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Zimmerman J.L.,Methodist Hospital | Zimmerman J.L.,New York Medical College | Shen M.C.,Methodist Hospital
Chest | Year: 2013

Rhabdomyolysis is a well-known clinical syndrome of muscle injury associated with myoglobinuria, electrolyte abnormalities, and often acute kidney injury (AKI). The pathophysiology involves injury to the myocyte membrane and/or altered energy production that results in increased intracellular calcium concentrations and initiation of destructive processes. Myoglobin has been identifi ed as the primary muscle constituent contributing to renal damage in rhabdomyolysis. Although rhabdomyolysis was fi rst described with crush injuries and trauma, more common causes in hospitalized patients at present include prescription and over-the-counter medications, alcohol, and illicit drugs. The diagnosis is confi rmed by elevated creatine kinase levels, but additional testing is needed to evaluate for potential causes, electrolyte abnormalities, and AKI. Treatment is aimed at discontinuation of further skeletal muscle damage, prevention of acute renal failure, and rapid identifi cation of potentially life-threatening complications. Review of existing published data reveals a lack of high-quality evidence to support many interventions that are often recommended for treating rhabdomyolysis. Early and aggressive fl uid resuscitation to restore renal perfusion and increase urine fl ow is agreed on as the main intervention for preventing and treating AKI. There is little evidence other than from animal studies, retrospective observational studies, and case series to support the routine use of bicarbonate-containing fl uids, mannitol, and loop diuretics. Hyperkalemia and compartment syndrome are additional complications of rhabdomyolysis that must be treated effectively. A defi nite need exists for well-designed prospective studies to determine the optimal management of rhabdomyolysis.


News Article | February 15, 2017
Site: www.prweb.com

In How to Create a Happy Workplace, author and executive coach Lorraine Grubbs interviewed CEOs, including John Johnson of David Weekley Homes, on topics ranging from building strong, resilient cultures of loyalty to customer engagement. In the book, Johnson recounts proven approaches that started with David Weekley and were used to create a long-lasting culture of spirited, dedicated and loyal employees. “As an entrepreneur, David had built a very successful home building company,” Johnson said. “He realized that to continue growing, he would need to give up some control and allow his leaders to take the reins. This is not typically easy for a founder to do, but to David, it came naturally. “David began to invest in the development of his leaders,” Johnson said. “He was the model of leadership to which we aspired – creative, imaginative and forward thinking. He is what some would call an ‘enlightened entrepreneur’ in that he shares his strengths and allows us to use his talents. The creativity and imagination of the company, demonstrated in the homes we build, the vision we have and the systems we use in our operations and our brand are a direct reflection of David Weekley.” David Weekley Homes, the nation’s largest privately-held builder, has been recognized 10 times for its award-winning culture by FORTUNE magazine. “The forward-thinking leaders interviewed in this book understand there are no shortcuts to creating a true culture of loyalty in your business,” author Grubbs comments. “I’m passionate about helping businesses create happy workplaces and my mission is to do so, one company at a time.” “We’ve always believed that valuing our Team Members is the right thing to do,” Johnson said. “Throughout our history, this viewpoint has never failed us. We are excited to be included in Lorraine’s book and the examples shared within offer forward-thinking companies a great value.” Grubb’s book also includes interviews from CEOs at Christian Brothers Automotive, Houston Methodist, Briggs & Veselka Co., Gillman Automotive, Hotze Health and Wellness Center and more. The book will be released as a softcover book and e-book available on Grubb’s website -http://www.LorraineGrubbs.com. For more information about David Weekley Homes, please visit http://www.DavidWeekleyHomes.com. David Weekley Homes, founded in 1976, is headquartered in Houston and operates in 23 cities across the United States. David Weekley Homes was the first builder in the United States to be awarded the Triple Crown of American Home Building, an honor which includes “America’s Best Builder,” “National Housing Quality Award” and “National Builder of the Year.” Weekley has also appeared 10 times on FORTUNE magazine’s “100 Best Companies to Work For®” list. Since inception, David Weekley Homes has closed more than 80,000 homes. For more information about David Weekley Homes, visit the company’s website at http://www.davidweekleyhomes.com. About “How to Create a Happy Workplace” Grubbs’ “A Happy Workplace” system, evolved out of her desire to help companies create cultures where employees come to work because they “want to”, not because they “have to.” As a business consultant to companies like Landry’s, State Farm, General Insulation, Methodist Hospital and others, Grubbs’ team assesses an organization’s loyalty and customer service, and helps build a blueprint for extraordinary employee loyalty and customer engagement. The common-sense tactics she recommends comprise essential components to create and sustain a successful atmosphere of loyalty and all the benefits that spring from it. Clients notice how their businesses change and their bottom line improves as employees became warrior spirits demonstrating increased productivity and elevated levels of customer service. For further information, please visit http://www.LorraineGrubbs.com or contact Grubbs at 281-813-0305. Lorraine Grubbs, was part of the Southwest Airlines Leadership Team for over 15 years. She has more than 30 years of experience as a leader, author and executive coach working exclusively in the field of how to build and retain loyalty in business. Her “A Happy Workplace” system incorporates proven and validated principles that companies who put their employees first utilize. She speaks four languages (English, Spanish, French and ‘Nautical’) and possesses various HR certifications. She regularly contributes articles to a variety of publications, and is a guest lecturer at Rice University and the University of Houston’s Executive MBA program. When not working, and flying, you’ll find Grubbs living aboard her boat “Loyalty” in Galveston, TX.


