Stanton Smullens | Thomas Jefferson University Hospital (original) (raw)
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Papers by Stanton Smullens
The Journal of cardiovascular surgery
Symptomatic carotid atherosclerotic disease occurring as a result of cervical irradiation often r... more Symptomatic carotid atherosclerotic disease occurring as a result of cervical irradiation often requires surgical intervention. Airway obstruction is an uncommon problem after most carotid surgery and has not been described for patients with cervical irradiation. Airway obstruction developed after two of five carotid endarterectomy procedures in previously irradiated necks requiring emergency tracheostomy or reintubation. Mechanisms of obstruction included endotracheal tube trauma to the fixed irradiated vocal cords and laryngeal edema caused by surgical dissection in an irradiated field. In addition, one patient in our series demonstrated hypercarbia as a result of bilateral carotid body ablation, a process known to impair the ventilatory response to hypoxia. An increased risk of airway obstruction after carotid surgery exists in patients with prior cervical irradiation. Preventive methods include the use of perioperative steroids and either carotid surgery with local anesthesia or...
Surgery, 1977
The sciatic artery is the principal blood supply to the lower extremity in the human embryo prior... more The sciatic artery is the principal blood supply to the lower extremity in the human embryo prior to the development of the femoral artery. Persistence of the sciatic artery in the adult is a rare albeit well documented anomaly with at least 29 cases reported in the world's literature and two additional cases presented here. The persistent sciatic artery is a branch of the internal iliac artery. It leaves the pelvis in close proximity with the sciatic nerve and is continuous with the popliteal artery. The superficial femoral artery usually is present and hypoplastic and only sends collaterals to the popliteal artery. Diagnosis of a patent sciatic artery is suggested by auscultation with a Doppler ultrasound and confirmed by autography. Obstruction and/or aneurysms of the sciatic artery should be treated with a femoral to popliteal or other distal artery bypass and ligation of the aneurysm if one is present.
Radiologic Clinics of North America
Stroke is the third most common cause of death in the United States, and 50 per cent of sources a... more Stroke is the third most common cause of death in the United States, and 50 per cent of sources arise in the extracranial carotid arteries. Well-performed vascular surgery provides a low-risk approach in preventing this devastating event if these sources can be identified before the stroke occurs. An awareness of the patient at risk, an appreciation of the type and location of the causative lesions, and a timely diagnosis offer the best chance for success.
Chest, 1988
Pseudoaneurysm of the ascending aorta is an unusual and potentially fatal complication of cardiov... more Pseudoaneurysm of the ascending aorta is an unusual and potentially fatal complication of cardiovascular surgery. Most pseudoaneurysms are associated with aortic valve or coronary artery bypass graft surgery and are often mycotic in origin. Chest roentgenography and aortography have been the principle methods of diagnosis. Recently, contrast enhanced computed tomography (CT) has proven to be a useful means of diagnosis, providing a less invasive method of distinguishing pseudoaneurysm from other causes of fever and mediastinal widening in the postoperative cardiovascular patient. Thirty one cases of postoperative pseudoaneurysm of the ascending aorta occurring since 1963 are reviewed, including seven cases from our experience.
Circulation, 1991
The initial outcome of a consecutive series of 43 intra-arterial urokinase infusions for thrombos... more The initial outcome of a consecutive series of 43 intra-arterial urokinase infusions for thrombosed infrainguinal grafts in 37 patients was analyzed. There was an 88% (38/43) technical success rate (complete clot lysis) and a 74% (32/43) clinical success rate. Complications occurred in 10 patients (23%) and were related to bleeding in four patients (9%). Patient age, graft age, location, material, and the duration of occlusion did not significantly influence the initial outcome, although there was a trend toward a higher bleeding complication rate among grafts ⩽I month of age at the time of thrombolysis. A second group of 43 infrainguinal grafts successfully recanalized using regional infusions of thrombolytic agents were followed for long-term patency. This group included 32 grafts successfully treated with urokinase and 11 grafts recanalized with streptokinase. By life-table analysis there was a 55.6% l-year patency, which fell to 42.4% at 4 years. Vein grafts had significantly (p...
