Fung H.B.,James ters Veterans Affairs Medical Center |
Monteagudo-Chu M.O.,Kingsbrook Jewish Medical Center
American Journal Geriatric Pharmacotherapy | Year: 2010
Background: Community-acquired pneumonia (CAP) is a frequent cause of hospitalization and death among the elderly. Objective: This article reviews information on CAP among the elderly, including age-related changes, predisposing risk factors, causes, treatment strategies, and prevention. Methods: Searches of MEDLINE (January 1990-November 2009), International Pharmaceutical Abstracts (January 1990-November 2009), and Google Scholar were conducted using the terms community-acquired pneumonia, pneumonia, treatment guidelines, and elderly. Additional publications were found by searching the reference lists of the identified articles. Studies that reported diagnostic criteria as well as the treatment outcomes achieved in adult patients with CAP were selected for this review. Results: Three practice guidelines, 5 reviews, and 43 studies on CAP in the elderly were identified in the literature search. Based on those publications, risk factors that predispose the elderly to pneumonia include comorbid conditions, poor functional and nutritional status, consumption of alcohol, and smoking. The clinical presentation of pneumonia in the elderly (≥65 years of age) may be subtle, lacking the typical acute symptoms (fever, cough, dyspnea, and purulent sputum) observed in younger adults. Pneumonia should be suspected in all elderly patients who have fever, altered mental status, or a sudden decline in functional status, with or without lower respiratory tract symptoms such as cough, purulent sputum, and dyspnea. Treatment of CAP in the elderly should be guided by the latest recommendations of the Infectious Diseases Society of America and the American Thoracic Society (IDSA/ATS), along with consideration of local rates and patterns of antimicrobial resistance, as well as individual patient risk factors for acquiring less common or more resistant pathogens. Recommended empiric antimicrobial regimens generally consist of either a β-lactam plus a macrolide or a respiratory fluoroquinolone alone. Adherence to the IDSA/ATS guidelines has been found to improve in-hospital mortality (adherence vs nonadherence, 8%; 95% CI, 7%-10% vs 17%; 95% CI, 14%-20%; P< 0.01), length of hospital stay (8 days; interquartile range [IQR], 5-15 vs 10 days; IQR, 6-24 days, respectively; P < 0.01), and time to clinical stability in elderly patients with CAP (percentage of stable patients by day 7, 71%; 95% CI, 68%-74% vs 57%; 95% CI, 53%-61%, respectively; P < 0.01). All elderly patients should be vaccinated against pneumococcal disease and influenza based on recommendations from the Centers for Disease Control and Prevention. Lifestyle modifications and nutritional support are also important elements in the prevention of pneumonia in the elderly. Conclusion: Adherence to established guidelines, along with customization of antimicrobial therapy based on local rates and patterns of resistance and patient-specific risk factors, likely will improve the treatment outcome of elderly patients with CAP. © 2010 Excerpta Medica Inc. All rights reserved.
Shogbon A.O.,Mercer University |
Levy S.B.,Kingsbrook Jewish Medical Center |
Levy S.B.,Long Island University
American Journal of Health-System Pharmacy | Year: 2010
Purpose. The current evidence on intensive glycemic control in the inpatient and outpatient settings and its implications to practice are reviewed. Summary. Poor glycemic control in patients with diabetes is associated with microvascular and macrovascular complications. Various clinical trials involving patients with type 1 and type 2 diabetes have revealed the benefits of intensive glycemic control in delaying the onset and progression of microvascular complications of diabetes. However, while long-term epidemiologic trials and a meta-analysis have shown a benefit of intensive glycemic control in reducing the incidence of macrovascular complications, recent clinical trials have not found similar benefits. The American Diabetes Association (ADA), American College of Endocrinology (ACE), and American Association of Clinical Endocrinologists recommend intensive control of glycosylated hemoglobin and plasma glucose at specified goals. Hyperglycemia in the inpatient setting is associated with increased morbidity and mortality. ACE and ADA recommend the use of an i.v. insulin infusion in critically ill inpatients with hyperglycemia. In noncritically ill inpatients, basal and bolus doses of insulin are recommended. The use of sliding-scale insulin as the sole therapy for inpatient hyperglycemia is discouraged. However, caution must be exercised to ensure a balance between controlling hyperglycemia and reducing the risk of hypoglycemia. Conclusion. While intensive glycemic control is known to prevent or delay the occurrence of microvascular complications of diabetes, macrovascular benefits are still uncertain. Current evidence suggests that intensive glycemic control should be initiated as soon as possible after diagnosis of type 1 or type 2 diabetes in order to maximize potential long-term macrovascular benefits. Inpatient hyperglycemia should be managed appropriately to reduce morbidity and mortality, with great care taken to avoid and appropriately treat hypoglycemia. Copyright © 2010, American Society of Health-System Pharmacists, Inc. All rights reserved.