News Article | February 20, 2017
Site: co.newswire.com

From the Floor of HIMSS 2017, CareSkore, the leader in end-to-end personalized population health management, announced today that it experienced tremendous growth in 2016 and expects that to accelerate further in 2017.  Headcount expanded 12x, including key executives in engineering and marketing.  Customers grew over 1,000% with numerous additional late-stage evaluations currently underway.  By the end of 2017, CareSkore expects to be deployed in hundreds of locations.  In a separate release, CareSkore also announced today both v3.0 of its product and its leading CCM solution.  In an earlier release, CareSkore announced the industry’s first population health management as a serviceTM. “The shift from fee-for-service contracts to value-based contracts is unstoppable,” said Jas Grewal, CEO of CareSkore.  “Our customers, comprising some of the largest providers and payers in the US, concluded that CareSkore is uniquely positioned to facilitate adoption of value-based contracting and optimization of service quality, ratings, and revenue across the entire continuum of care.” CareSkore is leading the way in applying advanced technologies to heath care IT to provide detailed insights, care plans, and patient engagement from the time patients enter the hospital until they complete their post-hospital treatment. “No other company is delivering a comparable breadth of capabilities in population health by applying advanced technology,” said Dr. Madison Sample Jr., Vice Chairman, Department of Anesthesiology, Methodist Hospital. “These capabilities, plus a simple and seamless deployment model, are driving significant improvements to address the nearly $60B in preventable spending by providers.” CareSkore also has aggressive plans for team expansion in 2017.  More recently, it expanded its management team with two key hires.  Nahrin Reihaneh, VP of Engineering, brings over 20-years’ experience in web development, software engineering, and, most recently, cloud integration at a company she co-founded.  Eric Thacker, VP of Marketing, leverages over 25-years’ experience in all aspects of technology marketing of hardware, software, SaaS, analytics, and virtualization. “The addition of Nahrin and Eric to our team will foster tremendous growth in both product development and market penetration,” continued Grewal.  “They are just the first key additions to our team, which we expect will accelerate in 2017.” CareSkore is the leading provider of personalized population health management, leveraging machine-learning to generate predictive and prescriptive real-time analytics to understand each patient you are managing, what you are managing them for, and how you are/should be managing them.  CareSkore’s AI-enhanced post-discharged engagement reduces risk of patient behaviors that could lead to poorer outcomes.  CareSkore’s end-to-end patient care management platform ensures quality results and maximum revenue with value-based contracts. For additional information, please contact Natacha Rousseau at (323) 352-6417 or by email: Natacha@CareSkore.com


Carragee E.J.,Stanford University | Hurwitz E.L.,University of Hawaii at Manoa | Weiner B.K.,Methodist Hospital
Spine Journal | Year: 2011

