Lin K.J.,Harvard University |
Lin K.J.,Jacobi Medical Center |
Hernandezdiaz S.,Harvard University |
Garcia Rodriguez L.A.,Spanish Center for Pharmacoepidemiologic Research
Gastroenterology | Year: 2011
Background & Aims: We investigated the effect of different prevention strategies against upper gastrointestinal bleeding (UGIB) in the general population and in patients on antithrombotic or anti-inflammatory treatments. Methods: We performed a population-based, nested, case-control study using The Health Improvement Network UK primary care database. From 2000 to 2007, we identified 2049 cases of UGIB and 20,000 controls. The relative risk (RR) of UGIB associated with various gastroprotective agents was estimated by comparing current use (defined as use within 30 days of the index date) with nonuse in the previous year, using multivariate logistic regression. Results: The adjusted RR of UGIB associated with current use of proton pump inhibitors (PPIs) for more than 1 month was 0.58 (95% confidence interval [CI], 0.420.79) among patients who received low-dose acetylsalicylic acid (ASA), 0.18 (95% CI, 0.040.79) for clopidogrel, 0.17 (95% CI, 0.040.76) for dual antiplatelet therapy, 0.48 (95% CI, 0.221.04) for warfarin, and 0.51 (95% CI, 0.340.78) for nonsteroidal anti-inflammatory drugs. The corresponding estimates for therapy with histamine-2receptor antagonists (H 2RAs) were more unstable, but tended to be of a smaller magnitude. In the general population, PPI use was associated with a reduced risk of UGIB compared with nonuse (RR, 0.80; 95% CI, 0.680.94); no such reduction was observed for H 2RAs or nitrates. Conclusions: PPI use was associated with a lower risk of UGIB in the general population and in patients on antithrombotic or anti-inflammatory therapy compared with nonuse of PPIs. The reduction in risks of UGIB was smaller in H 2RA than in PPI users. © 2011 AGA Institute.
Spaeth G.L.,Thomas Jefferson University |
Reddy S.C.,Jacobi Medical Center
Survey of Ophthalmology | Year: 2014
Optic disk imaging is integral to the diagnosis and treatment of patients with glaucoma. We discuss the various forms of imaging the optic nerve, including ophthalmoscopy, photography, and newer imaging modalities, including optical coherence tomography (OCT), confocal scanning laser ophthalmoscopy (HRT), and scanning laser polarimetry (GDx), specifically highlighting their benefits and disadvantages. We argue that ophthalmoscopy and photography remain the gold standard of imaging due to portability, ease of interpretation, and the presence of a large database of images for comparison. © 2014 Elsevier Inc.
Blumberg S.M.,Jacobi Medical Center
Pediatric Emergency Care | Year: 2016
OBJECTIVES: The aim of this study was to describe the epidemiology of radiologic safety events using an analysis of deidentified incident reports (IRs) collected within a large multicenter pediatric emergency medicine network. METHODS: This study is a report of a planned subanalysis of IRs that were classified as radiologic events. The parent study was performed in the PECARN (Pediatric Emergency Care Applied Research Network). Incident reports involving radiology were classified into subtypes: delay in test, delay in results, misread or changed reading, wrong patient, wrong site, or other. The severity of radiology-related incidents was characterized. Contributing factors were identified and classified as environmental, equipment, human (employee), information technology systems, parent or guardian, or systems based. RESULTS: Two hundred three (7.0%) of the 2906 IRs submitted during the study period involved radiology. Eighteen of the hospitals submitted at least 1 IR and 15 of these hospitals reported at least 1 radiologic event. The most common type of radiologic event was misread/changed reading, which accounted for over half of all IRs (50.3%). Human factors were the most frequent contributing factor identified and accounted for 67.6% of all factors. The severity of events ranged from unsafe conditions to events with temporary harm that required hospitalization. CONCLUSIONS: We described the epidemiology of radiology-related IRs from a large multicenter pediatric emergency research network. The study identified specific themes regarding types of radiologic errors, including the systems issues and the contributing factors associated with those errors. Results from this analysis may help identify effective intervention strategies to ameliorate the frequency of radiology-related safety events in the emergency department setting. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
Petrich A.,Montefiore Medical Center |
Petrich A.,Yeshiva University |
Cho S.I.,Jacobi Medical Center |
Billett H.,Montefiore Medical Center |
Billett H.,Yeshiva University
Cancer | Year: 2011