Parnes N.,Tri County Orthopedics |
Friedman D.,Cornell University |
Phillips C.,New York Presbyterian Lower ManhattanNY |
Phillips C.,Kingsbrook Jewish Medical Center |
Carey P.,U.S. Army
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2015
Purpose We report the outcome of an arthroscopic technique for coracoclavicular ligament reconstruction using an anatomic coracoid cerclage. Methods Between March 2011 and September 2012, 12 consecutive patients with symptomatic chronic (>4 weeks from injury) type V acromioclavicular separation for which nonoperative treatment failed were treated with arthroscopic double-bundle reconstruction of the coracoclavicular ligaments using tendon allograft by the first author. The clinical records, operative reports, and preoperative and follow-up radiographs were reviewed. The visual analog scale score, Subjective Shoulder Value, Simple Shoulder Test score, and Constant-Murley score were evaluated preoperatively and at each follow-up appointment. Results The study included 12 shoulders in 12 young active-duty soldiers with symptomatic high-grade acromioclavicular separation who were treated with a technique for arthroscopic reconstruction of the coracoclavicular ligaments. The mean age was 25 years (range, 20 to 35 years). The injury occurred during sports activity in 11 patients. One patient was injured in a motorcycle accident. The mean time from injury to surgery was 17.8 months (range, 1.5 to 72 months). The minimum length of follow-up was 24 months (mean, 30.4 months; range, 24 to 42 months). The mean preoperative and postoperative outcome scores were significantly different (P <.0001) for all subjective outcome measures. The mean Constant-Murley score improved from 58.4 (range, 51 to 76) to 96 (range, 88 to 100). The mean visual analog scale score improved from 8.1 (range, 7 to 10) to 0.58 (range, 0 to 2). The mean Subjective Shoulder Value improved from 32.9% (range, 10% to 70%) to 95% (range, 80% to 100%). The mean Simple Shoulder Test score improved from 6 (range, 5 to 8) to 11.83 (range, 11 to 12). All patients returned to their normal preinjury level of activity by 6 months. Radiographs at last follow-up showed no loss of reduction with maintenance of the coracoclavicular interval. There was 1 complication (8.5%), a postoperative superficial wound infection, that was treated accordingly. Conclusions We present an arthroscopic technique for double-bundle tendon graft reconstruction of the coracoclavicular ligaments using the coracoid cerclage technique. This method showed good outcomes and maintenance of radiographic reduction with high patient satisfaction and a low complication rate. Level of Evidence Level IV, therapeutic case series. © 2015 Arthroscopy Association of North America.
Hassan E.,Philips |
Hassan E.,University of Maryland, Baltimore |
Badawi O.,Philips |
Badawi O.,University of Maryland, Baltimore |
And 3 more authors.