Background context: Increasingly, reports of frequent and occasionally catastrophic complications associated with use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in spinal fusion surgeries are being published. In the original peer review, industry-sponsored publications describing the use of rhBMP-2 in spinal fusion, adverse events of these types and frequency were either not reported at all or not reported to be associated with rhBMP-2 use. Some authors and investigators have suggested that these discrepancies were related to inadequate peer review and editorial oversight. Purpose: To compare the conclusions regarding the safety and related efficacy published in the original rhBMP-2 industry-sponsored trials with subsequently available Food and Drug Administration (FDA) data summaries, follow-up publications, and administrative and organizational databases. Study design: Systematic review. Methods: Results and conclusions from original industry-sponsored rhBMP-2 publications regarding safety and related efficacy were compared with available FDA data summaries, follow-up publications, and administrative and organizational database analyses. Results: There were 13 original industry-sponsored rhBMP-2 publications regarding safety and efficacy, including reports and analyses of 780 patients receiving rhBMP-2 within prospective controlled study protocols. No rhBMP-2-associated adverse events (0%) were reported in any of these studies (99% confidence interval of adverse event rate <0.5%). The study designs of the industry-sponsored rhBMP-2 trials for use in posterolateral fusions and posterior lateral interbody fusion were found to have potential methodological bias against the control group. The reported morbidity of iliac crest donor site pain was also found to have serious potential design bias. Comparative review of FDA documents and subsequent publications revealed originally unpublished adverse events and internal inconsistencies. From this review, we suggest an estimate of adverse events associated with rhBMP-2 use in spine fusion ranging from 10% to 50% depending on approach. Anterior cervical fusion with rhBMP-2 has an estimated 40% greater risk of adverse events with rhBMP-2 in the early postoperative period, including life-threatening events. After anterior interbody lumbar fusion rates of implant displacement, subsidence, infection, urogenital events, and retrograde ejaculation were higher after using rhBMP-2 than controls. Posterior lumbar interbody fusion use was associated with radiculitis, ectopic bone formation, osteolysis, and poorer global outcomes. In posterolateral fusions, the risk of adverse effects associated with rhBMP-2 use was equivalent to or greater than that of iliac crest bone graft harvesting, and 15% to 20% of subjects reported early back pain and leg pain adverse events; higher doses of rhBMP-2 were also associated with a greater apparent risk of new malignancy. Conclusions: Level I and Level II evidence from original FDA summaries, original published data, and subsequent studies suggest possible study design bias in the original trials, as well as a clear increased risk of complications and adverse events to patients receiving rhBMP-2 in spinal fusion. This risk of adverse events associated with rhBMP-2 is 10 to 50 times the original estimates reported in the industry-sponsored peer-reviewed publications. © 2011 Elsevier Inc. All rights reserved.


Cagle P.T.,Methodist Hospital | Chirieac L.R.,Harvard University
Archives of Pathology and Laboratory Medicine | Year: 2012

Context.-Ongoing preclinical investigations and clinical trials involving new targeted therapies promise to improve survival for patients with lung cancer. Targeted therapeutic agents, based on genetic mutations and signaling pathways altered in lung cancer, have added significantly to our armamentarium for lung cancer treatment while minimizing drug toxicity. To date, 4 targeted therapies have been approved for treatment of lung cancer by the US Food and Drug Administration: gefitinib in 2002, erlotinib in 2003, bevacizumab in 2006, and crizotinib in 2011. Objective.-To review targeted therapies in lung cancer, the molecular biomarkers that identify patients likely to benefit from these targeted therapies, the basic molecular biology principles, selected molecular diagnostic techniques, and pathologic features correlated with molecular abnormalities in lung cancer. To review new molecular abnormalities described in lung cancer that are predictive for response to novel promising targeted agents in various phases of clinical trials. Data Sources.-Review of the literature covering the molecular abnormalities of lung cancer with a focus on the molecular diagnostics and targeted therapy. Special emphasis is placed on summarizing evolving technologies useful in the diagnosis and characterization of lung cancer. Conclusions.-Molecular testing of lung cancer expands the expertise of the pathologist, who will identify the tumor markers that are predictive of sensitivity or resistance to various targeted therapies and allow patients with cancer to be selected for highly effective and less toxic therapies.


Quigley E.M.M.,Methodist Hospital
American Journal of Gastroenterology | Year: 2013

Although the etiology of irritable bowel syndrome (IBS) remains unknown, clinical and laboratory observations suggest that within the broad and varying phenotype, that is, IBS, there may exist subgroups, which can be defined on the basis of a distinctive pathophysiological basis. Of these, postinfectious IBS is the best characterized; in IBS, in general, studies of inflammatory mediators and substances elaborated by cells involved in the intestinal immune response, such as proteases, suggest that some IBS sufferers can be differentiated on the basis of an aberrant immune response. Valdez-Morales and colleagues extend this concept by demonstrating the ability of supernatants of biopsy cultures from individuals with diarrhea-predominant IBS to enhance neuronal excitability - an effect that could well contribute to a clinical hallmark of IBS, namely, visceral hypersensitivity. © 2013 by the American College of Gastroenterology.