Background: Primary cardiac lymphoma (PCL) represents a rare subset of non-Hodgkin lymphoma, characterized by poor outcomes. The authors aimed to construct a framework of known clinical presentations, diagnostic features, disease complications, treatment, and outcomes to improve prognostication. Methods: Individual patient data were obtained from defined cases of PCL (1949-2009) and systematically analyzed. Results: The authors report results of a review of 197 cases of PCL, with half of all cases reported since 1995. Survival was affected by 4 factors: immune status, left ventricular involvement, presence of extra-cardiac disease, and arrhythmia. Median overall survival (OS) for immunocompromised and immunocompetent was 3.5 months (m) and not reached, respectively (HR 0.29, 95% CI, 0.13-0.68; P =.004). LV involvement was uncommon (26%) and associated with an OS of only 1m, whereas patients free of LV involvement had a median OS of 22m (HR 0.28, 95% CI, 0.12-0.64; P =.002). Patients with extracardiac disease had shorter median OS compared with those without (6m vs 22m, HR 0.49, 95% CI, 0.26-0.91; P =.02). Those patients with an arrhythmia of any type had a median OS that was not reached (n = 55), whereas those without rhythm disturbances (n = 41) had median OS of 6m (HR 0.51, 95% CI, 0.29-0.91; P =.024). Overall response rate to therapy was 84%, with long-term OS over 40%. Conclusions: The current study presents the largest analysis of PCL to date. The data demonstrate that PCL is now more frequently diagnosed premortem and appears to have reasonable response rates. Lack of LV involvement and the presence of arrhythmias are associated with improved survival. © 2010 American Cancer Society.
De Vos G.,Yeshiva University |
De Vos G.,Jacobi Medical Center
Current Allergy and Asthma Reports | Year: 2014
An accurate diagnosis of aeroallergen sensitization is pivotal to clinical practice and research. Given the recent technological advances in analyzing serum allergen-specific IgE, the question of which testing method, skin or serum testing, is superior in diagnosing allergic sensitization must be readdressed, as well as their value in predicting clinical disease. This review article provides a detailed summary of recent studies addressing these questions. Conclusively, most studies show substantial discordance between serum-specific IgE and skin testing results, suggesting that the two testing methods compliment each other and cannot be used interchangeably. On average, using only one testing method may misdiagnose every fourth allergically sensitized patient as non-sensitized. In addition, depending on the allergen tested, skin prick testing and serum-specific IgE testing appear to be the methods of choice in predicting outcomes of experimental allergen challenge, while intradermal testing is less contributory. © 2014 Springer Science+Business Media New York.
Dande A.S.,Jacobi Medical Center |
Pandit A.S.,Danbury Hospital
Current Treatment Options in Cardiovascular Medicine | Year: 2013
Opinion statement: The diagnosis of stress cardiomyopathy is often made during coronary angiography. At this point hemodynamic parameters should be assessed; a right heart catheterization with measurement of cardiac output by Fick and thermodilution methods is helpful. Patients with acute neurologic pathology who develop left ventricular dysfunction (neurogenic stunned myocardium) may not be candidates for coronary angiography and in such cases real-time myocardial contrast echocardiography or nuclear perfusion scan can be used to exclude obstructive coronary disease. Hypotension and shock can be due to low output state or left ventricular outflow tract obstruction. Low output state can be managed with diuretics and vasopressor support. Refractory shock and/or severe mitral regurgitation may require an intra-aortic balloon pump for temporary support. In patients with intraventricular gradient intravenous beta-blockers have been used safely. Hemodynamically unstable patients should be managed in a critical care unit and stable patients should be monitored on a telemetry unit as arrhythmias may occur. An echocardiogram should be performed to look for intraventricular gradient, mitral regurgitation, or left ventricular thrombus. If left ventricular thrombus is seen or suspected anticoagulation with warfarin or low molecular weight heparin is generally advised until recovery of myocardial function and resolution of thrombus occurs. In patients with subarachnoid hemorrhage the use of vasopressors to reduce cerebral vasospasm may worsen left ventricular outflow tract gradient. In hemodynamically stable patients, a beta-blocker or combined alpha/beta blocker should be initiated. Myocardial function generally recovers within days to weeks with supportive treatment in most patients. The use of a standard heart failure regimen including an angiotensin-converting enzyme inhibitor or aldosterone receptor antagonist, beta-blocker titrated to maximal dose, diuretics, and aspirin is common until complete recovery of myocardial function occurs. Chronic therapy with a beta-blocker may be advisable. The underlying diagnosis that precipitated stress cardiomyopathy such as critical illness, neurologic injury, or medication exposure should be identified and treated. © 2013 Springer Science+Business Media New York.