Critical Care Medicine | Year: 2010
Critically ill patients are particularly susceptible to adverse drug events (ADEs) due to their rapidly changing and unstable physiology, complex therapeutic regimens, and large percentage of medications administered intravenously. There are a wide variety of technologies that can help prevent the points of failure commonly associated with ADEs (i.e., the five "Rights": right patient; right drug; right route; right dose; right frequency). These technologies are often categorized by their degree of complexity to design and engineer and the type of error they are designed to prevent. Focusing solely on the software and hardware design of technology may over-or underestimate the degree of difficulty to avoid ADEs at the bedside. Alternatively, we propose categorizing technological solutions by identifying the factors essential for success. The two major critical success factors are: 1) the degree of clinical assessment required by the clinician to appropriately evaluate and disposition the issue identified by a technology; and 2) the complexity associated with effective implementation. This classification provides a way of determining how ADE-preventing technologies in the intensive care unit can be successfully integrated into clinical practice. Although there are limited data on the effectiveness of many technologies in reducing ADEs, we will review the technologies currently available in the intensive care unit environment. We will also discuss critical success factors for implementation, common errors made during implementation, and the potential errors using these systems. Copyright © 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.
Cristian A.,Kingsbrook Rehabilitation Institute |
Tran A.,Kingsbrook Jewish Medical Center |
Patel K.,3420 Avenue North
Physical Medicine and Rehabilitation Clinics of North America | Year: 2012
Cancer patients receive rehabilitation services in acute hospitalizations, rehabilitation wards, outpatient rehabilitation facilities, and home settings. Given the complexity and acuity of their medical care coupled with the long-term effects of the cancer and its treatments, patient safety is a significant concern in the delivery of rehabilitation services for this population. Cancer survivorship is growing in importance as a significant number of adults and children diagnosed with cancer are surviving beyond the 5-year mark. The goal of this article is to provide an overview to rehabilitation clinicians on the topic of patient safety in the rehabilitation of cancer patients. © 2012 Elsevier Inc.
Shyh G.,Kingsbrook Jewish Medical Center |
Cheng-Lai A.,Montefiore Medical Center
Cardiology in Review | Year: 2014
Obesity is a risk factor for a wide range of conditions, including cardiovascular disease. Although lifestyle modifications remain the cornerstone for the management of obesity, pharmacologic agents may be a helpful addition to patients who have comorbidities and do not respond adequately to diet and exercise. Lorcaserin and phentermine/topiramate ER are 2 long-awaited agents, approved in 2012 for obesity management, 13 years since orlistat received US Food and Drug Administration approval in 1999. Lorcaserin is a serotonin agonist, whereas phentermine/topiramate is a combination of a sympathomimetic agent and an antiepileptic drug; both these agents have been shown to reduce weight significantly and improve cardiovascular and metabolic parameters, such as blood pressure, lipids, and HbA1C. This article reviews the pharmacology and clinical efficacy and safety of each of these agents. The differences among the three available agents for long-term management of obesity will also be examined. Copyright © 2013 Lippincott Williams & Wilkins.
Hansen R.,Kingsbrook Jewish Medical Center |
Bryk E.,Kingsbrook Jewish Medical Center |
Vigorita V.,Kingsbrook Jewish Medical Center
Journal of Orthopaedic Research | Year: 2013
In the situation of an irreparable meniscus tear, an implant comparable to a normal meniscus is an attractive option. Using a canine model, we assessed the early and late histologic response to a tissue engineered meniscal collagen scaffold (CS). All animals received bilateral arthrotomies, and all joints receiving the CS had an 80% resection of the meniscus. Animals were sacrificed at 3 and 6 weeks, and 12, 13, and 17 months. The CS/tissue complex and host meniscal rim were sectioned for histologic examination with specific focus on the extracellular matrix, angiogenesis, cellular resorption of the scaffold, scaffold appearance, and CS/Host integration. Early histologic samples (3-6 weeks) revealed active angiogenesis and fibrin clots evolving into cellular granulation type tissue. At 12 months, a mature fibrochondrocytic matrix was depositing with gradations of dissolution and integration of the CS implant. Maturing CS/host integration was observed at 18 months. Active cellular resorption of the implant decreased over time. Four cases showed a mild non-specific chronic inflammation and one additional case showed inflammatory engulfment of the scaffold with giant cells at 3 weeks. No evidence of infection either clinically or histologically was observed at any time point. Overall, this histologic analysis demonstrated the active integration of a meniscal like cartilage into a tissue engineered biological scaffold in a canine model. © 2013 Orthopaedic Research Society.
