Mary E. Lough

All Publications

• Machine learning evaluation of inequities and disparities associated with nurse sensitive indicator safety events. Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing Georgantes, E. R., Gunturkun, F., McGreevy, T. J., Lough, M. E. 2024

  Abstract

  PURPOSE: To use machine learning to examine health equity and clinical outcomes in patients who experienced a nurse sensitive indicator (NSI) event, defined as a fall, a hospital-acquired pressure injury (HAPI) or a hospital-acquired infection (HAI).DESIGN: This was a retrospective observational study from a single academic hospital over six calendar years (2016-2021). Machine learning was used to examine patients with an NSI compared to those without.METHODS: Inclusion criteria: all adult inpatient admissions (2016-2021). Three approaches were used to analyze the NSI group compared to the No-NSI group. In the univariate analysis, descriptive statistics, and absolute standardized differences (ASDs) were employed to compare the demographics and clinical variables of patients who experienced a NSI and those who did not experience any NSIs. For the multivariate analysis, a light grading boosting machine (LightGBM) model was utilized to comprehensively examine the relationships associated with the development of an NSI. Lastly, a simulation study was conducted to quantify the strength of associations obtained from the machine learning model.RESULTS: From 163,507 admissions, 4643 (2.8%) were associated with at least one NSI. The mean, standard deviation (SD) age was 59.5 (18.2) years, males comprised 82,397 (50.4%). Non-Hispanic White 84,760 (51.8%), non-Hispanic Black 8703 (5.3%), non-Hispanic Asian 23,368 (14.3%), non-Hispanic Other 14,284 (8.7%), and Hispanic 30,271 (18.5%). Race and ethnicity alone were not associated with occurrence of an NSI. The NSI group had a statistically significant longer length of stay (LOS), longer intensive care unit (ICU) LOS, and was more likely to have an emergency admission compared to the group without an NSI. The simulation study results demonstrated that likelihood of NSI was higher in patients admitted under the major diagnostic categories (MDC) associated with circulatory, digestive, kidney/urinary tract, nervous, and infectious and parasitic disease diagnoses.CONCLUSION: In this study, race/ethnicity was not associated with the risk of an NSI event. The risk of an NSI event was associated with emergency admission, longer LOS, longer ICU-LOS and certain MDCs (circulatory, digestive, kidney/urinary, nervous, infectious, and parasitic diagnoses).CLINICAL RELEVANCE: Machine learning methodologies provide a new mechanism to investigate NSI events through the lens of health equity/disparity. Understanding which patients are at higher risk for adverse outcomes can help hospitals improve nursing care and prevent NSI injury and harm.

  View details for DOI 10.1111/jnu.12983

  View details for PubMedID 38773783

• Stir-up Regimen After General Anesthesia in the Postanesthesia Care Unit: A Nurse Led Stepped Wedge Cluster Randomized Control Trial. Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses Chen, L., Glatt, E., Kerr, P., Weng, Y., Lough, M. E. 2023

  Abstract

  To implement a standardized Stir-up Regimen (deep breathing, coughing, repositioning, mobilization [moving arms/legs], assessing and managing pain and nausea) within the first 30 minutes of arrival in the postanesthesia care unit (PACU), with a goal of decreasing recovery time in the immediate postanesthesia period (Phase I).A pragmatic stepped wedge cluster randomized control trial. Initially, data were collected on time in Phase I in three PACUs (control). Subsequently, the same three units were randomized to sequentially transition to the Stir-up Regimen (intervention).A stepped wedge cluster randomized control trial design was used to implement a standardized Stir-up Regimen in three PACUs in an academic hospital for adult patients who received at least 30 minutes of general anesthesia. The measured outcome was the PACU time in minutes from patient arrival to when the patient met Phase I discharge criteria. Differences between intervention and control groups were evaluated using a generalized mixed-effects model. Nurses were educated about the Stir-up Regimen in team huddles, in-services, video demonstrations, email notifications/reminders and reminders, and immediate feedback at the bedside. Implementation science principles were used to assess the adoption of the Stir-up Regimen through a presurvey, postsurvey and spot-check observations in all three PACUs.A total of 5,809 PACU adult patient admissions were included: control group (n = 2,860); intervention group (n = 2,949); males (n = 2,602), and females (n = 3,206). The intervention was associated with a reduction in overall mean Phase I recovery time of 4.9 minutes (95% CI: -8.4 to -1.4, P = .007). One PACU decreased time by 9.6 minutes (95% CI: -15.3 to -4.0, P < .001). The other units also reduced Phase I recovery time, but this did not reach statistical significance. The spot-check observations confirmed the intervention was adopted by the nurses, as most interventions were nurse-initiated versus patient-initiated during the first 30 minutes in PACU.Standardization of a Stir-up Regimen within 30 minutes of patient PACU arrival resulted in decreased Phase I recovery time.