News Article | November 30, 2016
Dr. Neal Goldberg explains how to achieve the most accurate mammogram following breast augmentation; He also touches on the effect breast implants can have on breastfeeding SCARSDALE, NY--(Marketwired - Nov 30, 2016) - For women, breast health and whole health can be closely linked. Many women considering breast augmentation may wonder if this procedure will make it more difficult to monitor their well-being. Dr. Goldberg, a plastic surgeon in Westchester, says a number of his patients are curious whether breast implants will interfere with mammograms, reducing their accuracy. He says that this does not have to be the case, and that there are steps one can take to ensure the imaging tests are as effective as possible. Mammograms are designed to aid physicians in evaluating breast tissue for signs of irregularities. Breast implants sometimes must be "moved out of the way" of the breast tissue to make this technique effective, Dr. Goldberg explains, and this can be done with additional imaging and technical expertise. He says patients should ask the scheduler if the facility is equipped to serve women with breast implants. The patient should also, he adds, ask for a radiologist with experience performing mammograms on breasts with implants. Dr. Goldberg says that there may be different methods used for silicone and saline implants, as well as for implants placed above and below the muscle. Another common question Dr. Goldberg says women have is whether breast implants will interfere with the ability to breastfeed. Many pediatricians recommend breast milk as the preferred nutrition for infants, and Dr. Goldberg explains that patients considering breast augmentation want to ensure they can still nurse if they have children in the future. He says implants should not affect one's capacity to lactate; however, augmentation techniques that minimize damage to milk ducts are recommended. Dr. Goldberg suggests women should discuss their concerns and family-building plans with an experienced plastic surgeon to learn more. About Neal Goldberg, MD, FACS Dr. Neal Goldberg is a board certified plastic and reconstructive surgeon practicing in the Westchester, Dobbs Ferry, and Scarsdale area. In addition to being a Fellow of the American College of Surgeons, he is also an active member of the American Society of Plastic Surgeons and several other prestigious medical organizations. Dr. Goldberg earned his undergraduate degree from the University of Pennsylvania -- Wharton School of Business, graduating magna cum laude, and his medical degree from New York University School of Medicine. He received additional medical training at the Albert Einstein College of Medicine, Montefiore Medical Center and the Jacobi Medical Center. Dr. Goldberg is available for interview upon request. For more information about Dr. Goldberg and his practice, please visit doctorgoldberg.com and facebook.com/nealgoldbergmd. To view the original source of this press release, click here: https://www.doctorgoldberg.com/news-room/westchester-plastic-surgeon-on-breast-health-and-mammograms-after-augmentation
News Article | November 20, 2016
Dr. Dr. Dilip Madnani, premier plastic surgeon of New York, NY has joined the prestigious Haute Beauty network. The Haute Beauty Network, affiliated with luxury lifestyle publication Haute Living, is proud to recognize Dr. Dilip Madnani as a prominent cosmetic surgeon and the network’s newest partner. Dr. Dilip Madnani is a facial plastic surgeon who is double board certified by both the American Board of Facial Plastic & Reconstructive Surgery and the American Board of Oto/Head & Neck Surgery. Dr. Madnani will share his skill and expert opinion with the Haute Beauty and Haute Living subscribers, educating readers on his industry and providing exciting and relevant news, tips, trends and insight relating to his specialties. Dr. Madnani spent his childhood in Hong Kong and attended boarding school in Europe. Growing up as an identical twin and having a talent for drawing and painting, the field of Facial Plastic Surgery was a natural fit as he has always been defined by his face. “Studying human faces was always fascinating to me, as an identical twin, we were always defined by our faces- people could never tell us apart despite our distinct personalities,” Madnani says. Dr. Madnani came to the U.S. for his undergraduate education at Brown University in Providence, Rhode Island and subsequently