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PubMed | Lincoln Medical Center and SUNY Downstate Medical Center
Type: | Journal: Journal of neurointerventional surgery | Year: 2016

Ischemic strokes result in significant healthcare expenditures (direct costs) and loss of quality-adjusted life years (QALYs) (indirect costs). Interventional therapy has demonstrated improved functional outcomes in patients with large vessel occlusions (LVOs), which are likely to reduce the economic burden of strokes.To develop a novel real-world dollar model to assess the direct and indirect cost-benefit of mechanical embolectomy compared with medical treatment with intravenous tissue plasminogen activator (IV tPA) based on shifts in modified Rankin scores (mRS).A cost model was developed including multiple parameters to account for both direct and indirect stroke costs. These were adjusted based upon functional outcome (mRS). The model compared IV tPA with mechanical embolectomy to assess the costs and benefits of both therapies. Direct stroke-related costs included hospitalization, inpatient and outpatient rehabilitation, home care, skilled nursing facilities, and long-term care facility costs. Indirect costs included years of life expectancy lost and lost QALYs. Values for the model cost parameters were derived from numerous resources and functional outcomes were derived from the MR CLEAN study as a reflective sample of LVOs. Direct and indirect costs and benefits for the two treatments were assessed using Microsoft Excel 2013.This cost-benefit model found a cost-benefit of mechanical embolectomy over IV tPA of $163624.27 per patient and the cost benefit for 50000 patients on an annual basis is $8181213653.77.If applied widely within the USA, mechanical embolectomy will significantly reduce the direct and indirect financial burden of stroke ($8 billion/50000 patients).

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.

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.

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.

Norwood A.,Harvard University | Mansbach J.M.,Harvard University | Clark S.,University of Pittsburgh | Waseem M.,Lincoln Medical Center | Camargo Jr. C.A.,Harvard University
Academic Emergency Medicine | Year: 2010

Objectives: There is little evidence about which children with bronchiolitis will have worsened disease after discharge from the emergency department (ED). The objective of this study was to determine predictors of post-ED unscheduled visits. Methods: The authors conducted a prospective cohort study of patients discharged from 2004 to 2006 at 30 EDs in 15 U.S. states. Inclusion criteria were diagnosis of bronchiolitis, age <2 years, and discharge home; the exclusion criterion was previous enrollment. Unscheduled visits were defined as urgent visits to an ED/clinic for worsened bronchiolitis within 2 weeks. Results: Of 722 patients eligible for the current analysis, 717 (99%) had unscheduled visit data, of whom 121 (17%; 95% confidence interval [CI] = 14% to 20%) had unscheduled visits. Unscheduled visits were more likely for children age <2 months (11% vs. 6%; p = 0.04), males (70% vs. 57%; p = 0.007), and those with history of hospitalization (27% vs. 18%; p = 0.01). The two groups were similar in other demographic and clinical factors (all p > 0.10). Using multivariable logistic regression, independent predictors of unscheduled visits were age <2 months, male, and history of hospitalization. Conclusions: In this study of children age younger than 2 years with bronchiolitis, one of six children had unscheduled visits within 2 weeks of ED discharge. The three predictors of unscheduled visits were age under 2 months, male sex, and previous hospitalization. © 2010 by the Society for Academic Emergency Medicine.

Bangalore S.,New York University | Toklu B.,New York University | Kotwal A.,University of Massachusetts Medical School | Volodarskiy A.,New York University | And 3 more authors.
BMJ (Clinical research ed.) | Year: 2014