  View details for DOI 10.1016/j.jopan.2023.07.014

  View details for PubMedID 37978971

• Critical Bias in Critical Care Devices. Critical care clinics Charpignon, M., Byers, J., Cabral, S., Celi, L. A., Fernandes, C., Gallifant, J., Lough, M. E., Mlombwa, D., Moukheiber, L., Ong, B. A., Panitchote, A., William, W., Wong, A. I., Nazer, L. 2023; 39 (4): 795-813

  Abstract

  Critical care data contain information about the most physiologically fragile patients in the hospital, who require a significant level of monitoring. However, medical devices used for patient monitoring suffer from measurement biases that have been largely underreported. This article explores sources of bias in commonly used clinical devices, including pulse oximeters, thermometers, and sphygmomanometers. Further, it provides a framework for mitigating these biases and key principles to achieve more equitable health care delivery.

  View details for DOI 10.1016/j.ccc.2023.02.005

  View details for PubMedID 37704341

• A STANDARDIZED STIR-UP REGIMEN SHORTENS PHASE I RECOVERY TIME IN PACU Chen, L., Glatt, E., Weng, Y., Kerr, P., Lough, M. E. ELSEVIER SCIENCE INC. 2023: E26

  View details for DOI 10.1016/j.jopan.2023.06.022

  View details for Web of Science ID 001059019400068

• A Method to Explore Variations of Ventilator-Associated Event Surveillance Definitions in Large Critical Care Databases in the United States. Critical care explorations Wong, A. I., Kim, H., Charpignon, M. L., Carvalho, L., Monares-Zepeda, E., Madushani, R. W., Adhikari, L., Kindle, R. D., Kutner, M., Celi, L. A., Lough, M. E., Mireles-Cabodevila, E. 2022; 4 (11): e0790

  Abstract

  The Centers for Disease Control has well-established surveillance programs to monitor preventable conditions in patients supported by mechanical ventilation (MV). The aim of the study was to develop a data-driven methodology to examine variations in the first tier of the ventilator-associated event surveillance definition, described as a ventilator-associated condition (VAC). Further, an interactive tool was designed to illustrate the effect of changes to the VAC surveillance definition, by applying different ventilator settings, time-intervals, demographics, and selected clinical criteria.Retrospective, multicenter, cross-sectional analysis.Three hundred forty critical care units across 209 hospitals, comprising 261,910 patients in both the electronic Intensive Care Unit Clinical Research Database and Medical Information Mart for Intensive Care III databases.A total of 14,517 patients undergoing MV for 4 or more days.We designed a statistical analysis framework, complemented by a custom interactive data visualization tool to depict how changes to the VAC surveillance definition alter its prognostic performance, comparing patients with and without VAC. This methodology and tool enable comparison of three clinical outcomes (hospital mortality, hospital length-of-stay, and ICU length-of-stay) and provide the option to stratify patients by six criteria in two categories: patient population (dataset and ICU type) and clinical features (minimum Fio2, minimum positive end-expiratory pressure, early/late VAC, and worst first-day respiratory Sequential Organ Failure Assessment score). Patient population outcomes were depicted by heatmaps with mortality odds ratios. In parallel, outcomes from ventilation setting variations and clinical features were depicted with Kaplan-Meier survival curves.We developed a method to examine VAC using information extracted from large electronic health record databases. Building upon this framework, we developed an interactive tool to visualize and quantify the implications of variations in the VAC surveillance definition in different populations, across time and critical care settings. Data for patients with and without VAC was used to illustrate the effect of the application of this method and visualization tool.