Chandler W.L.,Methodist Hospital
Blood Coagulation and Fibrinolysis | Year: 2013

This study provides the first estimates of microparticle numbers in platelet-rich plasma (PRP) from normal individuals, closer to in-vivo levels, using higher-resolution flow cytometry. We measured platelet (CD41+) and annexin V+ microparticles in fresh and frozen aliquots of PRP, platelet-poor plasma, platelet-free plasma (PFP), and microparticles isolated by high-speed centrifugation. PRP from healthy individuals contained 730  000/μl total microparticles based on light-scattering measurements. A median of 27 000/μl microparticles in PRP were of platelet origin and 120 000/μl annexin V+, and of these, 24 000/μl were dual-positive procoagulant platelet microparticles. Double centrifugation of PRP removed 99% of platelets, but also 80% of annexin V+ CD41+, 93% of annexin V+ CD41-, and 58% of annexin V- CD41+ microparticles. Loss of microparticles with centrifugation varied from individual to individual. Microparticle counts after isolation by centrifugation and double washing were not significantly different than counts in the original PFP sample, but lower than in PRP. Freeze-thawing of PFP had no effect on platelet microparticle counts, but slightly increased annexin V+, CD41- counts. Freeze-thawing of isolated washed microparticles resulted in a 30-50% increase in annexin V+ microparticles. PRP contains large numbers of cellular microparticles, including platelet and annexin V+ microparticles, which are lost to varying degrees when PRP is double centrifuged to remove platelets. Microparticles remaining in PFP can be recovered by high-speed centrifugation without loss compared to the original PFP sample. Freeze-thawing has variable effects on microparticle counts depending on the sample preparation used. © 2013 Wolters Kluwer Health Lippincott Williams & Wilkins.


Olsen R.J.,Methodist Hospital | Musser J.M.,Methodist Hospital
Annual Review of Pathology: Mechanisms of Disease | Year: 2010

Necrotizing fasciitis, also known as the flesh-eating disease, is a severe invasive infection associated with very high rates of human morbidity and mortality. It is most commonly caused by group A Streptococcus(GAS), a versatile human pathogen that causes diseases ranging in severity from uncomplicated pharyngitis (or strep throat) to life-threatening infections such as necrotizing fasciitis. Herein, we review recent discoveries bearing on the molecular pathogenesis of GAS necrotizing fasciitis. Importantly, the integration of new technologies and the development of human-relevant animal models have markedly expanded our understanding of the key pathogen-host interactions underlying GAS necrotizing fasciitis. For example, we now know that GAS organisms secrete a variety of proteases that disrupt host tissue and that these proteolytic enzymes are regulated by multiple transcriptional and posttranslational processes. This pathogenesis knowledge will be crucial to supporting downstream efforts that seek to develop novel vaccines and therapeutic agents for this serious human infection. Copyright © 2010 by Annual Reviews.


Mahmarian J.J.,Methodist Hospital
Journal of Nuclear Cardiology | Year: 2010

Stress single photon emission computed tomographic (SPECT) myocardial perfusion imaging has enjoyed great success over the past several decades as the modality of choice for accurately diagnosing and risk stratifying patients with suspected or known coronary artery disease. Same-day low-dose rest/high-dose stress imaging protocols have generally been widely adopted for this purpose. However, recent studies indicate that rest imaging may be unnecessary in patients with a normal initial stress SPECT. Elimination of the additional imaging would decrease costs, streamline patient evaluations, and reduce radiation exposure. SPECT imaging guidelines should be revised to reflect this new information. Copyright © 2010 by the American Society of Nuclear Cardiology.


Klebuc M.J.A.,Methodist Hospital
Plastic and Reconstructive Surgery | Year: 2011

Background: This article describes facial reanimation using the transfer of the trigeminal motor nerve branch of the masseter muscle (masseter nerve) to the facial nerve (masseter-to-facial nerve transfer). Methods: A retrospective review was performed of 10 consecutive facial paralysis patients treated with a masseter-to-facial nerve transfer for reanimation of the midface and perioral region over a 7-year period. Patients were evaluated with physical examination, direct measurement of commissure excursion, and video analysis. Results: All patients regained oral competence, good resting tone, and a smile, with a vector and strength comparable to those of the normal side. Motion developed an average of 5.6 months after masseter-to-facial nerve transfer, with 40 percent of patients developing an effortless smile by postoperative month 19. Conclusions: The masseter-to-facial nerve transfer is an effective method for reanimation of the midface and perioral region in a select group of facial paralysis patients. The technique is advocated for its limited donor-site morbidity, avoidance of interposition nerve grafts, and potential for cerebral adaptation, producing a strong, potentially effortless smile. Copyright © 2011 by the American Society of Plastic Surgeons.

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