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Colton, CA, United States

Dehal A.,Arrowhead Regional Medical Center | Abbas A.,Tulane University | Johna S.,Kaiser Permanente
Breast Cancer Research and Treatment | Year: 2013

To examine the effect of comorbidity on risk of postoperative complications, prolonged hospitalization (defined as above median length of stay), non-routine disposition, and in-patient death among women with breast cancer after surgery. Nationwide in-patient sample is a nationwide clinical and administrative database. Discharges of patients aged 40 years and older who underwent surgery for breast cancer from 2005 to 2009 were identified. Information about patients and hospitals characteristics were obtained. Comorbidities were identified and used to calculate Charlson comorbidity index (CCI) score. We divided patients based on these scores into four groups: 0, 1, 2, and ≥3. Multivariate logistic regression analyses were used to examine risk adjusted association between CCI score and the aforementioned outcomes. We identified 70,536 patients' discharges. Compared to a CCI score of zero as a reference group, CCI scores of 1, 2, and ≥3 increased the risk of post-operative complications by 1.7-fold, 2.6-fold, and 4.6-fold, respectively (p < 0.001). Patients with CCI scores of 1, 2, and ≥3 had higher risk of non-routine disposition by 1.3-folds, 1.7-folds, and 2.2-folds, respectively (p < 0.001). Patients with CCI scores of 1, 2, and ≥3 had higher risk of prolonged hospitalization by 1.2-folds, 1.6-folds, and 2.3-folds, respectively (p < 0.001). Similarly, CCI scores of 1, 2, and ≥3 increased risk of in-patient death by 3.1-folds (p 0.05), 5.4-folds (p 0.008), and 15.8-folds (p < 0.001), respectively. Comorbidity associated with worse in-hospital outcomes among women with breast cancer after surgery. Effective control of comorbidity in breast cancer patients may reduce post-operative morbidity and mortality. © 2013 Springer Science+Business Media New York. Source


Dehal A.,Arrowhead Regional Medical Center | Abbas A.,University of Florida | Abbas A.,Tulane University | Johna S.,Kaiser Permanente
Breast Cancer Research and Treatment | Year: 2013

To examine racial/ethnic disparities in stage of disease and comorbidity (pre-treatment), surgical treatment allocation (breast-conserving surgery versus mastectomy), and in-hospital outcomes after surgery (post-treatment) among women with breast cancer. Nationwide inpatient sample is a nationwide clinical and administrative database compiled from 44 states representing 95 % of all hospital discharges in the Unites States. Discharges of adult women who underwent surgery for breast cancer from 2005 to 2009 were identified. Information about patients and hospitals characteristics was obtained. Multivariate logistic regression analyses were used to examine the risk adjusted association between race/ethnicity and the aforementioned outcomes (pre-treatment, treatment, and post-treatment). We identified 75,100 patient discharges. Compared to Whites, African-Americans (1.17, p < 0.001), and Hispanics (1.20, p < 0.001) were more likely to present with regional or metastatic disease. Similarly, African-American (1.58, p < 0.001) and Hispanics (1.11, p 0.003) were more likely to have comorbidity. Compared to Whites, African-Americans (0.71, p < 0.001), and Hispanics (0.77, p < 0.001) were less likely to receive mastectomy. Compared to Whites, African-Americans were more likely to develop post-operative complications (1.35, p < 0.001) and in-hospital mortality (1.87, p 0.13). Other racial groups showed no statistically significant difference compared to Whites. After controlling for potential confounders, we found racial/ethnic disparities in stage, comorbidity, surgical treatment allocation, and in-hospital outcomes among women with breast cancer. Future researches should examine the underlying factors of these disparities. © 2013 Springer Science+Business Media New York. Source


Miulli D.E.,Arrowhead Regional Medical Center
The Journal of the American Osteopathic Association | Year: 2010