  View details for DOI 10.1097/CCE.0000000000000790

  View details for PubMedID 36406886

  View details for PubMedCentralID PMC9668560

• Nursing Workflow Change in a COVID-19 Inpatient Unit Following the Deployment of Inpatient Telehealth: An Observational Study Using a Real-Time Locating System. Journal of medical Internet research Vilendrer, S., Lough, M. E., Garvert, D. W., Lambert, M. H., Lu, J. H., Patel, B., Shah, N. H., Williams, M. Y., Kling, S. M. 2022

  Abstract

  BACKGROUND: The COVID-19 pandemic prompted widespread implementation of telehealth, including in the inpatient setting with the goals to reduce potential pathogen exposure events and personal protective equipment (PPE) utilization. Nursing workflow adaptations in these novel environments is of particular interest given the association between nursing time at the bedside and patient safety. Understanding the frequency and duration of nurse-patient encounters following the introduction of a novel telehealth platform in the context of COVID-19 may therefore provide insight into downstream impacts on patient safety, pathogen exposure, and PPE utilization.OBJECTIVE: To evaluate changes in nursing workflow relative to pre-pandemic levels using real-time locating system (RTLS) following the deployment of inpatient telehealth on a COVID-19 unit.METHODS: In March 2020, telehealth was installed in patient rooms in a COVID-19 unit and on movable carts in 3 comparison units. Existing RTLS captured nurse movement during 1 pre- and 5 post-pandemic stages (January-December 2020). Change in direct nurse-patient encounters, time spent in patient rooms per encounter, and total time spent with patients per shift relative to baseline were calculated. Generalized linear models assessed difference-in-differences in outcomes between COVID-19 and comparison units. Telehealth adoption was captured and reported at the unit level.RESULTS: Change in frequency of encounters and time spent per encounter from baseline differed between the COVID-19 and comparison units at all stages of the pandemic (all P's<0.0001). Frequency of encounters decreased (difference-in-differences range: -6.6 to -14.1 encounters) and duration of encounters increased (difference-in-differences range: 1.8 to 6.2 minutes) from baseline to a greater extent in the COVID-19 units compared to the comparison units. At most stages of the pandemic, the change in total time nurses spent in patient rooms per patient per shift from baseline did not differ between the COVID-19 and comparison units (p's>0.17). The primary COVID-19 unit quickly adopted telehealth technology during the observation period, initiating 15,088 encounters that averaged 6.6 minutes (standard deviation = 13.6) each.CONCLUSIONS: RTLS movement data suggests total nursing time at the bedside remained unchanged following the deployment of inpatient telehealth in a COVID-19 unit. Compared to other units with shared mobile telehealth units, frequency of nurse-patient in-person encounters decreased and duration lengthened on a COVID-19 unit with in-room telehealth availability, indicating "batched" redistribution of work to maintain total time at bedside relative to pre-pandemic periods. The simultaneous adoption of telehealth suggests virtual care was a complement to, rather than a replacement for, in-person care. Study limitations, however, preclude our ability to draw a causal link between nursing workflow change and telehealth adoption, and further evaluation is needed to determine potential downstream implications on disease transmission, PPE utilization, and patient safety.CLINICALTRIAL:

  View details for DOI 10.2196/36882

  View details for PubMedID 35635840

• Clinical Ladders for Clinical Nurse Specialists It's Time! CLINICAL NURSE SPECIALIST Lough, M. E. 2022; 36 (2): 71-72