attended medical school at the Albert Einstein College of Medicine in New York. He graduated medical school with a Dean’s recognition award and a distinction in research. After completing his internship in general surgery and residency in Oto/Head & Neck Surgery at Montefiore Medical Center, Dr. Madnani moved to New Mexico where he ran two successful private practices focusing on facial plastic surgery and reconstructive surgery of skin cancer defects of the face and neck, as well as all aspects of head and neck surgery. This experience further honed his skills as being one of the only Facial Plastic/Head and Neck surgeons in his corner of the state- he was exposed to an enormous variety of surgical cases that he was the only one qualified to perform. In New Mexico, he was Chairman of the Department of Surgery at Carlsbad Medical Center and a Clinical Assistant Professor at the UNM School of Medicine. Dr. Madnani has been working in New York since 2010 and specializes in face and neck lifts, upper and lower eyelid surgery and fat grafting/volumizing procedures to improve the shape and lines on the face. With a natural aesthetic and an eye for detail, Dr. Madnani’s special training allows him to perform all his procedures without the use of general anesthesia, maximizing patient safety and comfort. Among his many distinctions, Dr. Madnani has been voted top doctor in his specialty by Castle Connolly. Outside of his private practice, Dr. Madnani holds a faculty position at the Albert Eisntein College of Medicine as an Assistant Clinical Professor and is involved in teaching residents at Jacobi Medical Center.
News Article | December 1, 2016
December 1, 2016 -- (BRONX, NY) --The National Institutes of Health has awarded researchers at Albert Einstein College of Medicine and Pennsylvania State University a five-year, $12.2 million grant to continue studies on the aging brain, Alzheimer's disease and other dementias. More than five million Americans are living with Alzheimer's disease--a number that is expected to double by 2040 as baby boomers age. Scientists at the Einstein Aging Study will conduct the research in collaboration with experts at Pennsylvania State University. Their studies will enroll seniors who will be equipped with smartphones on which they'll answer questions testing their thinking ability--an effort to measure the cognitive changes that precede the onset of dementia. "We will also look at those risk factors for cognitive decline that can be corrected, including stress, pain, vascular disease and poor sleep," says Richard B. Lipton, M.D., co-principal investigator on the grant and the Edwin S. Lowe Chair in Neurology at Einstein, professor and vice chair of neurology at Einstein and Montefiore. "By linking specific risk factors to cognitive decline in the study participants, we hope to develop personalized interventions that will prevent the onset of Alzheimer's dementia." "Alzheimer's disease is usually diagnosed after many years of cognitive decline," says Martin J. Sliwinski, Ph.D., professor of human development and family studies at Penn State University, director of the Penn State Center for Healthy Aging and co-principal investigator on the grant. "The subtle changes in the brain and in cognition during pre-Alzheimer's are not well understood and can be difficult to track using typical one-time, in-person cognitive evaluations - 'snapshots' that can yield misleading results." The researchers say accurate data from their study will provide insight into the natural progression of the disease, shed light on the variability between individuals and help evaluate treatment effectiveness. The Einstein Aging Study will recruit 500 community dwelling participants over age 70 in the Bronx. The seniors will receive customized smartphones, which--over a 14-day period--will ask them multiple times a day to record their personal assessments on a range of measures and also play several short matching and memory games. These "measurement bursts" will allow the researchers to average multiple measurements so they can more accurately assess an individual's sense of well-being and cognitive status and track changes over time. Participants will also wear fitness trackers to measure sleep patterns and activity, along with monitors to measure heart rate. Some will undergo magnetic resonance imaging (MRI) of their brains, allowing researchers to assess the hippocampus, the part of the brain associated with