Current limitations on residency duty hours came about after the death of a patient in 1984 in a New York City hospital. This tragedy served as the catalyst for a new public awareness and subsequent change in philosophy regarding resident duty hours, fatigue factors, and risks to patients from the long and tedious shifts of residency. However, it has proven difficult to limit resident physician duty hours. To analyze the impact of resident duty hour limitation (RDHL) implementation on residents, faculty, and patients. The authors conducted a survey of faculty and resident attitudes and experiences regarding RDHLs in the graduate medical education department at Arrowhead Regional Medical Center (ARMC) in Colton, California. They also conducted a review of the literature on faculty and resident attitudes and experiences before and after implementation of RDHLs. Of 60 surveys sent to ARMC faculty members in 2009, 12 (20.0%) were returned. Of 140 surveys sent to ARMC residents, 96 (68.6%) were returned. The survey results and literature review indicated that most faculty physicians initially believed that decreasing resident duty hours would limit the time available to residents for educational experiences and participation in treatment procedures, operations, and consultations. In addition, faculty initially believed that fewer training hours would diminish the quality of residents' educational experiences. Residents also expected negative outcomes from RDHLs. However, statistical data on actual outcomes revealed that residency programs are not adversely affected by limiting resident work hours to 80 hours per week. Furthermore, benefits of RDHLs appear to include improved patient care and well-rounded and psychologically balanced residents. A survey and literature review revealed a number of benefits of RDHLs. It is unclear, however, whether additional limitations of resident work hours are necessary or could accommodate the growing amount of information and skills that are required to become a competent physician. Source


Twu C.,Arrowhead Regional Medical Center | Han E.S.,City of Hope
Biologics: Targets and Therapy | Year: 2012

Epithelial ovarian cancer is typically found in its advanced stages, where a combination of surgical debulking and platinum/taxane-based chemotherapy is recommended. Although over 70%-80% of patients achieve remission, a significant proportion develop recurrence of their disease. Additional cytotoxic chemotherapy, as well as surgery, is typically used to manage disease recurrence. Therapies that target specific pathways in cancer cells are rapidly developing in the laboratory and are increasingly being studied in patients with ovarian cancer. We review the current status of novel therapies in the management of epithelial ovarian cancer. © 2012 Twu and Han, publisher and licensee Dove Medical Press Ltd. Source


McCague A.,Arrowhead Regional Medical Center
Scandinavian journal of trauma, resuscitation and emergency medicine | Year: 2011

Sodium acetate has been shown to cause hemodynamic instability when used as a hemodialysis buffer. The pattern of hemodynamic response to injury will be evaluated between those who received sodium acetate and those who did not.The primary purpose of the study is to analyze the effect of sodium acetate on hemodynamic parameters. Secondarily we looked at the effects on prevention and treatment of hyperchloremic metabolic acidosis. The study arm was comprised of patients who had received sodium acetate infusions in place of normal saline between March 2005 and December 2009. A control arm was created based on matching three pre-treatment variables: injury severity score (ISS), pH (+/- 0.03) and base deficit (+/- 3). A retrospective chart review was performed for patients in both arms. Blood pressure, arterial blood gas data and chemistry values were recorded for the time points of -6, -1, 0, 1, 6, 12, 24, 48, and 72 hours from start of sodium acetate infusion. Patients were excluded based on the following criteria: patients who were given sodium bicarbonate within 48 hours of starting sodium acetate, those given sodium acetate as a bolus, non-trauma patients, burn patients, patients who expired within 24 hours of arrival to the ICU, patients diagnosed with rhabdomyolysis and patients whose medical record could not be obtained. A total of 78 patients were included in the study, 39 in the study arm and 39 in the control arm. There were no statistically significant drops in blood pressure within either group. The median pH between the two groups at the start of infusion was equal. Both groups trended towards normal pH with the study arm improving faster than the control arm. The median serum bicarbonate at start of sodium acetate infusion was 19 mmol/L and 20 mmol/L at time zero for the study and control arms respectively with both trending upward during the study period. Chloride trended up initially in both groups but the study arm began to correct sooner at 24 hours compared to 48 hours for the control arm. We analyzed the use of sodium acetate as an alternative to normal saline or lactated ringers during resuscitation of critically ill trauma patients at a single center. Our data shows that the hemodynamic profile remained favorable, without evidence of instability at any point during the study period. Normalization of hyperchloremia and metabolic acidosis occurred faster in the patients who received sodium acetate. Source

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