  View details for DOI 10.1097/NUR.0000000000000663

  View details for Web of Science ID 000778961300003

• Analysis of Discrepancies Between Pulse Oximetry and Arterial Oxygen Saturation Measurements by Race and Ethnicity and Association With Organ Dysfunction and Mortality. JAMA network open Wong, A. I., Charpignon, M., Kim, H., Josef, C., de Hond, A. A., Fojas, J. J., Tabaie, A., Liu, X., Mireles-Cabodevila, E., Carvalho, L., Kamaleswaran, R., Madushani, R. W., Adhikari, L., Holder, A. L., Steyerberg, E. W., Buchman, T. G., Lough, M. E., Celi, L. A. 2021; 4 (11): e2131674

  Abstract

  Importance: Discrepancies in oxygen saturation measured by pulse oximetry (Spo2), when compared with arterial oxygen saturation (Sao2) measured by arterial blood gas (ABG), may differentially affect patients according to race and ethnicity. However, the association of these disparities with health outcomes is unknown.Objective: To examine racial and ethnic discrepancies between Sao2 and Spo2 measures and their associations with clinical outcomes.Design, Setting, and Participants: This multicenter, retrospective, cross-sectional study included 3 publicly available electronic health record (EHR) databases (ie, the Electronic Intensive Care Unit-Clinical Research Database and Medical Information Mart for Intensive Care III and IV) as well as Emory Healthcare (2014-2021) and Grady Memorial (2014-2020) databases, spanning 215 hospitals and 382 ICUs. From 141 600 hospital encounters with recorded ABG measurements, 87 971 participants with first ABG measurements and an Spo2 of at least 88% within 5 minutes before the ABG test were included.Exposures: Patients with hidden hypoxemia (ie, Spo2 ≥88% but Sao2 <88%).Main Outcomes and Measures: Outcomes, stratified by race and ethnicity, were Sao2 for each Spo2, hidden hypoxemia prevalence, initial demographic characteristics (age, sex), clinical outcomes (in-hospital mortality, length of stay), organ dysfunction by scores (Sequential Organ Failure Assessment [SOFA]), and laboratory values (lactate and creatinine levels) before and 24 hours after the ABG measurement.Results: The first Spo2-Sao2 pairs from 87 971 patient encounters (27 713 [42.9%] women; mean [SE] age, 62.2 [17.0] years; 1919 [2.3%] Asian patients; 26 032 [29.6%] Black patients; 2397 [2.7%] Hispanic patients, and 57 632 [65.5%] White patients) were analyzed, with 4859 (5.5%) having hidden hypoxemia. Hidden hypoxemia was observed in all subgroups with varying incidence (Black: 1785 [6.8%]; Hispanic: 160 [6.0%]; Asian: 92 [4.8%]; White: 2822 [4.9%]) and was associated with greater organ dysfunction 24 hours after the ABG measurement, as evidenced by higher mean (SE) SOFA scores (7.2 [0.1] vs 6.29 [0.02]) and higher in-hospital mortality (eg, among Black patients: 369 [21.1%] vs 3557 [15.0%]; P<.001). Furthermore, patients with hidden hypoxemia had higher mean (SE) lactate levels before (3.15 [0.09] mg/dL vs 2.66 [0.02] mg/dL) and 24 hours after (2.83 [0.14] mg/dL vs 2.27 [0.02] mg/dL) the ABG test, with less lactate clearance (-0.54 [0.12] mg/dL vs -0.79 [0.03] mg/dL).Conclusions and Relevance: In this study, there was greater variability in oxygen saturation levels for a given Spo2 level in patients who self-identified as Black, followed by Hispanic, Asian, and White. Patients with and without hidden hypoxemia were demographically and clinically similar at baseline ABG measurement by SOFA scores, but those with hidden hypoxemia subsequently experienced higher organ dysfunction scores and higher in-hospital mortality.

