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1.  App Store for EHRs and Patients Both  
The Substitutable Medical Applications, Reusable Technologies (SMART) Platforms project ( www.smartplatforms.org ) seeks to develop an iPhone-like health information technology platform with substitutable apps constructed around core services. It is funded by a grant from the Office of the National Coordinator of Health Information Technology’s Strategic Health IT Advanced Research Projects (SHARP) Program. SMART technologies enable existing electronic health records and HIT platforms to run substitutable apps. Substitutability is the capability inherent in a system of replacing one application with another of similar functionality. We created a patient-facing SMART instance using the open source Indivo personally controlled health record (PCHR).
The SMART “read-only” API has been deployed on multiple systems, including the Cerner installation at Boston Children’s Hospital and the World Vista EHR. We sought to SMART-enable Indivo, the open source reference PCHR upon which HealthVault and other PCHRs were modeled. PCHRs provide patients with a secure repository of their health information that can be exposed to apps across a programming interface. We updated the open source Indivo PCHR to support the SMART API, enabling Indivo to act as a patient-facing apps platform, running the same or similar versions of apps that face clinicians.
PMCID: PMC3845767  PMID: 24303239
2.  Recognition and Management of Complications During Moderate and Deep Sedation. Part 2: Cardiovascular Considerations 
Anesthesia Progress  2011;58(3):126-138.
The risk for cardiovascular complications while providing any level of sedation or general anesthesia is greatest when caring for patients already medically compromised. It is reassuring that significant untoward events can generally be prevented by careful preoperative assessment, along with attentive intraoperative monitoring and support. Nevertheless, providers must be prepared to manage untoward events should they arise. This continuing education article will review cardiovascular complications and address their appropriate management.
doi:10.2344/0003-3006-58.3.126
PMCID: PMC3167157  PMID: 21882989
Medical emergencies; Sedation; Anesthesia; Complications
3.  Recognition and Management of Complications During Moderate and Deep Sedation Part 1: Respiratory Considerations 
Anesthesia Progress  2011;58(2):82-92.
The risk for complications while providing any level of sedation or general anesthesia is greatest when caring for patients having significant medical compromise. It is reassuring that significant untoward events can generally be prevented by careful preoperative assessment, along with attentive intraoperative monitoring and support. Nevertheless, we must be prepared to manage untoward events should they arise. This continuing education article will review respiratory considerations and will be followed by a subsequent article addressing cardiovascular considerations.
doi:10.2344/0003-3006-58.2.82
PMCID: PMC3198131  PMID: 21679044
Medical emergencies; Sedation; Anesthesia; Complications
4.  Effect of Time on Clinical Efficacy of Topical Anesthesia 
Anesthesia Progress  2009;56(2):36-41.
The objective of this study was to determine the effect of time on the clinical efficacy of topical anesthetic in reducing pain from needle insertion alone as well as injection of anesthetic. This was a randomized, double-blind, placebo-controlled, split-mouth, clinical trial which enrolled 90 subjects, equally divided into 3 groups based upon time (2, 5, or 10 minutes) of topical anesthetic (5% lidocaine) application. Each group was further subdivided into 2: needle insertion only in the palate or needle insertion with deposition of anesthetic (0.5 mL 3% mepivacaine plain). Each subject received drug on one side and placebo on the other. Subjects recorded pain on a 100-mm visual analog scale (VAS). The results showed that for needle insertion only, 5% lidocaine reduced pain as determined by a significant difference in mean VAS after 2 minutes (20.1 mm, P < .002), 5 minutes (15.7 mm, P < .022), and 10 minutes (13.7 mm, P < .04), as analyzed by paired t tests. For needle insertion plus injection of local anesthetic, a significant difference in mean VAS was noted only after 10 minutes (14.9 mm, P < .031), yet pain scores for both topical anesthetic and placebo were elevated at this time point resulting in no reduction in actual pain. Time of application did not result in a significant difference in effect for either needle insertion only or needle insertion plus injection of local anesthetic, as analyzed by 1-way analysis of variance (ANOVA). In conclusion, topical anesthetic reduces pain of needle insertion if left on palatal mucosa for 2, 5, or 10 minutes, but has no clinical pain relief for anesthetic injection.
doi:10.2344/0003-3006-56.2.36
PMCID: PMC2699690  PMID: 19642717
Topical anesthesia; Local anesthesia; Pain
5.  Management of Complications During Moderate and Deep Sedation: Respiratory and Cardiovascular Considerations 
Anesthesia Progress  2007;54(2):59-69.
The risk for complications while providing moderate and deep sedation is greatest when caring for patients already medically compromised. It is reassuring that significant untoward events can generally be prevented by careful preoperative assessment, along with attentive intraoperative monitoring and support. Nevertheless, we must be prepared to manage untoward events should they arise. This continuing education article will review critical aspects of patient management of respiratory and cardiovascular complications.
doi:10.2344/0003-3006(2007)54[59:MOCDMA]2.0.CO;2
PMCID: PMC1893095  PMID: 17579505
Medical emergencies; Sedation; Anesthesia; Complications
6.  Management of Medical Emergencies in the Dental Office: Conditions in Each Country, the Extent of Treatment by the Dentist 
Anesthesia Progress  2006;53(1):20-24.
doi:10.2344/0003-3006(2006)53[20:MOMEIT]2.0.CO;2
PMCID: PMC1586863  PMID: 16722281
7.  Capsaicin-induced joint inflammation is not blocked by local anesthesia. 
Anesthesia Progress  2004;51(1):2-9.
The purpose of this study was to evaluate the effect of local anesthetic blockade of afferent innervation on the development of capsaicin-induced edema in the rat temporomandibular joint (TMJ) region and on reflex jaw muscle activity. Under halothane anesthesia, 64 male Sprague-Dawley rats were prepared for monitoring of edema development by lateral movement of a needle overlying the left TMJ region and for acute recording of electromyographic activity in ipsilateral digastric and masseter muscles. A double-barrel catheter was inserted into the TMJ region for delivery of saline or 0.5% bupivacaine from 1 needle, followed with the injection of 1% capsaicin, 0.1% capsaicin, or vehicle control from the other needle 5 minutes later. Application of capsaicin into the saline pretreated TMJ region led to dose-dependent edema development and reflex jaw muscle activity; however, only 1% capsaicin solution resulted in significant tissue expansion and muscle activity when compared with the vehicle control. Pretreatment of the rat TMJ region with bupivacaine failed to inhibit capsaicin-induced edema development, although successful blockade of nerve conduction was confirmed with the absence of reflex jaw muscle activity. Capsaicin-induced edema of the rat TMJ region developed independent of axonal conduction, suggesting neurogenic inflammation may arise regardless of functional nerve conduction.
PMCID: PMC2007461  PMID: 15106683

Results 1-7 (7)