News Article | February 22, 2017
The International Association of HealthCare Professionals is pleased to welcome James T. McGlowan Jr., MD, FAAOS, Orthopedic Surgeon, to their prestigious organization with his upcoming publication in The Leading Physicians of the World. Dr. James T. McGlowan Jr. is a highly trained and qualified orthopedic surgeon with an extensive expertise in all facets of his work, especially sports medicine. Dr. McGlowan Jr. has been in practice for more than 16 years and is currently serving patients within his own private practice, Arthroscopy Sports Medicine & Minimally Invasive Associates, with several locations in Massachusetts. He is also affiliated with Beth Israel Deaconess Hospital, Boston Out-Patient Surgical Suites, Steward Carney Hospital, and Steward Norwood Hospital. Dr. McGlowan, Jr. graduated with his Medical Degree in 1992 from the University of Tennessee School of Medicine. Following his graduation, he subsequently completed his General Surgery residency at New York University Medical Center, followed by his fellowship training at Kingsbrook Jewish Medical Center. Dr. McGlowan, Jr. then undertook his Orthopedic residency training and Research fellowship at SUNY at Buffalo School of Medicine and Biomedical Sciences, before completing his Orthopaedic Sports Medicine fellowship at the University of Massachusetts. Furthermore, he served a fellowship in Arthroscopy and Sport Medicine with the Boston Red Sox. Dr. McGlowan Jr. is certified by and Diplomat of the American Board of Orthopedic Surgery, and has earned the coveted title of Fellow of the American Academy of Orthopedic Surgeons, Fellow of the American Association of Orthopedic Surgeons. An inductee of Alpha Epsilon Delta, Beta Beta Beta, and Sigma Tau Delta, Dr. McGlowan Jr. keeps up to date with the latest advances in his field by maintaining a professional membership with the Arthroscopic Association of North America and the American Orthopedic Society for Sports Medicine. For his wealth of experience and knowledge, Dr. McGlowan Jr. is the recipient of numerous awards and recognitions, and has participated in several presentations. In the past 16 years, he has performed over 6,000 successful arthroscopic joint procedures, 2000 reconstructive fracture procedures and 1,300 hip, knee and shoulder replacements. Dr. McGlowan performs minimally invasive hip, knee, and shoulder replacements. He also performs robotic patella femoral and partial knee replacements. Dr. McGlowan performs complex arthroscopic reconstruction surgery of the knee, shoulder, elbow and ankle. He has treated over 100 Division 1 athletes and athletes on scholarships post reconstructive surgery. He attributes his success to Jesus Christ, his parents, and his family. In his free time, Dr. McGlowan enjoys weight lifting, running, and volunteering in schools taking care of athletes. Learn more about Dr. McGlowan Jr. here: http://jamestmcglowanmd.com/ and be sure to read his 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 | February 15, 2017
PALO ALTO, CA--(Marketwired - Feb 14, 2017) - CloudMedx, a Health AI analytics company, today announced its release of risk adjustment module as part of its Clinical AI Platform. For larger healthcare providers, physician practices, and systems they will now be able to leverage their unstructured data to automate their risk adjustments for high risk patients. For payers, they can now get highly accurate risk scores to assess the overall health of their risk pool, ensure that they are reimbursed appropriately by the Centers for Medicare & Medicaid Services (CMS) based on how sick their members actually are, and know whether they will receive transfer payments or pay them out. Risk adjustment is a tool that allows payers to be reimbursed based on health status or "actuarial risk" of a patient population. It is designed to pay health plans more precisely for the anticipated health costs of a patient population by adjusting payments based on demographics and health status.1 These attributes are used to generate a risk score -- a measure of a patient's cost to a plan. As approximately 80% of the Medicare population has at least one chronic condition2, the clinical and financial impact of missing data is high, given the risk associated with an elderly population. Therefore, CloudMedx risk adjustment provides a quick snapshot of patients' risks to payers and providers that are regularly affected by overlooked data. How it is currently done Currently, health plans and providers continually conduct manual medical record reviews to identify additional conditions not captured through claims or encounter data and to verify the accuracy