  View details for DOI 10.1001/jamanetworkopen.2021.31674

  View details for PubMedID 34730820

• Village mentoring and hive learning: The MIT Critical Data experience. iScience Cosgriff, C. V., Charpignon, M., Moukheiber, D., Lough, M. E., Gichoya, J., Stone, D. J., Celi, L. A. 2021; 24 (6): 102656

  View details for DOI 10.1016/j.isci.2021.102656

  View details for PubMedID 34169236

• EXTERNAL FEMALE URINARY CATHETER: IMPLEMENTATION IN THE EMERGENCY DEPARTMENT JOURNAL OF EMERGENCY NURSING Root, N., Horigan, A. E., Lough, M. E. 2021; 47 (1): 131–38

  Abstract

  The emergency department is a care environment in which indwelling urinary catheters are placed frequently; however, the significance of the role of the emergency department in catheter-associated urinary tract infection prevention has been overlooked. The use of an external female urinary catheter is an alternative to placing an indwelling urinary catheter for female patients in the emergency department who are incontinent of urine or are immobile. The purpose was to describe the implementation of an initiative to decrease the number of indwelling urinary catheters and increase the use of external urinary female catheters in non-critically ill women who visited the emergency department at a 451-bed Magnet-designated community hospital in the Southeast. For this clinical implementation project, the Plan, Do, Check, Act framework was used to develop the initiative, and outcome data were collected retrospectively and included an indirect calculation of the number of indwelling urinary catheters placed in the emergency department. A total of 187 external catheters were used in place of indwelling catheters in female patients over a 3-month period. No skin irritation or breakdown was observed. This project demonstrated the initial staff acceptability and feasibility of external female urinary catheter use in the ED setting.

  View details for DOI 10.1016/j.jen.2020.09.008

  View details for Web of Science ID 000612616800020

  View details for PubMedID 33187721

• Nurse Practitioner-Directed Cardio-Diabetes Pilot Program JNP-JOURNAL FOR NURSE PRACTITIONERS Bryant, E., Janaszek, K., Nejedly, M., Li, E., Bouvier, M., Schroeder, K., Khandelwal, A., Lough, M. E., Lamendola, C., Reisenberg, A., Purewal, S., Maron, D. J. 2020; 16 (8): E123–E128

  View details for DOI 10.1016/j.nurpra.2020.05.009

  View details for Web of Science ID 000566686900008

• Registered nurses' experiences with urinary catheter insertion: A qualitative focus group study. Applied nursing research : ANR Lough, M. E., Eller, S., Mayer, B. 2020: 151293

  View details for DOI 10.1016/j.apnr.2020.151293

  View details for PubMedID 32532476

• Adapting rapid assessment procedures for implementation research using a team-based approach to analysis: a case example of patient quality and safety interventions in the ICU. Implementation science : IS Holdsworth, L. M., Safaeinili, N. n., Winget, M. n., Lorenz, K. A., Lough, M. n., Asch, S. n., Malcolm, E. n. 2020; 15 (1): 12

  Abstract

  Innovations to improve quality and safety in healthcare are increasingly complex, targeting multiple disciplines and organizational levels, and often requiring significant behavior change by those delivering care. Learning health systems must tackle the crucial task of understanding the implementation and effectiveness of complex interventions, but may be hampered in their efforts by limitations in study design imposed by business-cycle timelines and implementation into fast-paced clinical environments. Rapid assessment procedures are a pragmatic option for producing timely, contextually rich evaluative information about complex interventions implemented into dynamic clinical settings.We describe our adaptation of rapid assessment procedures and introduce a rapid team-based analysis process using an example of an evaluation of an intensive care unit (ICU) redesign initiative aimed at improving patient safety in four academic medical centers across the USA. Steps in our approach included (1) iteratively working with stakeholders to develop evaluation questions; (2) integration of implementation science frameworks into field guides and analytic tools; (3) selecting and training a multidisciplinary site visit team; (4) preparation and trust building for 2-day site visits; (5) engaging sites in a participatory approach to data collection; (6) rapid team analysis and triangulation of data sources and methods using a priori charts derived from implementation frameworks; and (7) validation of findings with sites.We used the rapid assessment approach at each of the four ICU sites to evaluate the implementation of the sites' innovations. Though the ICU projects all included three common components, they were individually developed to suit the local context and had mixed implementation outcomes. We generated in-depth case summaries describing the overall implementation process for each site; implementation barriers and facilitators for all four sites are presented. One of the site case summaries is presented as an example of findings generated using the method.A rapid team-based approach to qualitative analysis using charts and team discussion using validation techniques, such as member-checking, can be included as part of rapid assessment procedures. Our work demonstrates the value of including rapid assessment procedures for implementation research when time and resources are limited.