Disease Management - DIS MANAG, 2003
The societal and economic impact of asthma is a well-documented phenomenon in this country. Despi... more The societal and economic impact of asthma is a well-documented phenomenon in this country. Despite improved knowledge and techniques of care, there have been signs of worsening morbidity/mortality and a seeming disconnect between physician and patients as regards communication of care strategies. In an attempt to fashion innovative educational strategies to enhance primary care physician (PCP) and caregiver efficiencies in improving patient outcomes (clinical and financial), the "Preceptor" model of one-to-one PCP/asthma specialist has been developed. Review of utilization and prescribing data demonstrates a clear pattern of statistically significant cost improvement in the aggregate care setting, as well as improved appropriateness of use of proper asthma medications. Use of the "Preceptor" model of PCP learning is an effective and unique way to enhance both caregiver knowledge and improved care efficiency in asthma management.
Journal of vascular …, 1987
The ability of high-resolution ultrasound, angiography, and pathologic examination of endarterect... more The ability of high-resolution ultrasound, angiography, and pathologic examination of endarterectomy specimens to identify and quantitate atherosclerosis was compared in a five-center study. The carotid bifurcation in 900 patients was evaluated by angiography and ultrasound. In 216 ...
Patient Safety
Pennsylvania is the only state that requires healthcare facilities to report all events of harm o... more Pennsylvania is the only state that requires healthcare facilities to report all events of harm or potential for harm. Serious Events and Incidents are reported to the Pennsylvania Patient Safety Reporting System (PA-PSRS)*, which is the largest repository of patient safety data in the United States, and one of the largest in the world, with over 3.6 million acute care records. The overwhelming majority (97.1%) of all acute care event reports are Incidents. For 2019, there were 284,847 Incidents and 8,553 Serious Events for a total of 293,400 reported events. The counts of all events and the percentage that are Serious Events reported over the last eight years are provided in Figure 1. The total number of event reports has increased during the last four years. The number of reported Serious Events has increased over the past three years with the largest annual increase occurring in 2019 (+5.7%). This article will show details of the PA-PSRS acute care data along with longitudinal an...
Patient Safety
The Pennsylvania Patient Safety Reporting System (PA-PSRS) is the largest repository of patient s... more The Pennsylvania Patient Safety Reporting System (PA-PSRS) is the largest repository of patient safety data in the United States. In addition to over 3.6 million Acute Care records, PA-PSRS has collected more than 330,000 Long-Term Care (LTC) healthcare-associated in¬fection reports since 2009. A total of 28,310 infections were reported in 2019, representing a 9% decrease from the prior year. The Northwest region of the state had the highest infection reporting rate, with 1.25 reports per 1,000 resident days. There was a 20% reduction in both the number and reporting rate of respiratory tract infections from 2018 to 2019; however, respiratory tract infections remained the most frequently reported infection type overall. Cellulitis, soft tissue, or wound infection was the most frequently reported infection subtype in 2019, followed by pneumonia and symptomatic urinary tract infection. With this information, nursing homes and interested parties can determine which trends or characteri...
Headache the Journal of Head and Face Pain, Nov 1, 2002
To determine the reliability and validity of the Migraine Therapy Assessment Questionnaire (MTAQ)... more To determine the reliability and validity of the Migraine Therapy Assessment Questionnaire (MTAQ). Eligible patients between ages 18 and 65 with at least one migraine per month, a physician visit in the preceding 6 months, and a migraine diagnosis were recruited from physician offices in the Philadelphia area. Participants completed the MTAQ, Short Form-36 (SF-36), the Migraine Disability Assessment Score (MIDAS), the Beck Depression Inventory, a demographic questionnaire, and a medication use survey. The first 100 participants completed a second MTAQ approximately 2 weeks later. The test-retest reliability, construct, and predictive validity of the MTAQ were assessed. Two hundred fifty-one patients were recruited; 243 patients were assessable. All MTAQ questions had a kappa statistic of.5 or higher and an agreement of at least 76%. There was a significant level of agreement (.71) for the MTAQ summary score. MTAQ items regarding control, frequency, work loss, resource use, and satisfaction were associated with significant differences in SF-36 scores. MTAQ items related to work loss, emergency department use, headache frequency, and control were associated with days missed from work and degree of disability as measured by MIDAS. Suboptimal migraine management was significantly associated with MTAQ items indicating three or more headaches per month, missing time from work or school, taking daily medication for headaches, and having an emergency department visit in the last 6 months. MTAQ is a reliable and valid questionnaire to identify migraineurs whose migraine management may be suboptimal in a primary care setting.