OBJECTIVES: To investigate the relative benefits of unfractionated heparin, low molecular weight heparin(LMWH), fondaparinux, and bivalirudin as treatment options for patients with ST segment elevation myocardial infarction undergoing percutaneous coronary intervention (PCI).DESIGN: Mixed treatment comparison and direct comparison meta-analysis of randomized trials in the era of stents and P2Y12 inhibitors.DATA SOURCES AND STUDY SELECTION: A search of Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) for randomized trials comparing unfractionated heparin plus glycoprotein IIb/IIIa inhibitor(GpIIb/IIIa inhibitor), unfractionated heparin, bivalirudin, fondaparinux, or LMWH plus GpIIb/IIIa inhibitor for patients undergoing primary PCI.OUTCOMES: The primary efficacy outcome was short term (in hospital or within 30 days) major adverse cardiovascular event; the primary safety outcome was short term major bleeding.RESULTS: We identified 22 randomized trials that enrolled 22,434 patients. In the mixed treatment comparison models, when compared with unfractionated heparin plus GpIIb/IIIa inhibitor, unfractionated heparin was associated with a higher risk of major adverse cardiovascular events (relative risk 1.49 (95% confidence interval 1.21 to 1.84), as were bivalirudin (relative risk 1.34 (1.01 to 1.78)) and fondaparinux (1.78 (1.01 to 3.14)). LMWH plus GpIIb/IIIa inhibitor showed highest treatment efficacy, followed (in order) by unfractionated heparin plus GpIIb/IIIa inhibitor, bivalirudin, unfractionated heparin, and fondaparinux. Bivalirudin was associated with lower major bleeding risk compared with unfractionated heparin plus GpIIb/IIIa inhibitor (relative risk 0.47 (0.30 to 0.74)) or unfractionated heparin (0.58 (0.37 to 0.90)). Bivalirudin, followed by unfractionated heparin, LMWH plus GpIIb/IIIa inhibitor, unfractionated heparin plus GpIIb/IIIa inhibitor, and fondaparinux were the hierarchy for treatment safety. Results were similar in direct comparison meta-analyses: bivalirudin was associated with a 39%, 44%, and 65% higher risk of myocardial infarction, urgent revascularization, and stent thrombosis respectively when compared with unfractionated heparin with or without GpIIb/IIIa inhibitor. However, bivalirudin was associated with a 48% lower risk of major bleeding compared with unfractionated heparin plus GpIIb/IIIa inhibitor and 32% lower compared with unfractionated heparin alone.CONCLUSIONS: In patients undergoing primary PCI, unfractionated heparin plus GpIIb/IIIa inhibitor and LMWH plus GpIIb/IIIa inhibitor were most efficacious, with the lowest rate of major adverse cardiovascular events, whereas bivalirudin was safest, with the lowest bleeding. These relationships should be considered in selecting anticoagulant therapies in patients undergoing primary PCI. © Bangalore et al 2014.

PubMed | Lincoln Medical Center, Cornell University and St. George's University
Type: Journal Article | Journal: Emergency radiology | Year: 2016

Nasotracheal intubation (NTI) is used for maintaining airway access during maxillofacial surgery or in cases of severe oral trauma. We describe a case of middle turbinectomy complication as a result of NTI. The purposes of this paper are to raise awareness of this complication and review associated imaging findings.

PubMed | Lincoln Medical Center, Cornell College and New York University
Type: Journal Article | Journal: Ethnicity & disease | Year: 2016

Our objective was to determine the effectiveness of combining positive affect and self-affirmation strategies with motivational interviewing in achieving blood pressure control among hypertensive African Americans (AA) compared with AA hypertensives in an education-only control group.Randomized trial.Ambulatory practices in the South Bronx and Harlem, New York City.African American adults with uncontrolled hypertension.Participants were randomized to a positive affect and self-affirmation intervention or an education control group. The positive affect and self-affirmation intervention involved having participants think about things that made them happy and that reminded them of their core values on a daily basis. These strategies were reinforced every two months through motivational interviewing. The control arm received a workbook of strategies on blood pressure control. All participants were called every two months for one year.Blood pressure control rate.A total of 238 participants were randomized. The average age was 56 11 years, approximately 70% were female, 80% were not married, and up to 70% had completed high school. There was no difference in control rates between the intervention and the control group. However, at one year, female participants were more likely to be controlled. Participants with high depressive symptoms or high perceived stress at baseline were less likely to be controlled.While this study did not demonstrate an intervention effect, it does provide important insight into the psychosocial factors that may underlie blood pressure control in African Americans. Implications for future behavioral intervention trials are discussed.

PubMed | Lincoln Medical Center and New York Medical College
Type: Journal Article | Journal: 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>30kg/m(2)) and 302 (41%) individuals were overweight (BMI 25-30kg/m(2)). Adjusted regression analyses show that Latinos who are overweight or obese were found at greater odds of being men, residing in the US for >10years, in early stages 1-3 of change of physical activity behavior, and at lower odds of being young adults aged <35years orwith college education. Analysis of factors associated stages of change (SOC) revealed that subjects in these preliminarySOC 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 >10years in the US. With respect to diet, subjects in preliminary stages were at greater odds of being young adults <35years 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.