  View details for DOI 10.1186/s13012-020-0972-5

  View details for PubMedID 32087724

• CONTAMINATION IN ADULT MIDSTREAM CLEAN-CATCH URINE CULTURES IN THE EMERGENCY DEPARTMENT: A RANDOMIZED CONTROLLED TRIAL JOURNAL OF EMERGENCY NURSING Lough, M. E., Shradar, E., Hsieh, C., Hedlin, H. 2019; 45 (5): 488–501

  Abstract

  A midstream clean-catch urine sample is recommended to obtain a urine culture in symptomatic adults with suspected urinary tract infection. The aim of this randomized controlled trial was to determine whether a novel funnel urine-collection system combined with a silver-colloidal cleaning wipe would decrease mixed flora contamination in midstream clean-catch urine cultures from ambulatory adults in the emergency department.In a 2x2 factorial trial, adult participants were randomized to 4 groups: (A) sterile screw-top urine collection container/cup paired with a castile-soap wipe (control group); (B) sterile screw-top urine collection container/cup paired with a colloidal silver-impregnated wipe; (C) sterile urine-collection funnel paired with a castile-soap wipe; (D) sterile urine-collection funnel paired with a colloidal silver-impregnated wipe.The trial was stopped after interim analysis, as the contamination rate in the control group (30%) was markedly lower than the historical ED contamination rate (40%) at the study site. From 1,112 urinalysis results, 223 urine culture results were analyzed (190 female patients and 33 male patients). Urine contamination rates were as follows: Group A, n = 67 (29.9% contaminated); Group B, n = 69 (34.8% contaminated); Group C, n = 51 (23.5% contaminated); Group D, n = 36 (22.2% contaminated). The differences in contamination rates were not statistically different among any of the groups.The use of a funnel urine-collection system and silver-impregnated wipe did not reduce urine-culture contamination in adult midstream clean-catch urine cultures in the emergency department.

  View details for DOI 10.1016/j.jen.2019.06.001

  View details for Web of Science ID 000482217800004

  View details for PubMedID 31445626

• Volume-Based Feeding in Enteral Nutrition: What About Diabetes? CRITICAL CARE NURSE Lough, M. E. 2017; 37 (4): 76–77

  View details for PubMedID 28765357

• Transferring Scientific Knowledge Into Action at the Point of Care: Do We Have All the Facts? Clinical nurse specialist CNS Lough, M. E., Rice, K. L. 2016; 30 (6): 315-317

  View details for PubMedID 27753667

• Evaluating optimal patient-turning procedures for reducing hospital-acquired pressure ulcers (LS-HAPU): study protocol for a randomized controlled trial TRIALS Pickham, D., Ballew, B., Ebong, K., Shinn, J., Lough, M. E., Mayer, B. 2016; 17

  Abstract

  Pressure ulcers are insidious complications that affect approximately 2.5 million patients and account for approximately US$11 billion in annual health care spending each year. To date we are unaware of any study that has used a wearable patient sensor to quantify patient movement and positioning in an effort to assess whether adherence to optimal patient turning results in a reduction in pressure ulcer occurrence.This study is a single-site, open-label, two-arm, randomized controlled trial that will enroll 1812 patients from two intensive care units. All subjects will be randomly assigned, with the aid of a computer-generated schedule, to either a standard care group (control) or an optimal pressure ulcer-preventative care group (treatment). Optimal pressure ulcer prevention is defined as regular turning every 2 h with at least 15 min of tissue decompression. All subjects will receive a wearable patient sensor (Leaf Healthcare, Inc., Pleasanton, CA, USA) that will detect patient movement and positioning. This information is relayed through a proprietary mesh network to a central server for display on a user-interface to assist with nursing care. This information is used to guide preventative care practices for those within the treatment group. Patients will be monitored throughout their admission in the intensive care unit.We plan to conduct a randomized control trial, which to our knowledge is the first of its kind to use a wearable patient sensor to quantify and establish optimal preventative care practices, in an attempt to determine whether this is effective in reducing hospital-acquired pressure ulcers.ClinicalTrials.gov, NCT02533726 .

