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Doukky R.,Rush University Medical Center | Doukky R.,Jr Hospital Of Cook County | Hayes K.,Rush University Medical Center | Frogge N.,Rush University Medical Center | And 5 more authors.
Circulation | Year: 2013

BACKGROUND - Appropriate use criteria (AUC) have been developed to aid in the optimal use of single-photon emission computed tomography (SPECT)-myocardial perfusion imaging (MPI), a technique that is a mainstay of risk assessment for ischemic heart disease. The impact of appropriate use on the prognostic value of SPECT-MPI is unknown. METHODS AND RESULTS - A prospective cohort study of 1511 consecutive patients undergoing outpatient, community-based SPECT-MPI was conducted. Subjects were stratified on the basis of the 2009 AUC for SPECT-MPI into an appropriate or uncertain appropriateness group and an inappropriate group. Patients were prospectively followed up for 27±10 months for major adverse cardiac events of death, death or myocardial infarction, and cardiac death or myocardial infarction. In the entire cohort, the 167 subjects (11%) with an abnormal scan experienced significantly higher rates of major adverse cardiac events and coronary revascularization than those with normal MPI. Among the 823 subjects (54.5%) whose MPIs were classified as appropriate (779, 51.6%) or uncertain (44, 2.9%), an abnormal scan predicted a multifold increase in the rates of death (9.2% versus 2.6%; hazard ratio, 3.1; P=0.004), death or myocardial infarction (11.8% versus 3.3%; hazard ratio, 3.3; P=0.001), cardiac death or myocardial infarction (6.7% versus 1.7%; hazard ratio, 3.7; P=0.006), and revascularization (24.7% versus 2.7%; hazard ratio, 11.4; P<0.001). Among the 688 subjects (45.5%) with MPI classified as inappropriate, an abnormal MPI failed to predict major adverse cardiac events, although it was associated with a high revascularization rate. Furthermore, appropriate MPI use provided incremental prognostic value beyond myocardial perfusion and ejection fraction data. CONCLUSIONS - When performed for appropriate indications, SPECT-MPI continues to demonstrate high prognostic value. However, inappropriate use lacks effectiveness for risk stratification, further emphasizing the need for optimal patient selection for cardiac testing. © 2013 American Heart Association, Inc.


The International Association of HealthCare Professionals is pleased to welcome Cinnamon Sullivan, MD, Anesthesiologist, to their prestigious organization with her upcoming publication in The Leading Physicians of the World. Dr. Sullivan is the Director of Transplant Anesthesiology at Emory University Hospital with over 14 years of experience specializing in critical care, liver transplantation, and anesthesiology. Dr. Sullivan received her Medical Degree from the University of Iowa Carver College of Medicine in 2002. She then completed her Surgery internship at Iowa Methodist Medical Center, prior to completing a residency in Anesthesiology and Critical Care Medicine fellowship from Emory University Hospital. Dr. Sullivan holds dual board certification in both Anesthesiology and Critical Care Medicine, and maintains professional memberships with the International Liver Transplantation Society, and with the Quality Committee at The Society for the Advancement of Transplant Anesthesia. Dr. Sullivan is the recipient of many awards and recognitions, including the Anesthesia Resident’s Award in 2012, the Mentor of the Year Award, and the First Group Initiated into the Gold Humanitarian Awards. She attributes her success to the support of her husband, and not being discouraged by getting a late start in her medical career. When she is not assisting patients, Dr. Sullivan enjoys reading, traveling, softball, and triathlons. Learn more about Dr. Sullivan here: http://www.anesthesiology.emory.edu/faculty/sullivan-cinnamon.html and be sure to read her upcoming publication in The Leading Physicians of the World. FindaTopDoc.com is a hub for all things medicine, featuring detailed descriptions of medical professionals across all areas of expertise, and information on thousands of healthcare topics. Each month, millions of patients use FindaTopDoc to find a doctor nearby and instantly book an appointment online or create a review. Findatopdoc.com features each doctor’s full professional biography highlighting their achievements, experience, patient reviews and areas of expertise. A leading provider of valuable health information that helps empower patient and doctor alike, FindaTopDoc enables readers to live a happier and healthier life. For more information about FindaTopDoc, visit: http://www.findatopdoc.com


