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Winston-Salem, Massachusetts, United States

Saini N.,North Shore Medical Center | Mahindra A.,Massachusetts General Hospital
Expert Opinion on Investigational Drugs | Year: 2013

Introduction: The treatment options for patients with multiple myeloma (MM) remain limited. Immunomodulatory agents (IMiDs), such as thalidomide and lenalidomide, have changed the landscape in the treatment of patients with MM while newer IMiDs such as pomalidomide are showing promise in early clinical trials. Areas covered: This review focuses on the biologic rationales of IMiDs and the clinical results supporting their use in MM. It includes data on the new IMiD, pomalidomide and also explores the possible utility of combining IMiDs with other agents. A PubMed search and abstracts from oncology scientific meetings (ASCO and ASH) of articles related to IMiDs and MM was conducted. Expert opinion: IMiDs have shown clinical activity as single agents and in combination. Thalidomide was the first in class drug. Lenalidomide has a better toxicity profile than thalidomide. Pomalidomide may overcome resistance to lenalidomide indicating differences in their mechanisms of action and resistance. Molecular biomarkers may allow us to identify patients who will respond to IMiDs. © 2012 Informa UK, Ltd. Source

Alexander M.P.,Mayo Medical School | Nasr S.H.,Mayo Medical School | Watson D.C.,North Shore Medical Center | Mendez G.P.,Harvard University | Rennke H.G.,Harvard University
American Journal of Kidney Diseases | Year: 2011

Heavy chain deposition disease (HCDD) is a comparatively recently described entity characterized by glomerular and tubular basement membrane deposition of monoclonal heavy chains without associated light chains. To our knowledge, review of the literature shows only 24 previously reported cases of HCDD with unequivocal evidence of monoclonal heavy chain deposition in the kidney using immunofluorescence microscopic and electron microscopic studies. The predominant heavy chain subtype was γ. There has been a single case of μ HCDD and 2 previously reported cases of α HCDD. In this report, we describe 3 additional cases of α HCDD, all with a crescentic pattern of injury and one of which was associated with cutis laxa. We compare their clinicopathologic features with all previously reported cases of HCDD. © 2011 National Kidney Foundation, Inc. Source

Mulita A.,North Shore Medical Center
BMJ case reports | Year: 2014

Even though Streptococcus bacteraemia is an infrequent presentation of colonic malignancies, there is a well-established link between Streptococcus bovis bacteraemia and colonic malignancies. Most of the physicians are well aware of this correlation and further workup is pursued in most of the cases. However, many physicians may not be aware that other species of Streptococcus viridians, other than S. bovis, can be associated with colonic malignancies. In this case report, we present a case of Streptococcus viridians (anginosus) bacteraemia as a complication of an undiagnosed sigmoid adenocarcinoma. While further evidence is needed to warrant a gastrointestinal (GI) workup in a patient with other species of Streptococcus viridians bacteraemia, we would like to increase the awareness in the physicians' community regarding Streptococcus viridians, other than S. bovis bacteraemia. This would be especially relevant for patients who have no GI screening, as Streptococcus viridians bacteraemia can be an early sign of colonic neoplasm. 2014 BMJ Publishing Group Ltd. Source

McCabe J.M.,University of Washington | Kennedy K.F.,St Lukes Mid America Heart Institute | Eisenhauer A.C.,Brigham and Womens Hospital | Waldman H.M.,North Shore Medical Center | And 4 more authors.
Circulation | Year: 2014

BACKGROUND-: For patients who undergo primary percutaneous coronary intervention (PCI) for ST-segment-elevation myocardial infarction, the door-to-balloon time is an important performance measure reported to the Centers for Medicare & Medicaid Services (CMS) and tied to hospital quality assessment and reimbursement. We sought to assess the use and impact of exclusion criteria associated with the CMS measure of door-to-balloon time in primary PCI. METHODS AND RESULTS-: All primary PCI-eligible patients at 3 Massachusetts hospitals (Brigham and Women's, Massachusetts General, and North Shore Medical Center) were evaluated for CMS reporting status. Rates of CMS reporting exclusion were the primary end points of interest. Key secondary end points were between-group differences in patient characteristics, door-to-balloon times, and 1-year mortality rates. From 2005 to 2011, 26% (408) of the 1548 primary PCI cases were excluded from CMS reporting. This percentage increased over the study period from 13.9% in 2005 to 36.7% in the first 3 quarters of 2011 (P<0.001). The most frequent cause of exclusion was for a diagnostic dilemma such as a nondiagnostic initial ECG, accounting for 31.2% of excluded patients. Although 95% of CMS-reported cases met door-to-balloon time goals in 2011, this was true of only 61% of CMS-excluded cases and consequently 82.6% of all primary PCI cases performed that year. The 1-year mortality for CMS-excluded patients was double that of CMS-included patients (13.5% versus 6.6%; P<0.001). CONCLUSIONS-: More than a quarter of patients who underwent primary PCI were excluded from hospital quality reports collected by CMS, and this percentage has grown substantially over time. These findings may have significant implications for our understanding of process improvement in primary PCI and mechanisms for reimbursement through Medicare. © 2013 American Heart Association, Inc. Source

Schuur J.D.,Harvard University | Tibbetts S.A.,North Shore Medical Center | Tibbetts S.A.,University of Pennsylvania | Pines J.M.,University of Pennsylvania
Annals of Emergency Medicine | Year: 2010

Study objective: We assess performance and explore definitions for a new emergency department (ED) quality measure: the proportion of women aged 14 to 50 years who have abdominal pain and receive pregnancy testing (aimed at detecting ectopic pregnancy). Methods: We analyzed data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) (2002 to 2006) to test trends and predictors of the new measure, using both restrictive and broad definitions from the International Classification of Diseases, Ninth Revision (ICD-9) and reason-for-visit codes, and determine the proportion of women with ectopic pregnancy who had undergone pregnancy testing. For comparison, we conducted a detailed chart review in 4 US hospitals among patients who visited the ED in 2006. Results: Using a broad ICD-9 definition for inclusion in NHAMCS, 2.13 million women aged 14 to 50 years with abdominal pain visited an ED annually between 2002 and 2006. Of those, 33.0% (95% confidence interval [CI] 30.5% to 35.5%) received pregnancy testing. Testing rates were materially stable, regardless of the definition used (broad or restrictive ICD-9 or reason-for-visit code). Among women with an ICD-9 diagnosis of ectopic pregnancy, 55.6% (95% CI 43.7% to 67.6%) had a documented pregnancy test. In the chart review, among 200 women aged 14 to 50 years and with abdominal pain, 89.4% (95% CI 85.0% to 94.0%) were eligible for the measure; of those, 93.9% (95% CI 90.3% to 97.4%) received testing. Conclusion: Analysis of national ED survey data demonstrated a large performance gap for a new pregnancy testing quality measure, whereas focused chart review at 4 sites showed a smaller gap. Given these discrepancies, additional study is recommended before the widespread implementation of the pregnancy testing measure as an assessment of ED performance. © 2009 by the American College of Emergency Physicians. Source

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