  View details for DOI 10.1186/s13063-016-1313-5

  View details for Web of Science ID 000373488900003

  View details for PubMedID 27053145

  View details for PubMedCentralID PMC4823913

• Legal and clinical issues in genetics and genomics. Clinical nurse specialist CNS Lough, M. E., Seidel, G. D. 2015; 29 (2): 68-70

  View details for DOI 10.1097/NUR.0000000000000101

  View details for PubMedID 25654702

• Measurement of Thiamine Levels in Human Tissue B VITAMINS AND FOLATE: CHEMISTRY, ANALYSIS, FUNCTION AND EFFECTS Zahr, N. M., Lough, M. E., Jung, Y., Sullivan, E. V., Preedy, V. R. 2013; 4: 227-251

  View details for DOI 10.1039/9781849734714-00227

  View details for Web of Science ID 000326647100017

• Wernicke's Encephalopathy: Expanding the Diagnostic Toolbox NEUROPSYCHOLOGY REVIEW Lough, M. E. 2012; 22 (2): 181-194

  Abstract

  Wernicke's encephalopathy (WE) is a life threatening neurological disorder that results from thiamine (Vitamin B1) deficiency. Clinical signs include mental status changes, ataxia, occulomotor changes and nutritional deficiency. The conundrum is that the clinical presentation is highly variable. WE clinical signs, brain imaging, and thiamine blood levels, are reviewed in 53 published case reports from 2001 to 2011; 81 % (43/53) were non-alcohol related. Korsakoff Syndrome or long-term cognitive neurological changes occurred in 28 % (15/53). Seven WE cases (13 %) had a normal magnetic resonance image (MRI). Four WE cases (8 %) had normal or high thiamine blood levels. Neither diagnostic tool can be relied upon exclusively to confirm a diagnosis of WE.

  View details for DOI 10.1007/s11065-012-9200-7

  View details for Web of Science ID 000305248800010

  View details for PubMedID 22577001

• Collaborative Partnerships Between Critical Care and Psychiatry CRITICAL CARE NURSING CLINICS OF NORTH AMERICA Lough, M. E., Klevay, A. M. 2012; 24 (1): 81-?

  Abstract

  The model of collaboration developed by D'Amour and associates can be used to analyze components of collaboration within organizations as shown in Fig. 1. The model covers both interprofessional and interorganizational components of collaboration. A strong supportive organizational infrastructure is the powerful force that sustains successful collaboration between critical care and psychiatry. Professionals' recognition that we have complementary, nonoverlapping clinical skills with recognizance of shared and overlapping populations is vital. The beauty of collaboration is the appreciation of the full value of each participant's unique contribution and diversity. When there are multiple opportunities for collaboration, everyone benefits, especially the critical care patient.

  View details for DOI 10.1016/j.ccell.2012.01.003

  View details for Web of Science ID 000313395000007

  View details for PubMedID 22405713

• Standardizing Neurological Assessment in an Adult Intensive Care Unit International Stroke Conference Jensen, B. Y., Lough, M. E. LIPPINCOTT WILLIAMS & WILKINS. 2011: E130–E130

  View details for Web of Science ID 000287479400289

• Patient-focused care for the ventilator-dependent patient. Progress in cardiovascular nursing Lough, M. E. 1997; 12 (2): 41-2

  View details for PubMedID 9195649

• Cross-training across acuity levels. Critical care nurse Dirks, J. L., Lough, M. E., Moungey, S. J. 1995; 15 (1): 68-74

  View details for PubMedID 7712821

• Unit-based research in critical care nursing. Dimensions of critical care nursing : DCCN Rizzuto, C., Lough, M. E., Palange, K. 1990; 9 (3): 170-6

  Abstract

  This article describes the characteristics of unit-based nursing research, highlighting the experiences of staff nurses on two critical care units. On both units, study findings facilitated changes in practice. The authors evaluate their experience and offer suggestions to critical care nurses interested in unit-based research.