memory, and other cranial regions. Dr. Lipton has led the Einstein Aging Study since 1992, focusing on the aging brain, normal aging, mild cognitive impairment, Alzheimer's disease and other dementing disorders. The study, supported since 1980 by grants from the National Institute on Aging, involves an interdisciplinary team of neurologists, neuropsychologists, neuropathologists, neurochemists, social workers and other health care professionals. Over the course of three decades, the study has supported pioneering research in cognitive aging, increased our understanding of preclinical states of dementia and served as a national and international resource for Alzheimer's disease research. The new NIH funding will allow investigators to expand their research scope by using this mobile phone-based approach and collaborating with experts at Penn State. The grant is titled "Einstein Aging Study" (2P01AG003949-32). Additional researchers on the study include Mindy Katz, M.P.H., senior associate in the Saul R. Korey Department of Neurology, and Carol Derby, Ph.D., associate professor in the departments of neurology and epidemiology and population heath at Einstein, and Joshua Smyth, Ph.D., professor of biobehavioral health and medicine at Penn State, and Jacqueline Mogle, M.S., Ph.D., assistant professor in the College of Nursing at Penn State. Albert Einstein College of Medicine is one of the nation's premier centers for research, medical education and clinical investigation. During the 2015-2016 academic year, Einstein is home to 731 M.D. students, 193 Ph.D. students, 106 students in the combined M.D./Ph.D. program, and 278 postdoctoral research fellows. The College of Medicine has more than 1,900 full-time faculty members located on the main campus and at its clinical affiliates. In 2015, Einstein received $148 million in awards from the National Institutes of Health (NIH). This includes the funding of major research centers at Einstein in aging, intellectual development disorders, diabetes, cancer, clinical and translational research, liver disease, and AIDS. Other areas where the College of Medicine is concentrating its efforts include developmental brain research, neuroscience, cardiac disease, and initiatives to reduce and eliminate ethnic and racial health disparities. Its partnership with Montefiore Medical Center, the University Hospital and academic medical center for Einstein, advances clinical and translational research to accelerate the pace at which new discoveries become the treatments and therapies that benefit patients. Through its extensive affiliation network involving Montefiore, Jacobi Medical Center--Einstein's founding hospital, and three other hospital systems in the Bronx, Brooklyn and on Long Island, Einstein runs one of the largest residency and fellowship training programs in the medical and dental professions in the United States. For more information, please visit www.einstein.yu.edu, read our blog, follow us on Twitter, like us on Facebook, and view us on YouTube.
News Article | December 2, 2016
The International Nurses Association is pleased to welcome Efia K. Boateng, RN, BSN, to their prestigious organization with her upcoming publication in the Worldwide Leaders In Healthcare. Efia K. Boateng is a Registered Nurse currently serving patients at Jacobi Medical Center in Bronx, New York. With over seven years of experience in nursing, Efia has an extensive expertise in all facets of nursing, especially ambulatory surgical clinic nursing. Efia K. Boateng graduated with her Bachelor of Science Degree in Nursing in 2009 from the University of Ghana in Accra, the capital of Ghana, becoming a Registered Nurse. Upon relocating to the United States, Efia has continued to take a number of advanced training courses whilst serving as a nurse. As an ambulatory surgical clinic nurse, Efia has to provide expert assistance for a wide range of surgical procedures. To keep up to date with the latest advances and developments of her field, Efia maintains a professional membership with the American Nurses Association, and is a keen reader of their journal. She attributes her success to her unwavering dedication to her career, and her love for caring for people in their time of need. When she is not assisting patients, Efia enjoys traveling. Learn more about Efia K. Boateng here: http://inanurse.org/network/index.php?do=/4132970/info/ and read her upcoming publication in Worldwide Leaders in Healthcare.