of coding. This is always done well after the patient has already been seen, diagnosed and treated by the provider, with little emphasis on longitudinal health care. This process is labor intensive, expensive and time consuming and can have serious repercussions on patient health. "Physician data is critical for accurate risk adjustment as physicians are the largest source of healthcare data," said Tashfeen Suleman, CEO of CloudMedx. "With CloudMedx's risk adjustment module, we are automatically pulling charts out of EMRs, and using natural language processing to identify the correct codes, diagnoses and automatically risk adjusting patients based on CMS guidelines. This information can be provided within 24 hours so care providers can more properly assess patient risk, improving the course of treatment. Payers can use this information to more accurately reflect their patient risk pool, potentially leading to accurate reimbursement." How CloudMedx does it CloudMedx combines a curated clinical ontology -- a dynamic network of interrelated symptoms, diagnoses, medications, lab tests and procedures -- with natural language processing so large volumes of unanalyzed free text (otherwise known as unstructured data such as clinical notes, discharge summaries, etc.) inform the patient risk profiles. This reduces the burden of the current risk adjustment pipeline that exists in many healthcare systems and leverages key data that hasn't been used in the past. The logic is that if a clinician is armed with an extensive knowledge base combined with their informed observations, a holistic diagnosis can be made when the patient is being seen by providers. Further, if a patient's risk score is correctly represented, the patient can benefit from appropriate interventions that can benefit their long term health. Dr. Imran Hameed, CEO of All Medical Care IPA, stated that, "As an IPA, we believe that CloudMedx's new module is the answer to many issues surrounding patient's data collection and its proper and efficient use. The system is the much needed tool to collect the right clinical and financial data from doctors' EMRs to identify sicker patients, missing quality metrics data and improve care quality and efficiency. What makes this module unique and effective is that it does this electronically and efficiently instead of current labor intensive mechanisms like chart review." CloudMedx can integrate directly with a provider's electronic health record and workflow while providing insights that assist the physician at the point of care as well as coders that are assessing the clinical documentation. As more providers become integrated payer/provider organizations and as the healthcare industry is regularly improving risk adjustment methodology, CloudMedx technology can catalyze effective use of this vital tool. The potent combination of the CloudMedx Clinical AI platform and a clinician's experience will have a very significant impact on how care is delivered. All Medical Care IPA (individual practitioner association) was established in the spring of 2012 by a group of 10 high caliber doctors and healthcare providers with impeccable reputations with a combined New York City practice experiences of more than 100 years. The goal of the IPA is to strengthen the delivery of healthcare by connecting physicians to meet the challenges of today's complex healthcare system and bring about positive changes in it. Mr Joel Greenberg, Esq and Ms Claudia Hinrichsen, Esq, with extensive healthcare legal background helped establish the IPA. Imran Hameed, MPH, PhD, is the CEO of the group and has extensive healthcare management experiences which includes board and operations steering committee membership at Healthfirst HMO, director of managed care at Kingsbrook Jewish Medical Center, Brooklyn, NY, physician practice management, medical billing, outcomes manager at Schering Plough pharmaceutical company and related fields. Beverly Slater, RN, has an extensive clinical and management experiences, and is the network manager of the IPA. About CloudMedx CloudMedx is a "Clinical AI Platform" that provides precision encounters by offering real time and retrospective clinical insights at all points of care. The company utilizes evidence based algorithms, machine learning and natural language processing to read through structured and unstructured data sources and provides predictive analytics to support health systems and payers better manage their patients. Trusted by some of the best performing healthcare organizations in the country, CloudMedx is headquartered in downtown Palo Alto. More information is available at www.cloudmedxhealth.com
News Article | December 19, 2016
