In the 2017–2018 U.S. News and World Report hospital rankings, UCHealth University of Colorado Hospital ranked in the top 50 for 11 medical specialties and was rated the #15 overall adult hospital in the country.In 2005, UCH was redesignated by the American Nurses Credentialing Center (ANCC) as a magnet facility. In 2010, the hospital received its third redesignation of Magnet status. The hospital is currently pursuing its fourth Magnet designation.S..
There are many challenges associated with the safe use of fluoroscopy. These challenges include but are not limited to highly variable regulatory requirements, scope of practice concerns, inconsistent education and training, and lack of staff empowerment. Challenges are further compounded by the increasing use of fluoroscopy across a wide range of medical specialties. To facilitate consensus on how to address the issues, the ACR convened the multidisciplinary Blue Ribbon Panel on Fluoroscopy Safety (BRP-FS), with 32 organizations represented. The goal of the BRP-FS is to establish multi- and interspecialty consensus standards for the safe use of fluoroscopy in health care, including minimum and uniform standards for the education and training of fluoroscopy users that apply across geographic and professional boundaries, for the benefit of all patients and health care providers. Recommendations are made for local practices, professional organizations, industry, regulatory agencies, and accreditation bodies. Foundational to the recommendations of the BRP-FS are the personnel training and procedure classification frameworks in National Council on Radiation Protection and Measurement Commentary No. 33.
Denver Health Medical Center is a 555 bed level 1 trauma center in Denver, Colorado. It was one of the original founding hospitals of the Orthopedic Trauma Association and has a storied history of excellence in trauma care, noting one of the highest survival rates for trauma patients in the country. This past year they had 2,584 trauma admissions, 569 of which had and Injury Severity Score (ISS) >15. The hospital is a host site for orthopedic surgery residents from the University of Colorado as part of their trauma and hand training. This article displays the experiences and roles of each resident on the trauma service and how the educational curriculum prepares them for practice. The goal for residents by the completion of their training is to be comfortable with Level 1 trauma call at any institution they practice, with particular expertise in management of complex upper extremity injuries, polytraumatized patients and complex pelvis/acetabulum injuries. While not all trainees will deliver definitive care for these injuries in practice, the experience at Denver Health offers the opportunity to see and manage these patients during the course of their training so they have the foundational knowledge to care for any patient who presents to their hospital. Voices in Orthopaedics™…is orthopaedic residency program forum. Residencies that contribute choose the nature o fthe article they want to write about. This gives a voice to the future of orthopaedics. If you want your residency involved email us at editorial@joei.pub
Background: Heparin-Induced Thrombocytopenia (HIT) is a serious immune-mediated complication characterized by anti-platelet factor 4 (PF4)/heparin antibodies that activate platelets, causing thrombocytopenia and a paradoxical prothrombotic state. Management requires immediate heparin discontinuation and alternative anticoagulation due to thrombotic risks. Case Presentation: We report a 36-year-old pregnant female with heart failure who developed HIT after heparin exposure during extracorporeal membrane oxygenation (ECMO) support and was subsequently evaluated for heart transplantation. Confirmed HIT led to switching anticoagulation to bivalirudin. Prior to transplantation, where intraoperative heparin is standard, she underwent plasmapheresis (PLEX) followed by intravenous immunoglobulin (IVIG) and corticosteroids to reduce circulating HIT antibodies. This immune-modulating approach enabled safe intraoperative heparin use without thrombotic complications. Post-transplant HIT assays were negative, with platelet recovery and stable coagulation parameters. Discussion: This case demonstrates that combined PLEX and IVIG can effectively lower pathogenic HIT antibodies, permitting necessary heparin administration in critical settings like heart transplantation. Conclusion: Given the lack of standardized guidelines for managing HIT when heparin exposure is unavoidable, this report highlights a promising strategy to mitigate risks and underscores the need for further research to optimize care in such complex clinical scenarios.
Exocrine pancreatic insufficiency (EPI) is a clinically significant disorder characterized by inadequate secretion or activity of pancreatic digestive enzymes, leading to maldigestion, malabsorption, and adverse nutritional and metabolic consequences. The causes of EPI can be divided into loss of pancreatic parenchyma, inhibition or inactivation of pancreatic secretion, and postcibal pancreatic asynchrony. Although most associated with intrinsic pancreatic diseases such as cystic fibrosis, chronic pancreatitis or pancreatic cancer, EPI is increasingly recognized in a range of other conditions including diabetes, inflammatory bowel disease, celiac disease, hypersecretory states, gastrointestinal surgeries, small intestinal bacterial overgrowth, drug side effects and aging. This narrative review summarizes the diagnosis and treatment of EPI along with a focused review of the pathophysiology, clinical consequences, diagnostic approaches, and treatment principles of EPI for a variety of conditions.
Donor-derived Trypanosoma cruzi infection is a recognized complication of solid organ transplantation, but ocular involvement has never been reported. We described a case of necrotizing retinitis due to T. cruzi in a heart transplant recipient. A 62-year-old man developed unexpected donor-derived Chagas disease 3 months posttransplant and completed a 12-week course of nifurtimox with near-complete clearance of parasitemia. Thirty-eight days after nifurtimox discontinuation, he presented with progressive unilateral vision loss and clinical findings consistent with acute retinal necrosis. Vitreous biopsy with pan-pathogen polymerase chain reaction was negative for viral etiologies but confirmed T. cruzi. Despite systemic benznidazole therapy and clearance of blood parasitemia, intraocular disease progressed, ultimately attempting a salvage adjunctive intravitreal therapy with voriconazole. Ocular inflammation improved, but vision remained limited to light perception. This case underscores the need for continued clinical vigilance for late complications of Chagas disease in transplant recipients. Universal screening for donors with T. cruzi should be considered in future practice, pending the identification of the most appropriate assay, improved accessibility to such assays, and logistical challenges faced by individual organ procurement organizations.
