mother of three children, aged 9, 6, and 3.

That's why she looks forward to her 2-hour dance rehearsals every Thursday night, which she began 3 years ago as an outlet for exercise and stress release.

Dancing “is almost like yoga for my mind or meditation—it's a chance to step away from what I do every day, all day,” said 39-year-old Dr. Gillis, who practices ob.gyn. in Bozeman, Mont. “I'm not mom, and I'm not the doctor. I'm just dancing, minding what my feet are doing. It's relaxing mentally, a chance to step away.”

A Montana native, Dr. Gillis starting dancing competitively as a freshman in high school and went on to join the dance company at Montana State University in Bozeman, where she specialized in lyrical and tap dancing. Her dancing days were put on hold when she enrolled into medical school at the University of Washington, Seattle. “It was very sad,” she recalled. “With medical school and residency, I was too busy.”

When she relocated back to Bozeman, she joined Tanya's Dance Co. in Belgrade, Mont. (www.tanyasdanceco.com

Tap dancing “has become my new favorite. But I also like lyrical dance; it's more expressionistic,” Dr. Gillis said. She's also adept at clogging, which she described as “an American version of Irish folk dancing. It's all about the footwork. There is not a lot of arm movement or upper body motion, but the steps are quite different from Irish folk dancing.”

She also admires the work of the Alvin Ailey American Dance Theater, a New York City-based company that does extensive touring.

Tanya's Dance Co.—whose members range in age from 18 to their early 50s—competes with other dance groups in Montana during March and April and stages a local performance in June. Right before the curtain went up at last year's performance someone's child yelled out, “Go, Mom!” which caused the dancers to erupt with laughter, she recalled.

In the spring of 2007, Dr. Gillis and her teammates received the honor of having the No. 1 tap routine in a statewide competition. Such events represent a chance “to take an individual talent and turn it into a team sport because we compete as a team,” she said. “The judges score you on costumes, makeup, and hair—so everything needs to be very uniform.”

She said she enjoys such camaraderie with other women from all walks of life. “I interact with people that I would never interact with on a daily basis,” she said. “Nobody else in my group is a physician or in the medical profession.”

Dr. Gillis initially worried what her patients would think about their doctor performing dance routines in public, but she is over that now, and explained that many of her patients showered her with support and encouragement. In fact, some members of the dance team are her patients. “This is a small town, so it happens,” she said.

Her goal is to keep building her skills and to keep dancing as long as she is physically able. “There are some incredibly difficult tap moves that I watch my teacher do and I'm just in awe,” she said. “I'm constantly striving to see if I can get my feet to move like that or learn a complicated series of steps. It's challenging,” she added.

Dr. Gillis noted that it saddens her to think she went 10 years without dancing, “because it was such a joy to get back into. Being a physician you have to maintain balance and things that you enjoy outside of medicine.”

Dr. Shaun J. Gillis calls clogging “an American version of Irish folk dancing. It's all about the footwork." Courtesy Dr. Shaun J. Gillis

CORONADO, CALIF. — Reports are challenging the validity of the five National Emergency X-Radiography Utilization Study criteria to diagnose spine injury in children.

The criteria (posterior midline cervical tenderness; no evidence of intoxication; normal level of alertness; no focal neurologic deficit; and no painful, distracting injury) were established in a study of 34,069 trauma victims (N. Engl. J. Med. 2000;343:94–9). Of these, 818 (2.4%) had cervical spine injury.

The researchers reported the criteria were 99% sensitive for cervical spine injury and 99.6% sensitive for clinically significant cervical spine injury in adults. Specificity was 12.9% in both groups.

In a subset analysis of 3,065 children from the National Emergency X-Radiography Utilization Study (NEXUS) study, 30 had cervical spine injuries (Pediatrics 2001;108:E20). The NEXUS criteria for detecting cervical spine injury were 100% sensitive and only 19.9% specific. However, none of the children studied were less than 2 years old and only 817 (27%) were younger than age 8 years.

“Until we come up with pediatric-specific criteria, it's reasonable to apply the NEXUS criteria to awake and alert patients,” Dr. Julie C. Leonard said at a meeting sponsored by the American College of Emergency Physicians. “However, if you have a high index of suspicion by either mechanism or self-reported pain, you should use your clinical acumen.”

