Publications by authors named "Nancy Peterson"

10 Publications

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Edoxaban and implantable cardiac device interventions: insights from the ENGAGE AF-TIMI 48 trial.

Europace 2019 Feb;21(2):306-312

Cardiovascular Division, TIMI Study Group, Brigham and Women's Hospital, 350 Longwood Avenue, 1st Floor Offices, Boston, MA 02115, USA.

Aims: Pacemaker, implantable cardioverter-defibrillator, and cardiac resynchronization therapy device implantations and generator changes are frequently performed in patients receiving direct oral anticoagulants. In an exploratory analysis, we investigated the outcome of patients undergoing such device procedures in the ENGAGE AF-TIMI 48 trial.

Methods And Results: During the trial, 1217 device procedures were performed in 1145 patients, with intervention dates available for 1203 procedures. Two hundred and twenty-five procedures (in 212 patients) were performed >30 days after study drug was stopped and are not included in the event analysis. For most interventions (n = 728, 74%), study drug was interrupted >3 days (median for the entire cohort: 5 days, interquartile range 0-11 days); 250 interventions were performed with ≤3 days study drug interruption. During the first 30 days after the procedure, six strokes/systemic embolic events (SEEs) (three each in the lower-dose edoxaban and warfarin arm) and one major bleeding event (in the lower-dose edoxaban arm) occurred; no stroke/SEEs or major bleeds occurred around the 295 device procedures in the higher-dose edoxaban arm. Two ischaemic and one major bleeding event occurred after the 288 device procedures performed with ≤3 days periprocedural interruption of study drug.

Conclusion: In this first experience of patients undergoing device surgery with edoxaban, a low risk of ischaemic and bleeding events was observed during the first 30 days post-procedure. Our data are in line with current recommendations of no or only brief interruption of non-vitamin K antagonist oral anticoagulants prior to cardiac device surgery.
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http://dx.doi.org/10.1093/europace/euy253DOI Listing
February 2019

Cardioversion of Atrial Fibrillation in ENGAGE AF-TIMI 48.

Clin Cardiol 2016 Jun 30;39(6):345-6. Epub 2016 Mar 30.

TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital (Nordio, Giugliano), Boston, Massachusetts.

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http://dx.doi.org/10.1002/clc.22537DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6490822PMC
June 2016

Severe maternal morbidity in a large cohort of women with acute severe intrapartum hypertension.

Am J Obstet Gynecol 2016 07 30;215(1):91.e1-7. Epub 2016 Jan 30.

California Maternal Quality Care Collaborative, Stanford University, Palo Alto, CA.

Background: Hypertensive diseases of pregnancy are associated with severe maternal morbidity and remain common causes of maternal death. Recently, national guidelines have become available to aid in recognition and management of hypertension in pregnancy to reduce morbidity and mortality. The increased morbidity related to hypertensive disorders of pregnancy is presumed to be associated with the development of severe hypertension. However, there are few data on specific treatment or severe maternal morbidity in women with acute severe intrapartum hypertension as opposed to severe preeclampsia.

Objective: The study aimed to characterize maternal morbidity associated with women with acute severe intrapartum hypertension, and to determine whether there was an association between various first-line antihypertensive agents and posttreatment blood pressure.

Study Design: This retrospective cohort study of women delivering between July 2012 and August 2014 at 15 hospitals participating in the California Maternal Quality Care Collaborative compared women with severe intrapartum hypertension (systolic blood pressure >160 mm Hg or diastolic blood pressure >105 mm Hg) to women without severe hypertension. Hospital Patient Discharge Data and State of California Birth Certificate Data were used. Severe maternal morbidity using the Centers for Disease Control and Prevention criteria based on International Classification of Diseases-9 codes was compared between groups. The efficacy of different antihypertensive medications in meeting the 1-hour posttreatment goal was determined. Statistical methods included distribution appropriate univariate analyses and multivariate logistic regression.

