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Pittsfield, MA, United States

Richardson W.S.,Ochsner Clinic | Fanelli R.D.,Berkshire Medical Center
Surgical Endoscopy and Other Interventional Techniques | Year: 2010

Background: The development and implementation of evidence-based clinical practice guidelines involves many challenges. The Society of the American Gastrointestinal and Endoscopic Surgeons (SAGES) has been at the forefront of guideline development for laparoscopic surgery since 1991, providing its membership with guidelines on the clinical application of procedures and the granting of privileges. The objective of this study was to assess the use of SAGES guidelines by its members. Methods: An electronic survey of SAGES members was conducted via e-mail in August 2007. Members were asked if they used the guidelines, how often, for what purposes and when, and to rank the frequency of use and the usefulness of each of the 26 guidelines. They also were asked to suggest topics for new guideline development and to provide comments. Results: Two hundred thirty-nine SAGES members (4.1%) responded to the survey; 121 (50%) responders used the guidelines. Of these, 95% accessed the guidelines monthly or less often, 58% after hours, 52% during work hours, and 9% while on call. Reasons for guideline use included developing practice protocols (56%) and patient treatment paradigms (51%), creating education and training guidelines for staff privileges (35%), and credentialing new medical staff (25%). The most often used and most useful guidelines included clinical application guidelines on laparoscopic bariatric, antireflux, biliary, and colorectal surgery, laparoscopic appendectomy, and deep vein thrombosis prophylaxis. Some respondents indicated no knowledge of guideline existence and made requests for new guidelines. Conclusions: The results of this survey provided valuable information about current use of SAGES guidelines by its members. The pattern of use highlights the need for interventions that increase member awareness and adoption of these guidelines. Such efforts are currently underway. © 2010 Springer Science+Business Media, LLC. Source

Riascos D.,Northwestern University | De Leon D.,Northwestern University | Baker-Nigh A.,Northwestern University | Nicholas A.,Beth Israel Deaconess Medical Center | And 5 more authors.
Acta Neuropathologica | Year: 2011

The reasons for the selective vulnerability of distinct neuronal populations in neurodegenerative disorders are unknown. The cholinergic neurons of the basal forebrain are vulnerable to pathology and loss early in Alzheimer's disease and in a number of other neurodegenerative disorders of the elderly. In the primate, including man, these neurons are rich in the calcium buffer calbindin-D 28K. Here, we confirm that these neurons undergo a substantial loss of calbindin in the course of normal aging and report a further loss of calbindin in Alzheimer's disease both at the level of RNA and protein. Significantly, cholinergic neurons that had lost their calbindin in the course of normal aging were those that selectively degenerated in Alzheimer's disease. Furthermore, calbindin-containing neurons were virtually resistant to the process of tangle formation, a hallmark of the disease. We conclude that the loss of calcium buffering capacity in these neurons and the resultant pathological increase in intracellular calcium are permissive to tangle formation and degeneration. © 2011 Springer-Verlag. Source

Michaels B.M.,University of Massachusetts Amherst | Csank G.A.,University of Massachusetts Amherst | Ryb G.E.,University of Maryland, Baltimore | Eko F.N.,Tulane University | Rubin A.,Berkshire Medical Center
Aesthetic Surgery Journal | Year: 2012

Background: There are several commercially available neurotoxins to improve facial aesthetics, but few prospective, randomized trials have been conducted without commercial support to compare these agents. Objectives: The authors present the results of a study examining and comparing the effects of onabotulinumtoxinA (BoNT-ONA; Botox, Allergan, Inc., Irvine, California) and abobotulinumtoxinA (BoNT-ABO; Dysport, Ipsen Ltd, Slough, UK). Methods: The authors enrolled 53 patients in a prospective, randomized trial in which each patient received a dose of BoNT-ONA on one side of the upper face and BoNT-ABO on the other. The effects of each agent were monitored and recorded over 150 days according to each patient's ability to elevate the brow, wrinkle count (as measured by the Visia system; Canfield Imaging Systems, Fairfield, New Jersey), and assessment of Fitzpatrick wrinkle scale rankings by blinded graders. Results: Results showed no statistically significant differences between the two agents. Both agents yielded measurable improvements on wrinkles of the upper face at 150 days. Conclusions: At the current pricing of the agents, BoNT-ABO offers a significant cost savings over BoNT-ONA, with a comparable efficacy. The effect of both drugs appears to be more prolonged than indicated in the current manufacturer guidelines. © 2012 The American Society for Aesthetic Plastic Surgery, Inc. Source