THOROFARE, NJ--(Marketwired - Dec 19, 2016) - Akers Biosciences, Inc. ( : AKER) ( : AKR.L), (the "Company" or "Akers Bio"), a developer of rapid health information technologies, has signed a three-year agreement with the Greater New York Hospital Association (GNYHA) to introduce the Company's flagship rapid tests for heparin-induced thrombocytopenia ("HIT") across GNYHA's network of over 300 member hospitals. Founded in 1904, GNYHA is a trade and group purchasing association representing a large number of hospitals and healthcare systems in New York, New Jersey, Connecticut, and Rhode Island; including some of the most prestigious healthcare organizations in the United States. Akers Bio's flagship PIFA Heparin/PF4 Rapid Assay and PIFA PLUSS PF4 tests were designed to quickly determine at -- or near -- the point-of-care if a patient being treated with the widely used blood thinner heparin may be developing HIT. This clinical syndrome reverses heparin's intended therapeutic effect and transforms it into a clotting agent. Patients suffering HIT are at risk of developing limb- and life-threatening complications, so the timely test result provided by the Company's Heparin/PF4 devices is paramount to effective and cost-efficient clinical decision making. Akers Bio believes its rapid tests have the capacity to provide dramatic cost savings for hospitals when compared to traditional testing methodologies for detecting HIT. The Company estimates that a typical hospital can save $0.5 - $1 million per annum in testing, pharmacy, and clinical monitoring costs. Under the terms of the agreement, Akers Bio's flagship PIFA Heparin/PF4 Rapid Assay and PIFA PLUSS PF4 tests will be evaluated at two significant GNYHA member hospitals, Kaleida Health -- which is the largest provider in Western New York -- and Kingsbrook Jewish Medical Center - a major teaching hospital in Brooklyn. The outcome of the evaluations will be shared with GNYHA's extensive member network to which Akers Bio will, with GNYHA's support, begin marketing the Company's tests. "Akers Bio is delighted to have signed a three-year agreement with GNYHA, one of the premier group purchasing organizations in the United States healthcare sector. Their membership includes a diverse listing of prominent and large integrated delivery networks (IDNs) and hospitals. Enhanced access to GNYHA's network has the potential to dramatically increase domestic sales of our flagship product. "We look forward to working with GNYHA to introduce PIFA Heparin/PF4 clinical diagnostic products that will improve effectiveness, operational efficiency and profitable outcomes for their members." Akers Bio develops, manufactures, and supplies rapid screening and testing products designed to deliver quicker and more cost-effective healthcare information to healthcare providers and consumers. The Company has advanced the science of diagnostics while responding to major shifts in healthcare through the development of several proprietary platform technologies. The Company's state-of-the-art rapid diagnostic assays can be performed virtually anywhere in minutes when time is of the essence. The Company has aligned with major healthcare companies and high volume medical product distributors to maximize product offerings, and to be a major worldwide competitor in diagnostics. Additional information on the Company and its products can be found at www.akersbio.com. Follow us on Twitter @AkersBio. Statements contained herein that are not based upon current or historical fact are forward-looking in nature and constitute forward-looking statements within the meaning of Section 27A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of 1934. Such forward-looking statements reflect the Company's expectations about its future operating results, performance and opportunities that involve substantial risks and uncertainties. These statements include but are not limited to statements regarding the intended terms of the offering, closing of the offering and use of any proceeds from the offering. When used herein, the words "anticipate," "believe," "estimate," "upcoming," "plan," "target", "intend" and "expect" and similar expressions, as they relate to Akers Biosciences, Inc., its subsidiaries, or its management, are intended to identify such forward-looking statements. These forward-looking statements are based on information currently available to the Company and are subject to a number of risks, uncertainties, and other factors that could cause the Company's actual results, performance, prospects, and opportunities to differ materially from those expressed in, or implied by, these forward-looking statements.