Results: There were 2252 women with acute severe intrapartum hypertension and 93,650 women without severe hypertension. Severe maternal morbidity was significantly more frequent in the women with severe hypertension (8.8%) compared to the control women (2.3%) (P < .0001). Severe maternal morbidity rates did not increase with increasing severity of blood pressures (P = .90 for systolic and .42 for diastolic). There was no difference in severe maternal morbidity between women treated (8.6%) and women not treated (9.5%) (P = .56). Antihypertensive treatment rates were significantly higher in hospitals with a level IV neonatal intensive care unit (85.8%) compared to a level III neonatal intensive care unit (80.2%) (P < .001), and in higher-volume hospitals (84.5%) compared to lower-volume hospitals (69.1%) (P < .001). Severe maternal morbidity rates among severely hypertensive women were significantly higher in hospitals with level III neonatal intensive care unit level compared to hospitals with a level IV neonatal intensive care unit (10.6% vs 5.7%, respectively; P < .001), and significantly higher in low-delivery volume hospitals compared to high-delivery volume hospitals (15.5% vs 7.6%, respectively; P < .001). Only 53% of women treated with oral labetalol as first-line medication met the posttreatment goal of nonsevere hypertension, significantly less than those treated with intravenous hydralazine, intravenous labetalol, or oral nifedipine (68%, 71%, and 82%, respectively) (P = .001). Severe intrapartum hypertension remained untreated in 17% of women.

Conclusion: Women with acute severe intrapartum hypertension had a significantly higher risk of severe maternal morbidity compared to women without severe hypertension. Significantly lower antihypertensive treatment rates and higher severe maternal morbidity rates were seen in lower-delivery volume hospitals.
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http://dx.doi.org/10.1016/j.ajog.2016.01.176DOI Listing
July 2016

Prototype to practice: Developing and testing a clinical decision support system for secondary stroke prevention in a veterans healthcare facility.

Comput Inform Nurs 2010 Nov-Dec;28(6):353-63

Stroke Center, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.

A clinical decision support system that guides nurse practitioners and other healthcare providers in secondary stroke prevention was developed by a multidisciplinary team with funding received from the Veterans Health Administration Office of Nursing Services. This article presents alpha-testing results obtained while using an integrated model for clinical decision support system development that emphasizes end-user perspectives throughout the development process. Before-after and descriptive methods were utilized to evaluate functionality and usability of the prototype among a sample of multidisciplinary clinicians. The predominant functionality feature of the tool is automated prompting and documentation of secondary stroke prevention guidelines in the electronic medical record. Documentation of guidelines was compared among multidisciplinary providers (N = 15) using test case scenarios and two documentation systems, standard versus the prototype. Usability was evaluated with an investigator-developed questionnaire and one open-ended question. The prototype prompted a significant increase (P < .05) in provider documentation for six of 11 guidelines as compared with baseline documentation while using the standard system. Of a possible 56 points, usability was scored high (mean, 48.9 [SD, 6.8]). These results support that guideline prompting has been successfully engineered to produce a usable and useful clinical decision support system for secondary stroke prevention.
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http://dx.doi.org/10.1097/NCN.0b013e3181f69c5bDOI Listing
February 2011

HSUS responds to latest letter about feral cats.

Authors:
Nancy Peterson

J Am Vet Med Assoc 2006 May;228(10):1490; author reply 1490-1

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http://dx.doi.org/10.2460/javma.228.10.1490DOI Listing
May 2006

Utilization of the medical librarian in a state Medicaid program to provide information services geared to health policy and health disparities.

J Med Libr Assoc 2006 Apr;94(2):174-9

Commonwealth of Massachusetts, Executive Office of Health and Human Services, Office of Medicaid, 1 Ashburton Place, Room 1109 Boston, Massachusetts 02108-1518, USA.

Objective: The role of two solo medical librarians in supporting Medicaid programs by functioning as information specialists at regional and state levels is examined.

Setting: A solo librarian for the Massachusetts Medicaid (MassHealth) program and a solo librarian for the New England States Consortium Systems Organization (NESCSO) functioned as information specialists in context to support Medicaid policy development and clinical, administrative, and program staff for state Medicaid programs.

Brief Description: The librarian for MassHealth initially focused on acquiring library materials and providing research support on culturally competent health care and outreach, as part of the United States Department of Health and Human Services Culturally and Linguistically Appropriate Services in Health Care Standards. The NESCSO librarian focused on state Medicaid system issues surrounding the implementation of the Health Insurance Portability and Accountability Act. The research focus expanded for both the librarians, shaping their roles to more directly support clinical and administrative policy development. Of note, the availability and dissemination of information to policy leaders facilitated efforts to reduce health disparities. In Massachusetts, this led to a state legislative special commission to eliminate health disparities, which released a report in November 2005. On a regional level, the NESCSO librarian provided opportunities for states in New England to share ideas and Medicaid program information. The Centers for Medicaid and Medicare are working with NESCSO to explore the potential for using the NESCSO model for collaboration for other regions of the United States.