News Article | March 22, 2016
Site: www.biosciencetechnology.com

In 2011, about a month after joining the MIT faculty, Feng Zhang attended a talk by Harvard Medical School Professor Michael Gilmore, who studies the pathogenic bacterium Enteroccocus. The scientist mentioned that these bacteria protect themselves from viruses with DNA-cutting enzymes known as nucleases, which are part of a defense system known as CRISPR. “I had no idea what CRISPR was but I was interested in nucleases,” Zhang said. “I went to look up CRISPR, and that’s when I realized you might be able to engineer it for use for genome editing.” Zhang devoted himself to adapting the system to edit genes in mammalian cells and recruited new members to his nascent lab at the Broad Institute of MIT and Harvard to work with him on this project. In January 2013, they reported their success in the journal Science. Since then, scientists in fields from medicine to plant biology have begun using CRISPR to study gene function and investigate the possibility of correcting faulty genes that cause disease. Zhang now heads a lab of 19 scientists who continue to develop the system and pursue applications of genome editing, especially in neuroscience. “The goal is to try to make our lives better by developing new technologies and using them to understand biological systems so that we can improve our treatment of disease and our quality of life,” said Zhang, who is also a member of MIT’s McGovern Institute for Brain Research and recently earned tenure in MIT’s Departments of Biological Engineering and Brain and Cognitive Sciences. Growing up in Des Moines, Iowa, where his parents moved from China when he was 11, Zhang had plenty of opportunities to feed his interest in science. He participated in Science Bowl competitions and took special Saturday science classes, where he got his first introduction to molecular biology. Experiments such as extracting DNA from strawberries and transforming bacteria with genes for drug resistance whetted his appetite for genetic engineering, which was further stimulated by a showing of “Jurassic Park.” “That really caught my attention,” he recalls. “It didn’t seem that far-fetched. I guess that’s what makes it good science fiction. It kind of tantalizes your imagination.” As a sophomore in high school, Zhang began working with Dr. John Levy in a gene therapy lab at the Iowa Methodist Medical Center in Des Moines, where he studied green fluorescent protein (GFP). Scientists had recently figured out how to adapt this naturally occurring protein to tag and image proteins inside living cells. Zhang used it to track viral proteins within infected cells to determine how the proteins assemble to form new viruses. He also worked on a project to adapt GFP for a different purpose — protecting DNA from damage induced by ultraviolet light. At Harvard University, where he earned his undergraduate degree, Zhang majored in chemistry and physics and did research under the mentorship of Xiaowei Zhuang, a professor of chemistry and chemical biology. “I was always interested in biology but I felt that it’s important to get a solid training in chemistry and physics,” he said. While Zhang was at Harvard, a close friend was severely affected by a psychiatric disorder. That experience made Zhang think about whether such disorders could be approached just like cancer or heart disease, if only scientists knew more about their underlying causes. “The difference is we’re at a much earlier stage of understanding psychiatric diseases. That got me really interested in trying to understand more about how the brain works,” he said. At Stanford University, where Zhang earned his Ph.D. in chemistry, he worked with Karl Deisseroth, who was just starting his lab with a focus on developing new technology for studying the brain. Zhang was the second student to join the lab, and he began working on a protein called channelrhodopsin, which he and Deisseroth believed held potential for engineering mammalian cells to respond to light. The resulting technique, known as optogenetics, has transformed biological research. Collaborating with Edward Boyden, a member of the Deisseroth lab who is now a professor at MIT, Zhang adapted channelrhodopsin so that it could be inserted into neurons and make them light-sensitive. Using this approach, neuroscientists can now selectively activate and de-activate specific neurons in the brain, allowing them to map brain circuits and investigate how disruption of those circuits causes disease. After leaving Stanford, Zhang spent a year as a junior fellow at the Harvard Society of Fellows, studying brain development with Professor Paola Arlotta and collaborating with Professor George Church. That’s when he began to focus on gene editing — a type of genetic engineering that allows researchers to selectively delete a gene or replace it with a new one. He began with zinc finger nucleases — enzymes that can be designed to target and cut specific DNA sequences. However, these proteins turned out to be challenging to work with, in part because it is so time-consuming to design a new protein for each possible DNA target. That led Zhang to experiment with a different type of nucleases known as transcription activator-like effector nucleases (TALENs), but these also proved laborious to work with. “Learning how to use them is a project on its own,” Zhang said. When he heard about CRISPR in early 2011, Zhang sensed that harnessing the natural bacterial process held the potential to solve many of the challenges associated with those earlier gene-editing techniques. CRISPR includes a nuclease called Cas9, which can be guided to the correct genetic target by RNA molecules known as guide strands. For each target, scientists need only design and synthesize a new RNA guide, which is much simpler than creating new TALEN and zinc finger proteins. Since his first CRISPR paper in 2013, Zhang’s lab has devised many enhancements to the original system, such as making the targeting more precise and preventing unintended cuts in the wrong locations. They also recently reported another type of CRISPR system based on a different nuclease called Cpf1, which is simpler and has unique features that further expand the genome editing toolbox. Zhang’s lab has become a hub for CRISPR research worldwide. It has shared CRISPR-Cas9 components in response to nearly 30,000 requests from academic laboratories around the world and has trained thousands of researchers in the use of CRISPR-Cas9 genome-editing technology through in-person events and online opportunities. His team is now working on creating animal models of autism, Alzheimer’s, and other neurological disorders, and in the long term, they hope to develop CRISPR for use in humans to potentially cure diseases caused by defective genes. “There are many genetic diseases that we don’t have any way of treating and this could be one way, but we still have to do a lot of work,” Zhang said.


