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Reich D.J.,Hahnemann University
Current Opinion in Organ Transplantation | Year: 2013

PURPOSE OF REVIEW: Healthcare reform and the national quality strategy is increasingly impacting transplant practice, as exemplified by quality assessment and performance improvement (QAPI) regulations for pretransplant and posttransplant care. Transplant providers consider not just patient comorbidities, donor quality, and business constraints, but also regulatory mandates when deciding how to care for transplant candidates and recipients. This review describes transplant quality oversight agencies and regulations, and explores recent literature on the pros and cons of transplant QAPI. RECENT FINDINGS: Transplant's heavily regulated system of care and remuneration involves extensive QAPI process and outcome requirements, and assessment of lifelong, risk-adjusted data from the national, audited, publicly reported, electronic registry. Transplant is a model-integrated delivery system, with payment bundling and accountability for equitable access to high quality, efficient, cost-sensitive, and multidisciplinary care. However, transplant QAPI requires expensive resources and, to bolster wise risk-taking, novel treatments, and access to care, more nuanced risk adjustment, public reporting, and attention to geographic competitive variability. However, transplant QAPI requires expensive resources. In order to bolster wise risk-taking, novel treatments, and access to care, QAPI also requires more nuance in the areas of risk adjustment, public reporting, and attention to geographic competitive variability. SUMMARY: With its focus on innovation and on clinical outcomes, transplantation is poised to continue providing outstanding clinical care and to pioneering systems that advance patient safety, satisfaction, and resource utilization, leading in the field of QAPI and healthcare reform. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source


Feo L.,Hahnemann University | Schaffzin D.M.,Chase Medical
Advances in Therapy | Year: 2011

Colonic stents traditionally have been used for the management of colorectal cancer, either as a palliative treatment or as a bridge to surgery. More recently, colonic stents have also been advocated as part of the therapy of benign strictures. A number of colonic stents are available worldwide, four of which are made in the USA. These stents are classified as covered or uncovered, with similar clinical applications. Technical and clinical success rates are similar among these different stents, as well as the rate of complications, which mainly consist of obstruction and migration. The deployment systems utilize fluoroscopy, endoscopy, or both. More recently, stents became available that are deployed "through the scope" (TTS) making the procedure faster. However, this advance does not exclude the use of fluoroscopy, particularly in those cases where the direct visualization of the proximal end of the stricture is absent. The increasing experience in the management of colorectal cancer with colonic stents decreases the morbidity and mortality, as well as cost, in comparison with surgical intervention for acute colonic obstruction. Management with colonic stents can also rule out proximal synchronous lesions after initial decompression prior to definitive surgery. Benign conditions may also be treated with stents. A multidisciplinary approach for the use of colonic stents during assessment and management of acute colonic obstruction is necessary in order to achieve a satisfactory outcome, whether that be better quality of life or improved survival. © 2011 Springer Healthcare. Source


Chauhan V.,Hahnemann University
Postgraduate medicine | Year: 2012

Bone disease is common in recipients of kidney, heart, lung, liver, and bone marrow transplants, and causes debilitating complications, such as osteoporosis, osteonecrosis, bone pain, and fractures. The frequency of fractures ranges from 6% to 45% for kidney transplant recipients to 22% to 42% for heart, lung, and liver transplant recipients. Bone disease in transplant patients is the sum of complex mechanisms that involve both preexisting bone disease before transplant and post-transplant bone loss due to the effects of immunosuppressive medications. Evaluation of bone disease should preferably start before the transplant or in the early post-transplant period and include assessment of bone mineral density and other metabolic factors that influence bone health. This requires close coordination between the primary care physician and transplant team. Patients should be stratified based on their fracture risk. Prevention and treatment include risk factor reduction, antiresorptive medications, such as bisphosphonates and calcitonin, calcitriol, and/or gonadal hormone replacement. A steroid-avoidance protocol may be considered. Source


Garber B.B.,Hahnemann University | Morris A.,Albert Einstein Medical Center
International Journal of Impotence Research | Year: 2013

To present a case of intravesical erosion of an infected multiple-component inflatable penile prosthesis (IPP) reservoir. We retrospectively reviewed a case of complete intravesical erosion of an infected IPP reservoir. We also reviewed the prior urologic literature concerning bladder-related reservoir complications, and formulated potential strategies to prevent these complications in the future. This patient was successfully managed with complete explantation of the cylinders and pump, along with cystotomy, intravesical reservoir removal and cystorraphy. Several months later, he was successfully reimplanted with a multiple-component IPP, and, with 7 months follow-up, has had no further complications. Management of intravesical placement or erosion of an IPP reservoir should be tailored to the clinical scenario. In cases with peri-prosthetic infection and subsequent intravesical reservoir erosion, complete explantation and delayed subsequent reimplantation has been successful. Inadvertent intravesical reservoir placement has been successfully managed via immediate cystotomy, reservoir repositioning and cystorraphy. Reservoir insertion via a counter-incision, an infrapubic approach and under direct vision can avoid this complication. Bladder laceration during reservoir reinflation has been successfully managed with cystorraphy and reservoir repositioning. © 2012 Macmillan Publishers Limited All rights reserved. Source


Haberman A.,Hahnemann University
Journal of Computer Assisted Tomography | Year: 2015

Malignant peritoneal mesothelioma (MPM) is a rare and fatal cancer arising from the mesothelial cells lining the peritoneum. This typically occurs in men in their fifth and sixth decades, but can be seen in women and any age group. Pleural and extrapleural mesothelioma can arise in the setting of asbestos exposure, but other reported causes of MPM include exposure to silicate fibers and radiation therapy. Because it presents with vague symptoms such as abdominal pain, anorexia, and weight loss, it is generally advanced at diagnosis. This is a case of MPM that presented initially at contrast-enhanced computed tomography as a small focal lesion in the lesser sac, ultimately resulting in death from complications of the disease. © 2015 Wolters Kluwer Health, Inc. Source

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