Wu J.J.,Chestnut Medical | Baldwin B.C.,Berkshire Medical Center | Goldwater E.,University of Massachusetts Amherst | Counihan T.C.,Veteran Affairs Medical Center
Hernia | Year: 2016

Purpose: Many surgeons are reluctant to offer elective inguinal and femoral hernia repair (IHR) to the elderly due to concerns of increased risk. The authors sought to evaluate the outcomes of elderly patients undergoing IHR compared to the general population. Methods: We performed a retrospective review of the 2011 NSQIP database evaluating 19,683 patients undergoing IHR. Patients were divided by age into three categories: <65, 65–79 and >80. Logistic regression analysis was used to assess impact of comorbid conditions and type of surgery on outcomes. Patients were analyzed for mortality and complications based on their age and the types of surgery (elective, urgent, emergent, laparoscopic versus open) and comorbid conditions. Results: There were 17,375 male patients (88 %). 92.7 % were elective. 70 % were performed using an open technique. Age distribution was 63.4 % < 65, 26.6 % 65–79, 10 % >80. Mortality was similar across age groups in elective repair. Mortality was increased in emergency repair in all age groups (p < 0.001). Mortality was increased in emergency surgery compared to elective surgery in patients >80 (OR = 57, p < 0.001). Mortality was similar between laparoscopic and open in <65 (OR = 0.96, p = 0.97) and unable to be assessed in other age groups. Dyspnea and COPD predicted higher mortality and complications with emergency surgery in the elderly (age 65–79 OR 15.3 and 14.9, respectively, age >80 OR 56.5 and 14.9, respectively). Conclusions: Elective inguinal hernia repair carries a similar mortality in the elderly compared to the general population. Emergent IHR carries a very high risk of death in the elderly. The authors recommend considering elective IHR regardless of age. © 2016 Springer-Verlag France Source

Imran S.,Berkshire Medical Center | Eva G.,University of Massachusetts Amherst | Christopher S.,Berkshire Medical Center | Flynn E.,Berkshire Medical Center | Henner D.,Berkshire Medical Center
Journal of Clinical Laboratory Analysis | Year: 2010

Context: Urine specific gravity (USG) is often used by clinicians to estimate urine osmolality. USG is measured either by refractometry or by reagent strip. Objective: We studied the correlation of USG obtained by either method with a concurrently obtained osmolality. Design: Using our laboratory's records, we retrospectively gathered data on 504 urine specimens on patients on whom a simultaneously drawn USG and an osmolality were available. Out of these, 253 USG's were measured by automated refractometry and 251 USG's were measured by reagent strip. Urinalysis data on these subjects were used to determine the correlation between USG and osmolality, adjusting for other variables that may impact the relationship. The other variables considered were pH, protein, glucose, ketones, nitrates, bilirubin, urobilinogen, hemoglobin, and leukocyte esterase. The relationships were analyzed by linear regression. Results: This study demonstrated that USG obtained by both reagent strip and refractometry had a correlation of approximately 0.75 with urine osmolality. The variables affecting the correlation included pH, ketones, bilirubin, urobilinogen, glucose, and protein for the reagent strip and ketones, bilirubin, and hemoglobin for the refractometry method. At a pH of 7 and with an USG of 1.010 predicted osmolality is approximately 300 mosm/kg/H2O for either method. For an increase in SG of 0.010, predicted osmolality increases by 182 mosm/kg/H2O for the reagent strip and 203 mosm/kg/H2O for refractometry. Pathological urines had significantly poorer correlation between USG and osmolality than "clean" urines. Conclusion: In pathological urines, direct measurement of urine osmolality should be used. © 2010 Wiley-Liss, Inc. Source

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