The Journal of cardiovascular surgery
Symptomatic carotid atherosclerotic disease occurring as a result of cervical irradiation often r... more Symptomatic carotid atherosclerotic disease occurring as a result of cervical irradiation often requires surgical intervention. Airway obstruction is an uncommon problem after most carotid surgery and has not been described for patients with cervical irradiation. Airway obstruction developed after two of five carotid endarterectomy procedures in previously irradiated necks requiring emergency tracheostomy or reintubation. Mechanisms of obstruction included endotracheal tube trauma to the fixed irradiated vocal cords and laryngeal edema caused by surgical dissection in an irradiated field. In addition, one patient in our series demonstrated hypercarbia as a result of bilateral carotid body ablation, a process known to impair the ventilatory response to hypoxia. An increased risk of airway obstruction after carotid surgery exists in patients with prior cervical irradiation. Preventive methods include the use of perioperative steroids and either carotid surgery with local anesthesia or...
Surgery, 1977
The sciatic artery is the principal blood supply to the lower extremity in the human embryo prior... more The sciatic artery is the principal blood supply to the lower extremity in the human embryo prior to the development of the femoral artery. Persistence of the sciatic artery in the adult is a rare albeit well documented anomaly with at least 29 cases reported in the world's literature and two additional cases presented here. The persistent sciatic artery is a branch of the internal iliac artery. It leaves the pelvis in close proximity with the sciatic nerve and is continuous with the popliteal artery. The superficial femoral artery usually is present and hypoplastic and only sends collaterals to the popliteal artery. Diagnosis of a patent sciatic artery is suggested by auscultation with a Doppler ultrasound and confirmed by autography. Obstruction and/or aneurysms of the sciatic artery should be treated with a femoral to popliteal or other distal artery bypass and ligation of the aneurysm if one is present.
Radiologic Clinics of North America
Stroke is the third most common cause of death in the United States, and 50 per cent of sources a... more Stroke is the third most common cause of death in the United States, and 50 per cent of sources arise in the extracranial carotid arteries. Well-performed vascular surgery provides a low-risk approach in preventing this devastating event if these sources can be identified before the stroke occurs. An awareness of the patient at risk, an appreciation of the type and location of the causative lesions, and a timely diagnosis offer the best chance for success.
Chest, 1988
Pseudoaneurysm of the ascending aorta is an unusual and potentially fatal complication of cardiov... more Pseudoaneurysm of the ascending aorta is an unusual and potentially fatal complication of cardiovascular surgery. Most pseudoaneurysms are associated with aortic valve or coronary artery bypass graft surgery and are often mycotic in origin. Chest roentgenography and aortography have been the principle methods of diagnosis. Recently, contrast enhanced computed tomography (CT) has proven to be a useful means of diagnosis, providing a less invasive method of distinguishing pseudoaneurysm from other causes of fever and mediastinal widening in the postoperative cardiovascular patient. Thirty one cases of postoperative pseudoaneurysm of the ascending aorta occurring since 1963 are reviewed, including seven cases from our experience.
Circulation, 1991
The initial outcome of a consecutive series of 43 intra-arterial urokinase infusions for thrombos... more The initial outcome of a consecutive series of 43 intra-arterial urokinase infusions for thrombosed infrainguinal grafts in 37 patients was analyzed. There was an 88% (38/43) technical success rate (complete clot lysis) and a 74% (32/43) clinical success rate. Complications occurred in 10 patients (23%) and were related to bleeding in four patients (9%). Patient age, graft age, location, material, and the duration of occlusion did not significantly influence the initial outcome, although there was a trend toward a higher bleeding complication rate among grafts ⩽I month of age at the time of thrombolysis. A second group of 43 infrainguinal grafts successfully recanalized using regional infusions of thrombolytic agents were followed for long-term patency. This group included 32 grafts successfully treated with urokinase and 11 grafts recanalized with streptokinase. By life-table analysis there was a 55.6% l-year patency, which fell to 42.4% at 4 years. Vein grafts had significantly (p...