Halub M.E.,The Surgical Center | Sidwell R.A.,Iowa Methodist Medical Center | Sidwell R.A.,University of Iowa
Surgical Clinics of North America | Year: 2015

The goal of preoperative cardiac evaluation is to screen for undiagnosed cardiac disease or to find evidence of known conditions that are poorly controlled to allow management that reduces the risk of perioperative cardiac complications. A careful history and physical examination combined with the procedure-specific risk is the cornerstone of this assessment. This article reviews a brief history of prior cardiac risk stratification indexes, explores current practice guidelines by the American College of Cardiology and the American Heart Association Task Force, reviews current methods for preoperative evaluation, discusses revascularization options, and evaluates perioperative medication recommendations. © 2015 Elsevier Inc.


Ueda K.,University of Iowa | Puangsuvan S.,University of Iowa | Puangsuvan S.,Advocate Trinity Hospital | Hove M.A.,University of Iowa | And 2 more authors.
British Journal of Anaesthesia | Year: 2013

BackgroundCannulation of the radial artery in infants and small children can be challenging, even for the most experienced providers. Utilizing Doppler to aid in radial artery cannulation has been well described. Recent studies have demonstrated the efficacy of ultrasound (US) image-guided vascular access techniques in the paediatric population. The utility of these two techniques, when used by non-expert personnel, has not been studied.MethodsThis is a randomized prospective study to compare the utility of two different radial arterial cannulation techniques in paediatric patients weighing <12 kg: US-guided technique (US group) vs Doppler-assisted technique (Doppler group) when used by trainees with limited experience. The primary objective was to compare the first-attempt success rate between each group. As a secondary objective, success rate within 10 min was compared.ResultsThe trial was prematurely terminated after 50% of paediatric patients (n=104) were included in the study and 52 of each were randomized to the US or Doppler group. A total of 12 anaesthesia trainees performed radial arterial cannulations. The first-attempt success rate was greater in the US group compared with the Doppler group [17/52 (33%) vs 8/52 (15%), P=0.039, odds ratio (OR): 2.67, confidence interval (CI): 1.03-6.91]. The overall success rate within 10 min was 34/52 (65%) in the US group and 24/52 (46%) in the Doppler group (P=0.048, OR: 2.20, CI: 1.00-4.85).ConclusionsUS-guided radial arterial cannulation in infants and small children provided a greater chance for success at the first attempt compared with the Doppler-assisted technique. © 2012 © The Author [2012]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.