  View details for DOI 10.1097/00003465-199005000-00011

  View details for PubMedID 2340788

• Quality of life for heart transplant recipients. The Journal of cardiovascular nursing Lough, M. E. 1988; 2 (2): 11-22

  View details for PubMedID 3280737

• Impact of protection isolation on the incidence of infection after heart transplantation. journal of heart transplantation Gamberg, P., Miller, J. L., LOUGH, M. E. 1987; 6 (3): 147-149

  Abstract

  Infection is a major cause of morbidity and mortality in heart transplantation. Therefore protective isolation has been an inherent part of our postoperative regimen. For retrospective review we selected patients before and after modification of protective isolation. The intensity of protective isolation appeared to have no impact on incidence, morbidity, or mortality resulting from infection in these study groups.

  View details for PubMedID 3309216

• IMPACT OF SYMPTOM FREQUENCY AND SYMPTOM DISTRESS ON SELF-REPORTED QUALITY-OF-LIFE IN HEART-TRANSPLANT RECIPIENTS HEART & LUNG LOUGH, M. E., Lindsey, A. M., SHINN, J. A., Stotts, N. A. 1987; 16 (2): 193-200

  View details for Web of Science ID A1987G410400016

  View details for PubMedID 3546207

• INTRODUCTION TO HEMODYNAMIC MONITORING NURSING CLINICS OF NORTH AMERICA LOUGH, M. E. 1987; 22 (1): 89-110

  Abstract

  This article discusses nursing care of the patient who requires hemodynamic monitoring. This will include care of the patient who requires intra-arterial pressure monitoring, central venous pressure (CVP) monitoring, left atrial pressure (LAP) monitoring, and monitoring of left heart pressures, cardiac output, and systemic vascular resistance using a pulmonary artery (PA) catheter.

  View details for Web of Science ID A1987G570200009

  View details for PubMedID 3644293

• Left ventricular assist device as a bridge to heart transplantation: a case study. journal of heart transplantation Williams, B. A., LOUGH, M. E., SHINN, J. A. 1987; 6 (1): 23-28

  Abstract

  Stanford University Medical Center has successfully utilized a left ventricular assist device as bridge support for 9 days in a 52-year-old man awaiting heart transplantation. During this time he developed a pericardial tamponade, but no other serious medical complications occurred. Major nursing care issues focused on pain control, vigorous pulmonary toilet, and left ventricular assist device timing. This article outlines the responsibilities of critical care nurses and what was learned from the experience. The recipient was discharged home 106 days after heart transplantation.

  View details for PubMedID 3302185

• NETWORKING AND WORKING WITH A MENTOR - KEYS TO ELICITING SUPPORT FOR CLINICAL RESEARCH AS A STAFF NURSE HEART & LUNG LOUGH, M. E. 1986; 15 (5): 525-527

  View details for Web of Science ID A1986E079400015

  View details for PubMedID 3639079

• Self-reported change in physical symptoms from cyclosporine-based therapy to azathioprine-based therapy in heart transplant recipients. journal of heart transplantation LOUGH, M. E., Miller, J. L., Gamberg, P. 1986; 5 (4): 322-326

  Abstract

  Since the introduction of cyclosporine, 183 heart transplants have been performed at Stanford University Medical Center. Although cyclosporine has improved survival rates, it is also associated with progressive renal dysfunction. Seventeen of these recipients have been converted from cyclosporine-based therapy to azathioprine-based therapy because of significant nephrotoxicity. Fourteen of these recipients participated in a study to examine change in physical symptoms since immunoconversion. Most reported little change in physical symptoms following conversion, although 79% experienced rejection following the drug change. Overall, the change in immunosuppressive medications had little impact on perceived symptoms.

  View details for PubMedID 3305825