A recent 20-year review that applied the NEXUS criteria to 190 children with cervical spine injury found the criteria were 94% sensitive among children aged less than 8 and 100% sensitive in those older than 8 (Neurosurgery 2008;62:700–8). A Pediatric Emergency Care Applied Research Network study found the NEXUS criteria were 83% sensitive among 539 children with spinal injury who presented to the emergency department. Of the 90 children missed by the NEXUS criteria, 58 (64%) were younger than 8 years of age.

Dr. Leonard, of Washington University, St. Louis, said a risk-stratification system is needed. High-risk populations also must be considered, like those with Down syndrome or juvenile idiopathic arthritis.

Dr. Leonard disclosed no conflicts.

CORONADO, CALIF. — Reports are challenging the validity of the five National Emergency X-Radiography Utilization Study criteria to diagnose spine injury in children.

The criteria (posterior midline cervical tenderness; no evidence of intoxication; normal level of alertness; no focal neurologic deficit; and no painful, distracting injury) were established in a study of 34,069 trauma victims (N. Engl. J. Med. 2000;343:94–9). Of these, 818 (2.4%) had cervical spine injury.

The researchers reported the criteria were 99% sensitive for cervical spine injury and 99.6% sensitive for clinically significant cervical spine injury in adults. Specificity was 12.9% in both groups.

In a subset analysis of 3,065 children from the National Emergency X-Radiography Utilization Study (NEXUS) study, 30 had cervical spine injuries (Pediatrics 2001;108:E20). The NEXUS criteria for detecting cervical spine injury were 100% sensitive and only 19.9% specific. However, none of the children studied were less than 2 years old and only 817 (27%) were younger than age 8 years.

“Until we come up with pediatric-specific criteria, it's reasonable to apply the NEXUS criteria to awake and alert patients,” Dr. Julie C. Leonard said at a meeting sponsored by the American College of Emergency Physicians. “However, if you have a high index of suspicion by either mechanism or self-reported pain, you should use your clinical acumen.”

A recent 20-year review that applied the NEXUS criteria to 190 children with cervical spine injury found the criteria were 94% sensitive among children aged less than 8 and 100% sensitive in those older than 8 (Neurosurgery 2008;62:700–8). A Pediatric Emergency Care Applied Research Network study found the NEXUS criteria were 83% sensitive among 539 children with spinal injury who presented to the emergency department. Of the 90 children missed by the NEXUS criteria, 58 (64%) were younger than 8 years of age.

Dr. Leonard, of Washington University, St. Louis, said a risk-stratification system is needed. High-risk populations also must be considered, like those with Down syndrome or juvenile idiopathic arthritis.

Dr. Leonard disclosed no conflicts.

CORONADO, CALIF. — Reports are challenging the validity of the five National Emergency X-Radiography Utilization Study criteria to diagnose spine injury in children.

The criteria (posterior midline cervical tenderness; no evidence of intoxication; normal level of alertness; no focal neurologic deficit; and no painful, distracting injury) were established in a study of 34,069 trauma victims (N. Engl. J. Med. 2000;343:94–9). Of these, 818 (2.4%) had cervical spine injury.

The researchers reported the criteria were 99% sensitive for cervical spine injury and 99.6% sensitive for clinically significant cervical spine injury in adults. Specificity was 12.9% in both groups.

In a subset analysis of 3,065 children from the National Emergency X-Radiography Utilization Study (NEXUS) study, 30 had cervical spine injuries (Pediatrics 2001;108:E20). The NEXUS criteria for detecting cervical spine injury were 100% sensitive and only 19.9% specific. However, none of the children studied were less than 2 years old and only 817 (27%) were younger than age 8 years.

“Until we come up with pediatric-specific criteria, it's reasonable to apply the NEXUS criteria to awake and alert patients,” Dr. Julie C. Leonard said at a meeting sponsored by the American College of Emergency Physicians. “However, if you have a high index of suspicion by either mechanism or self-reported pain, you should use your clinical acumen.”

A recent 20-year review that applied the NEXUS criteria to 190 children with cervical spine injury found the criteria were 94% sensitive among children aged less than 8 and 100% sensitive in those older than 8 (Neurosurgery 2008;62:700–8). A Pediatric Emergency Care Applied Research Network study found the NEXUS criteria were 83% sensitive among 539 children with spinal injury who presented to the emergency department. Of the 90 children missed by the NEXUS criteria, 58 (64%) were younger than 8 years of age.

Dr. Leonard, of Washington University, St. Louis, said a risk-stratification system is needed. High-risk populations also must be considered, like those with Down syndrome or juvenile idiopathic arthritis.

Dr. Leonard disclosed no conflicts.