Fahler J.,Iowa Methodist Medical Center | Wall G.C.,Iowa Inflammatory Bowel Disease Center | Wall G.C.,Drake University | Leman B.I.,Iowa Inflammatory Bowel Disease Center
Annals of Pharmacotherapy | Year: 2012

OBJECTIVE: To report a case of refractory nausea in a patient with idiopathic gastroparesis successfully treated with aprepitant. CASE SUMMARY: A 41-year-old female with idiopathic gastroparesis demonstrated by a delayed gastric emptying time experienced significant nausea, vomiting, and abdominal pain. This resulted in numerous hospital admissions and regular outpatient intravenous fluid administration. Over a 3-year period the patient had been treated with numerous agents for nausea and vomiting, including metoclopramide 10 mg 3 times daily, ondansetron 8 mg 2 times daily, and promethazine (various doses from 12.5 to 25 mg orally up to 3 times daily). No treatment tried was either tolerated or effective. As a last option before considering gastric pacing the patient was started on aprepitant 40 mg daily. The patient had a dramatic response to aprepitant and reported that her nausea had decreased significantly after 48 hours of starting the medication (2 doses). She was able to tolerate oral feeding and her need for outpatient intravenous hydration abated. Over the course of 2 months while using aprepitant her gastroparesis symptoms continued to improve. She reported no adverse effects attributable to aprepitant. After the first 2 months of aprepitant treatment, the patient was unable to continue the medication due to cost. Although her symptoms did worsen after discontinuation, they did not return to their initial severity. At 4 months after the trial of aprepitant, she continued to have improved symptoms. She claimed not to have daily nausea or vomiting, but still required high-dose promethazine and occasional outpatient intravenous fluids. At that point, she had gained 7.2 kg from the time that she had started aprepitant. DISCUSSION: Aprepitant, a neurokinin-1 receptor antagonist, is approved in the US for nausea and vomiting associated with surgery and cancer chemotherapy. To our knowledge, this is the second reported case of its use in gastroparesis-induced nausea. Our patient reported relief of nausea and vomiting despite existing evidence showing that aprepitant has no significant effect on accelerating gastric emptying. Despite its acquisition cost, our patient avoided hospital admission and the administration of intravenous hydration, suggesting aprepitant may be cost-effective in this case. CONCLUSIONS: Aprepitant may have some utility in treating refractory nausea caused by gastroparesis. This case suggests that the drug's antiemetic effect may be successfully used in areas not approved by the Food and Drug Administration. A controlled trial examining aprepitant in patients with such challenging clinical conditions may be warranted.


Janus T.J.,Iowa Methodist Medical Center
Journal of trauma nursing : the official journal of the Society of Trauma Nurses | Year: 2012

The purpose of this article was to determine assessable risk levels for pneumonia in trauma patients with pulmonary contusion. A retrospective review and analysis of national trauma data of patients with pulmonary contusion were identified to develop a risk assessment model. Trauma data for 2007 were used to determine risk factors for subsequent complication of pneumonia in pulmonary contusion patients. Available patient comorbidities were considered in model development. Next, 2008 data were used to test and finalize model. Pneumonia risk was categorized into 3 ordinal levels, based on equal-sized proportions of pulmonary contusion patients. Significant risk factors for pneumonia included age, gender, pulse rate, systolic blood pressure, obesity, Glasgow Coma Scale motor score, and ventilation on admission. The final risk adjustment model had good fit and discrimination. Study analyses used more than 40 000 trauma patient data to devise assessable risk levels for pneumonia in pulmonary contusion diagnosed patients. Study data can assist in direction of care and triaging of urgent care patients at risk of pneumonia, possibly leading to mitigation and prevention of pneumonia in at risk patients. Further review of study outcomes should occur to fully understand applicability and usefulness in urgent settings.