Results/outcomes: With the increased attention on evidence-based health care and reduction of health disparities, medical librarians are called on to support a variety of health care information needs. Nationally, state Medicaid programs are being called on to provide coverage and make complex medical decisions regarding the delivery of benefits. Increasing numbers of beneficiaries and shrinking Medicaid budgets demand effective and proactive decision making to provide quality care and to accomplish the missions of state Medicaid programs. In this environment, the opportunities for information professionals to provide value and knowledge management are increasing.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1435841PMC
April 2006

An absent pulse is not sensitive for the early detection of peripheral arterial disease.

Fam Med 2006 Jan;38(1):38-42

Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey VA Medical Center, USA.

Background: This study's objective was to determine the test characteristics of pedal pulse palpation in the diagnosis of peripheral arterial disease (PAD) when compared to the more widely recommended screening tool, the ankle-brachial index (ABI).

Methods: We screened patients > 50 years of age for PAD within primary care clinics in Houston. PAD was diagnosed by an ABI of <0.9. At each visit, pedal pulse palpation was performed for each leg. Of the patients who screened positive for PAD by ABI, we determined the sensitivity, specificity, and positive predictive value of pulse palpation.

Results: We enrolled 403 patients with a mean age of 63.8 +/- .36 years. The prevalence of PAD was 16.6% (67 patients total). Of the 45 patients with disease involving their left leg, 37 (82.2%) had a palpable pulse. Of the 37 patients with disease involving their right leg, 25 (67.6%) had a palpable pulse. The sensitivity of a non-detectable pulse for the diagnosis of PAD was 17.8% and 32.4% for the left leg and the right leg, respectively. The specificity of pulse palpation for the detection of PAD was 98.7% and 97.8% for the left leg and the right leg, respectively.

Conclusions: Pulse palpation is not sensitive for the detection of PAD compared to ABI. More than two thirds of the patients within our cohort with PAD of either the left or right leg had a detectable pulse.
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January 2006

Inside outreach: a challenge for health sciences librarians.

J Med Libr Assoc 2005 Jul;93(3):327-37

Lamar Soutter Library, University of Massachusetts Medical School, 55 Lake Avenue, North Worcester, Massachusetts 01655, USA.

Objective: Like medical and health sciences libraries throughout the country, the Lamar Soutter Library (LSL) at the University of Massachusetts Medical School is dealing with ever-increasing outreach needs in times of diminishing funding. With the goal of reshaping the library's outreach program to better serve our patron groups, the Outreach Study Group was formed to investigate existing models of outreach.

Methods: The group initially examined the current literature and subsequently conducted a nationwide survey of medical and health sciences libraries to identify trends in outreach. This article details the methods used for the survey, including establishing criteria for selecting participants, determining the focus, and developing and conducting the survey.

Results: Of the 40 libraries invited to participate, 63% completed the survey. An analysis of the data revealed successes, problems, and trends. The group's conclusions led to recommendations for the LSL's future outreach efforts.

Conclusions: Analysis of the data revealed key findings in the areas of strategic planning, funding, and evaluation. A thoughtful definition of outreach ensures that outreach activities are expressions of the library's mission. Funding shifts require flexible programs. Evaluation provides data necessary to create new programs, sustain successful ones, and avoid repeating mistakes.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1176229PMC
July 2005

My blizzard baby.

Authors:
Nancy Peterson

Nebr Nurse 2005 Mar-May;38(1):29

Heart & Hands WomanCare, USA.

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June 2005

Using talking lights illumination-based communication networks to enhance word comprehension by people who are deaf or hard of hearing.

Am J Audiol 2003 Jun;12(1):17-22

Talking Lights, LLC, Boston, MA, USA.

This article details a new method that has been developed to transmit auditory and visual information to people who are deaf or hard of hearing. In this method, ordinary fluorescent lighting is modulated to carry an assistive data signal throughout a room while causing no flicker or other distracting visual problems. In limited trials with participants who are deaf or hard of hearing, this assistive system, combined with commercial voice recognition software, showed statistically significant improvement in sentence recognition compared to recognition of audio-only or audio-plus-speech-reading stimuli.
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http://dx.doi.org/10.1044/1059-0889(2003/005)DOI Listing
June 2003