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Misumida N.,Mount Sinai Beth Israel | Harjai K.,Geisinger Clinic | Kernis S.,Lourdes Medical Center
Journal of Cardiovascular Pharmacology and Therapeutics | Year: 2015

Background: The effect of oral beta-blocker therapy on long-term mortality in patients with ST-segment elevation myocardial infarction (STEMI) who are treated with primary percutaneous coronary intervention (PCI) and who have preserved left ventricular ejection fraction (LVEF) remains unclear. Methods: We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for studies evaluating the effect of oral beta-blocker therapy in patients with STEMI who underwent primary PCI and who had preserved LVEF. The primary outcome was all-cause mortality. Randomized controlled trials and the observational studies that reported an adjusted hazard ratio (or hazard ratio in the propensity score-matched patients) with follow-up duration equal to or more than 6 months were included. Pooled hazard ratio with 95% confidence interval (CI) was calculated using a random effect model. Results: No randomized controlled trials met the inclusion criteria. Seven observational studies totaling 10 857 patients met the inclusion criteria. Follow-up duration ranged from 6 months to 5.2 years. Preserved LVEF was defined as 40% in 4 studies and 50% in 3 studies. Based on the pooled estimate, oral beta-blocker therapy was associated with a reduction in all-cause mortality (combined hazard ratio 0.79, 95% CI 0.65-0.97). Conclusion: This meta-analysis demonstrates that oral beta-blocker therapy is associated with decreased all-cause mortality in patients with STEMI who are treated with primary PCI and who have preserved LVEF. This supports the current American College of Cardiology Foundation/American Heart Association 2013 Guideline for the Management of STEMI. © SAGE Publications. Source


Takemoto R.C.,New York University | Lonner B.,Mount Sinai Beth Israel | Andres T.,New York University | Park J.,New York University | And 5 more authors.
The Journal of bone and joint surgery. American volume | Year: 2015

BACKGROUND: Wound drains that are left in place for a prolonged period of time have a higher rate of bacterial contamination. Following spinal surgery, a drain is often left in place for a longer period of time if it maintains a high output. Given the major consequences of an infection following spinal surgery and the lack of data with regard to the use of antibiotics and drains, we performed a study of patients with a drain following spinal surgery to compare infection rates between those who were treated with antibiotics for twenty-four hours and those who received antibiotics for the duration for which the drain was in place.METHODS: We performed a prospective randomized trial of 314 patients who underwent multilevel thoracolumbar spinal surgery followed by use of a postoperative drain. The patients were randomized into two groups, one of which received perioperative antibiotics for twenty-four hours (twenty-four-hour group) and the other of which received antibiotics for the duration that the drain was in place (drain-duration group). Data collected included demographic characteristics, medical comorbidities, type of spinal surgery, and surgical site infection.RESULTS: Twenty-one (12.4%) of the 170 patients in the twenty-four-hour group and nineteen (13.2%) of the 144 in the drain-duration group developed a surgical site infection (p = 0.48). There were no significant differences between the twenty-four-hour and drain-duration groups with respect to demographic characteristics (except for the American Society of Anesthesiologists [ASA] classification), operative time, type of surgery, drain output, or length of hospital stay.CONCLUSIONS: Continuing perioperative administration of antibiotics for the entire duration that a drain is in place after spinal surgery did not decrease the rate of surgical site infections. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated. Source


Powell D.K.,New York Presbyterian Columbia Campus | Silberzweig J.E.,Mount Sinai Beth Israel
Clinical Imaging | Year: 2015

Purpose: Assess the utilization of American College of Radiology Appropriateness Criteria (ACR-AC) among radiology residency program directors (PDs) and residents. Methods: Radiology PD and resident survey. Results: Seventy-four percent (46/62) of PDs promote ACR-AC in education (P<. .05), and 84% (317/376) of residents have read at least a few (P<. .05). Seventy-four percent (74/100) of first-year residents compared to 56.8% (157/276) of second- to fourth-year residents report at least occasional faculty reference of ACR-AC (P<. .05). ACR-AC are well regarded (P<. .05), but 40% believe that they are perplexing. Conclusion: There is widespread resident awareness of ACR-AC and integration into resident training. However, faculty are only beginning to teach with them, and radiologists are not citing them with clinicians. © 2015 Elsevier Inc. Source


Perlman D.C.,Mount Sinai Beth Israel | Gelpi-Acosta C.,National Research and Development Institutes Inc | Friedman S.R.,National Research and Development Institutes Inc | Jordan A.E.,New York University | Hagan H.,New York University
International Journal of Drug Policy | Year: 2015

Background: Genetic testing will soon enter care for human immunodeficiency virus (HIV) and hepatitis C virus (HCV), and for addiction. There is a paucity of data on how to disseminate genetic testing into healthcare for marginalized populations. We explored drug users' perceptions of genetic testing. Methods: Six focus groups were conducted with 34 drug users recruited from syringe exchange programmes and an HIV clinic between May and June 2012. Individual interviews were conducted with participants reporting previous genetic testing. Results: All participants expressed acceptance of genetic testing to improve care, but most had concerns regarding confidentiality and implications for law enforcement. Most expressed more comfort with genetic testing based on individual considerations rather than testing based on race/ethnicity. Participants expressed comfort with genetic testing in medical care rather than drug treatment settings and when specifically asked permission, with peer support, and given a clear rationale. Conclusion: Although participants understood the potential value of genetic testing, concerns regarding breaches in confidentiality and discrimination may reduce testing willingness. Safeguards against these risks, peer support, and testing in medical settings based on individual factors and with clear rationales provided may be critical in efforts to promote acceptance of genetic testing among drug users. © 2014 Elsevier B.V. Source


Preeshagul I.R.,Mount Sinai Beth Israel | Van Besien K.,New York Medical College | Mark T.M.,New York Medical College
Current Hematologic Malignancy Reports | Year: 2014

The treatment of multiple myeloma (MM) has dramatically changed in the last decade due to the introduction of the immunomodulatory drugs (IMIDs) and proteasome inhibitors, otherwise known as the novel agents. Prior to the advent of the novel agents, the gold standard of treatment had been high-dose chemotherapy with autologous stem cell transplantation (HDT/ASCT) for eligible candidates. Given the remarkable activity of the novel agents, and the significant morbidity of HDT/ASCT, the role of stem cell transplantation has now come into question. In this review, we explore the benefits and drawbacks to HDT/ASCT in the era of the novel therapies. © 2014, Springer Science+Business Media New York. Source

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