Clemen L.J.,Iowa Methodist Medical Center
Journal of trauma nursing : the official journal of the Society of Trauma Nurses | Year: 2012

Insertion of prehospital peripheral intravenous (PIV) catheters frequently occurs under suboptimal conditions. Timely replacement of prehospital PIV catheters may minimize the risk of inhospital catheter-related infections. Inconsistent recommendations exist concerning when prehospital PIV catheters should be replaced. The following study assessed compliance with hospital order sets for the discontinuation of prehospital PIV catheters in trauma patients and their associated complications. Results revealed 33.62% compliance with the trauma order set and 66.38% compliance with the hospital order set. Less than 1% of patients exhibited an associated complication. Guidelines for replacement of prehospital PIV catheters should focus less on time since insertion and more on patient factors.


DeVore K.J.,Iowa Methodist Medical Center
Pharmacotherapy | Year: 2010

Solar burn reactivation, a rare and idiosyncratic drug reaction, has been reported with the use of a variety of drugs. This reaction is believed to be the result of exposure to ultraviolet light during the subsiding phase of an acute inflammatory reaction. It affects areas of the body that have been previously sunburned. We describe a 16-year-old girl who was receiving treatment for acute lymphoblastic leukemia and experienced a second-degree solar burn reactivation reaction to methotrexate. The patient had a mild sunburn on her face and shoulders the day she went to the oncology clinic for her interim maintenance chemotherapy with vincristine 1.5 mg/m2/dose and methotrexate 100 mg/m2/dose. Three days later, she returned to the clinic with a 2-day history of fever (≤ 100.2°F), nausea, vomiting, and malaise; the sunburn on her face and shoulders also had become severe, without further sun exposure. Laboratory results revealed elevated blood urea nitrogen and serum creatinine concentrations, and her methotrexate level was elevated at 0.9 mM. The patient was diagnosed with acute renal failure, dehydration, methotrexate toxicity, and second-degree solar burn reactivation reaction. She was admitted to the children's hospital and treated with sodium bicarbonate, acetaminophen with codeine, ondansetron, and silvadene cream. On hospital day 3, the patient's methotrexate level decreased to less than 0.1 mM. The sunburn continued to heal, and after a 14-day hospital stay, complicated by a streptococcal infection, grade 3 mucositis, bacteremia, and mild gastritis and duodenitis, the patient recovered and was discharged. Use of the Naranjo adverse drug reaction probability scale indicated a probable relationship (score of 6) between the patient's solar burn reactivation and methotrexate. Although methotrexate-induced solar burn reactivation is rare, clinicians should be aware of this potential adverse reaction and consider delaying administration of methotrexate by 5-7 days if a patient reports ultraviolet-related erythema in the past 2-4 days or presents with a notable sunburn.


Beauregard R.,Iowa Methodist Medical Center
The World's Leading Conference on Laser Safety, ILSC 2013 - International Laser Safety Conference | Year: 2013

The Medical Laser Safety Officer has the responsibility to administer the Laser Safety Program in the treatment area of the Health Care Facility. One important component of the safety program is the evaluation and control of potential hazards associated with the Laser and its use. This presentation will focus on the electrical hazards that may adversely affect health care personnel and the patients receiving treatment. These non-beam hazards often do not receive the attention they should when performing a hazard analysis. A more thorough evaluation may be performed and a more detailed Safety Audit checklist may be developed when the MLSO has specific information regarding electrical systems and components. Information presented in this document will include: A) Defining an electrical shock B) Understanding micro/ macro currents and shocks C) Electrical power systems: grounded versus isolated D) Power outlets, cords, cord caps and strain relief E) Extension cords F) Leased equipment electrical safety considerations G) Regulatory agencies and Standards By applying specific knowledge of the electrical environment in the laser treatment area, the MLSO will have the opportunity to develop useful electrical safety audits, hazard evaluations and control measures. The MLSO will also have an understanding of the role that the Clinical Engineering/ Bio-Med and Facilities Management departments have in providing support in the maintenance of an electrically safe laser use environment.

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