NASHVILLE, Tenn.--(BUSINESS WIRE)--The Physician Services business of Envision Healthcare Corporation (NYSE: EVHC) has further expanded its anesthesia specialty and its footprint in Phoenix, Arizona, through the acquisition of Desert Mountain Consultants in Anesthesia, Inc. The group’s 14 physicians provide anesthesia services at HonorHealth’s John C. Lincoln Medical Center and Deer Valley Medical Center, as well as several ambulatory surgery centers. Dr. Mark Wix, MD, President of Desert Mountain Consultants, commented, “We are excited to partner with Envision and move into the next chapter of our future. With healthcare continuing to evolve, we feel that adding the right strategic partner will allow us to focus on patient care and put our practice in position to succeed for the long term.” Robert J. Coward, President of Envision’s Physician Services business, noted, “Desert Mountain Consultants is a premier practice in Maricopa County, and this new partnership provides a natural extension of Envision’s existing anesthesia and other multi-specialty offerings in the greater Phoenix area. Having physicians effectively work and grow together has always been a core part of our mission and is a critical component in collaborating with our hospital partners to create high-performing clinical networks for the benefit of their patients and the communities in which they reside.” Envision Healthcare Corporation is a leading provider of physician-led services, ambulatory surgery center management, post-acute care and medical transportation. Physician-led services encompass providers at 780 hospitals in 45 states and include leadership positions in emergency department and hospitalist services, anesthesiology, radiology, and women’s / children’s services, as well as offerings in general surgery and office-based medicine. As a market leader in ambulatory surgical care, the company owns and operates 260 surgery centers and one surgical hospital in 35 states and the District of Columbia, with medical specialties ranging from gastroenterology to ophthalmology and orthopedics. Post-acute care is delivered through an array of clinical professionals and integrated technologies designed to contribute to efficient and effective population health management strategies. As a leader in healthcare transportation services, the company operates in 39 states and the District of Columbia. In total, the company offers a differentiated suite of clinical solutions on a national scale, creating value for health systems, payors, providers and patients. For additional information, visit Certain statements and information in this communication may be deemed to be “forward-looking statements” within the meaning of the Federal Private Securities Litigation Reform Act of 1995. Forward-looking statements may include, but are not limited to, statements relating to Envision Healthcare Corporation’s (the “Company”) objectives, plans and strategies, and all statements (other than statements of historical facts) that address activities, events or developments that the Company intends, expects, projects, believes or anticipates will or may occur in the future. These statements are often characterized by terminology such as “believe,” “hope,” “may,” “anticipate,” “should,” “intend,” “plan,” “will,” “expect,” “estimate,” “project,” “positioned,” “strategy” and similar expressions, and are based on assumptions and assessments made by the Company’s management in light of their experience and their perception of historical trends, current conditions, expected future developments, and other factors they believe to be appropriate. Any forward-looking statements in this communication are made as of the date hereof, and the Company undertakes no duty to update or revise any such statements, whether as a result of new information, future events or otherwise. Forward-looking statements are not guarantees of future performance. Whether actual results will conform to expectations and predictions is subject to known and unknown risks and uncertainties, including: (i) risks and uncertainties discussed in the reports that each of the Company, Envision and AMSURG have filed with the Securities and Exchange Commission; (ii) general economic, market, or business conditions; (iii) the impact of legislative or regulatory changes, such as changes to the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010; (iv) changes in governmental reimbursement programs; (v) decreases in revenue and profit margin under fee-for-service contracts due to changes in volume, payor mix and reimbursement rates; (vi) the loss of existing contracts; (vii) risks associated with the ability to successfully integrate the Company’s operations and employees following the merger; (viii) the ability to realize anticipated benefits and synergies of the business combination; and (ix) the potential impact of the consummation of the transaction on the Company’s relationships, including with employees, customers and competitors; and (x) other circumstances beyond the Company’s control. Refer to the section entitled “Risk Factors” in each of Envision’s and AMSURG’s annual and quarterly reports filed in 2016 for a discussion of important factors that could cause actual results, developments and business decisions to differ materially from forward-looking statements.

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