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Yelon J.A.,Lincoln Medical Center | Luchette F.A.,Vice Chair VA Affairs | Luchette F.A.,Loyola University
Geriatric Trauma and Critical Care | Year: 2014

Geriatric Trauma and Critical Care provides a multidisciplinary overview of the assessment and management of the elderly patient presenting with surgical pathology. By utilizing current literature and evidence-based resources, the textbook elucidates the unique nature of caring for the elderly population. The structure of the volume provides the reader with an overview of the physiologic and psychological changes, as well as the impact on the healthcare system, associated with the aging process. Emphasis is placed on the impact of aging, pre-existing medical problems, effects of polypharmacy, advanced directives and end-of-life wishes on acute surgical problems, including trauma and surgical critical care. Special attention is given to the ethical implications of management of the aged. The multidisciplinary contributors provide a unique point of view not common to surgical texts. The textbook is the definitive resource for practicing surgeons, emergency medicine physicians, intensivists, anesthesiologists, hospitalists, geriatricians, as well as surgical residents, nurses and therapists, all who care for elderly patients with surgical emergencies. © Springer Science+Business Media New York 2014.

Panchal H.,Mount Sinai School of Medicine | Panchal H.,Albert Einstein Medical Center | Muskovich J.,University of Toledo | Patterson J.,Lincoln Medical Center | And 3 more authors.
Transplant International | Year: 2015

This study analyzed outcomes of retransplantation from expanded criteria donors (ECD) over the last two decades to determine the benefits and risks of using ECD kidneys for retransplantation. Data from the United Network for Organ Sharing database were collected and analyzed. Graft survival, death-censored graft survival, and patient survival for retransplantation with ECD kidneys (re-ECD) were reported and compared with primary transplantation with ECD kidneys (prim-ECD) and retransplantation with standard criteria donor kidneys (re-SCD). Re-ECD kidneys had higher risk of graft failure compared with prim-ECD (hazard ratio [HR] = 1.19) and to re-SCD (HR = 1.76). Patient survival was better in re-ECD compared with prim-ECD (HR = 0.89) but was worse than re-SCD (HR = 1.82). After censoring the patients who died with a functioning graft, re-ECD had a higher mortality risk compared with prim-ECD (HR = 1.45) and re-SCD (HR = 1.79). Transplantation improves quality of life and reduces healthcare costs, and due to the risk associated with resumption of hemodialysis and the longer waiting list times for SCD kidneys, there is a benefit to accepting ECD kidneys for select patients requiring retransplantation. Although this benefit exists for select patients, retransplantation with ECD kidneys should be undertaken with trepidation, and appropriate informed consent should be obtained. © 2015 Steunstichting ESOT.

Gold M.,Lincoln Medical Center
Topics in Magnetic Resonance Imaging | Year: 2015

Like the brain, the spinal cord is subject to trauma, infection, ischemia, hemorrhage, and compression. Early diagnosis is the key to preventing significant morbidity in the form of permanent disability. MR imaging is the gold standard for assessing acute injury to the spinal cord, intervertebral discs, ligaments, and surrounding soft tissues. In this article we systematically review the MRI findings in spinal cord trauma, ligamentous injury, epidural hematoma, epidural abscess, and metastatic disease. © 2015 Wolters Kluwer Health, Inc. All rights reserved.

Kanna B.,Lincoln Medical Center | Kanna B.,New York Medical College | Boutin-Foster C.,New York Medical College
Journal of Community Health | Year: 2016

New York City (NYC) Latinos are disproportionately affected by obesity. However, little information is available on demographic and behavioral factors linked to body mass index (BMI) in this population. A community-based survey was conducted in the inner-city Bronx community of NYC to evaluate these factors among Latino New Yorkers. 738 Latinos completed the survey. 241 (32.7 %) participants were obese (BMI > 30 kg/m2) and 302 (41 %) individuals were overweight (BMI 25–30 kg/m2). Adjusted regression analyses show that Latinos who are overweight or obese were found at greater odds of being men, residing in the US for >10 years, in early stages 1–3 of change of physical activity behavior, and at lower odds of being young adults aged <35 years or with college education. Analysis of factors associated stages of change (SOC) revealed that subjects in these preliminary SOC related to physical activity were at greater odds of speaking Spanish alone, in the same SOC with respect to diet, and at lower odds of living >10 years in the US. With respect to diet, subjects in preliminary stages were at greater odds of being young adults <35 years of age or in early SOC of physical activity and at lower odds of low income <20 dollars per year. The survey shows that Latino New-Yorkers in the Bronx with high prevalence of overweight status and obesity have unique demographic, socio-economic, behavioral and cultural factors that can be linked to excessive body weight. © 2016 Springer Science+Business Media New York

Piacenti F.J.,Lincoln Medical Center | Leuthner K.D.,University of Nevada, Las Vegas
Journal of Pharmacy Practice | Year: 2013

Antimicrobial stewardship programs are essential to health care institutions to promote the appropriate use of antibiotics not only to decrease antimicrobial resistance but to prevent the spread and infection of Clostridium difficile. Clostridium difficile-associated diarrhea is increasing rapidly in the United States and is now considered a major public health problem that poses an immediate threat to the health of patients prescribed antibiotics, more so than antimicrobial resistance. Clostridium difficile-associated disease is the result of collateral damage to the normal bacterial flora of the human body, which is an inevitable consequence of any antibiotic use. Antimicrobial stewardship programs such as audit with feedback and antibiotic restriction are designed to help limit Clostridium difficile infections and other hospital-associated organisms by optimizing antimicrobial selection, dosing, de-escalation, and duration of therapy. These programs also incorporate implementation of hospital-wide guidelines, staff education, enforcement of infection-control policies, and the use of electronic medical records when possible to help control antibiotic use. This article reviews the literature on how antimicrobial stewardship programs impact Clostridium difficile rates and discusses experiences in designing, implementing, monitoring, and follow-through of such programs. © The Author(s) 2013.

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