Disease Management - DIS MANAG, 2003
The societal and economic impact of asthma is a well-documented phenomenon in this country. Despi... more The societal and economic impact of asthma is a well-documented phenomenon in this country. Despite improved knowledge and techniques of care, there have been signs of worsening morbidity/mortality and a seeming disconnect between physician and patients as regards communication of care strategies. In an attempt to fashion innovative educational strategies to enhance primary care physician (PCP) and caregiver efficiencies in improving patient outcomes (clinical and financial), the "Preceptor" model of one-to-one PCP/asthma specialist has been developed. Review of utilization and prescribing data demonstrates a clear pattern of statistically significant cost improvement in the aggregate care setting, as well as improved appropriateness of use of proper asthma medications. Use of the "Preceptor" model of PCP learning is an effective and unique way to enhance both caregiver knowledge and improved care efficiency in asthma management.
Journal of vascular …, 1987
The ability of high-resolution ultrasound, angiography, and pathologic examination of endarterect... more The ability of high-resolution ultrasound, angiography, and pathologic examination of endarterectomy specimens to identify and quantitate atherosclerosis was compared in a five-center study. The carotid bifurcation in 900 patients was evaluated by angiography and ultrasound. In 216 ...
Patient Safety
Pennsylvania is the only state that requires healthcare facilities to report all events of harm o... more Pennsylvania is the only state that requires healthcare facilities to report all events of harm or potential for harm. Serious Events and Incidents are reported to the Pennsylvania Patient Safety Reporting System (PA-PSRS)*, which is the largest repository of patient safety data in the United States, and one of the largest in the world, with over 3.6 million acute care records. The overwhelming majority (97.1%) of all acute care event reports are Incidents. For 2019, there were 284,847 Incidents and 8,553 Serious Events for a total of 293,400 reported events. The counts of all events and the percentage that are Serious Events reported over the last eight years are provided in Figure 1. The total number of event reports has increased during the last four years. The number of reported Serious Events has increased over the past three years with the largest annual increase occurring in 2019 (+5.7%). This article will show details of the PA-PSRS acute care data along with longitudinal an...
Patient Safety
The Pennsylvania Patient Safety Reporting System (PA-PSRS) is the largest repository of patient s... more The Pennsylvania Patient Safety Reporting System (PA-PSRS) is the largest repository of patient safety data in the United States. In addition to over 3.6 million Acute Care records, PA-PSRS has collected more than 330,000 Long-Term Care (LTC) healthcare-associated in¬fection reports since 2009. A total of 28,310 infections were reported in 2019, representing a 9% decrease from the prior year. The Northwest region of the state had the highest infection reporting rate, with 1.25 reports per 1,000 resident days. There was a 20% reduction in both the number and reporting rate of respiratory tract infections from 2018 to 2019; however, respiratory tract infections remained the most frequently reported infection type overall. Cellulitis, soft tissue, or wound infection was the most frequently reported infection subtype in 2019, followed by pneumonia and symptomatic urinary tract infection. With this information, nursing homes and interested parties can determine which trends or characteri...
Headache the Journal of Head and Face Pain, Nov 1, 2002
To determine the reliability and validity of the Migraine Therapy Assessment Questionnaire (MTAQ)... more To determine the reliability and validity of the Migraine Therapy Assessment Questionnaire (MTAQ). Eligible patients between ages 18 and 65 with at least one migraine per month, a physician visit in the preceding 6 months, and a migraine diagnosis were recruited from physician offices in the Philadelphia area. Participants completed the MTAQ, Short Form-36 (SF-36), the Migraine Disability Assessment Score (MIDAS), the Beck Depression Inventory, a demographic questionnaire, and a medication use survey. The first 100 participants completed a second MTAQ approximately 2 weeks later. The test-retest reliability, construct, and predictive validity of the MTAQ were assessed. Two hundred fifty-one patients were recruited; 243 patients were assessable. All MTAQ questions had a kappa statistic of.5 or higher and an agreement of at least 76%. There was a significant level of agreement (.71) for the MTAQ summary score. MTAQ items regarding control, frequency, work loss, resource use, and satisfaction were associated with significant differences in SF-36 scores. MTAQ items related to work loss, emergency department use, headache frequency, and control were associated with days missed from work and degree of disability as measured by MIDAS. Suboptimal migraine management was significantly associated with MTAQ items indicating three or more headaches per month, missing time from work or school, taking daily medication for headaches, and having an emergency department visit in the last 6 months. MTAQ is a reliable and valid questionnaire to identify migraineurs whose migraine management may be suboptimal in a primary care setting.