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Gooneratne N.S.,University of Pennsylvania | Patel N.P.,University of Pennsylvania | Patel N.P.,Reading Hospital and Medical Center | Corcoran A.,University of Pennsylvania
Journal of the American Geriatrics Society | Year: 2010

Chronic obstructive pulmonary disease (COPD) in older adults is a complex disorder with several unique age-related aspects. Underlying changes in pulmonary lung function and poor sensitivity to bronchoconstriction and hypoxia with advancing age can place older adults at greater risk of mortality or other complications from COPD. The establishment of the Global Initiative for Obstructive Lung Disease criteria, which can be effectively applied to older adults, has more rigorously defined the diagnosis and management of COPD. An important component of this approach is the use of spirometry for disease staging, a procedure that can be performed in most older adults. The management of COPD includes smoking cessation, influenza and pneumococcal vaccinations, and the use of short- and long-acting bronchodilators. Unlike with asthma, corticosteroid inhalers represent a third-line option for COPD. Combination therapy is frequently required. When using various inhaler designs, it is important to note that older adults, especially those with more-severe disease, may have inadequate inspiratory force for some dry-powder inhalers, although many older adults find the dry-powder inhalers easier to use than metered-dose inhalers. Other important treatment options include pulmonary rehabilitation, oxygen therapy, noninvasive positive airway pressure, and depression and osteopenia screening. Clinicians caring for older adults with an acute COPD exacerbation should also guard against prognostic pessimism. Although COPD is associated with significant disability, there is a growing range of treatment options to assist patients. © 2010, The American Geriatrics Society. Source

Schnatz P.F.,Reading Hospital and Medical Center
Obstetrics and Gynecology | Year: 2011

Objective: To estimate whether mammography can be an early, valid tool for predicting the development of coronary heart disease (CHD) in women. Methods: Women presenting for routine mammograms between June and August 2004 were recruited for the study. Baseline data collected included risk factors and family history of heart disease, as well as any cardiac events experienced by the patient. Similar follow-up data were collected during subsequent years, and these patient-completed surveys were correlated with the baseline mammograms screened for breast arterial calcifications. Results: Throughout the 5-year follow-up, CHD was present in 20.8% of women who screened positive for breast arterial calcification and in 5.4% of who screened negative for breast arterial calcification (P<.001). Among women who did not have CHD at baseline, breast arterial calcification-positive women were more likely to develop CHD or a stroke than those who were breast arterial calcification-negative (6.3% compared with 2.3%, P=.003; and 58.3% compared with 13.3%, P<.001), respectively. These results remained significant even when controlling for age. Conclusion: The presence of breast arterial calcifications on mammograms indicates a significantly increased risk of developing CHD or a stroke. These results suggest that breast arterial calcifications should be routinely reported on mammograms and viewed as a marker for the development of CHD. © 2011 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins. Source

Myers S.R.,Reading Hospital and Medical Center | McGuirl J.,Cognitive Systems Analytics | Wang J.,Ohio State University
Obesity Surgery | Year: 2013

Background: Roux-en-Y gastric bypass is an effective treatment for severe obesity and obesity-related comorbidities. Presently, gastric bypass is performed most often laparoscopically, although a robotic-assisted procedure is the preferred approach for an increasing number of bariatric surgeons. Methods: This retrospective study compared the results of 100 Roux-en-Y gastric bypass operations using the da Vinci robot and 100 laparoscopic Roux-en-Y gastric bypasses performed laparoscopically. Short-term outcomes were determined by evaluating mortality, length of stay, length of operation, return to the operating room within 90 days of operation, conversions to open procedure, leaks, strictures, transfusions, and hospital readmissions. Results: There was no mortality, pulmonary embolus, or conversion to open procedure in either group. Both the laparoscopic and robotic operative times decreased progressively, although the robotic operation time was longer (mean, 144 versus 87 min, P < 0.001). The length of stay was shorter for the robotic-assisted group (37 versus 52 h, P < 0.001), and 60 % of these patients were discharged after one night's stay (P < 0.001). There were fewer transfusions (P = 0.005) and readmissions (P =.560) in the robotic group. The stricture rate was higher in the first 50 robotic procedures (17 mm gastrotomy) but resolved in the second 50 procedures (21 mm gastrotomy). There was no difference in the rate of leak and return to the operating room between groups (both P > 0.05). Conclusions: These results indicate that Roux-en-Y gastric bypass can be performed safely with robotic assistance, even during the first 100 cases. © 2013 Springer Science+Business Media New York. Source

Vyas P.A.,Reading Hospital and Medical Center | Donato A.A.,Jefferson Medical College
Southern Medical Journal | Year: 2012

Acute pulmonary embolism (PE) is a common clinical condition with presentations that may vary from asymptomatic subsegmental emboli to massive vascular obstruction and shock with high risk of death. Identifying patients at highest risk for death is critical to select those who would benefit most from thrombolytic therapy. New and evolving clinical prediction models, serum tests, and imaging modalities are being used to improve our ability to identify potential thrombolytic candidates. We review the evolution of the present guidelines on the management of PE, specifically regarding the evolving role of thrombolytics; outcomes following thrombolytic therapy, including mortality, hemorrhage, hemodynamic improvement, and prevention of chronic thromboembolic pulmonary hypertension; and our strategy for risk stratification of pulmonary embolism. Copyright © 2012 by The Southern Medical Association. Source

Yazdanyar A.,Reading Hospital and Medical Center | Wasko M.C.,West Penn Allegheny Health System | Kraemer K.L.,University of Pittsburgh | Ward M.M.,U.S. National Institutes of Health
Arthritis and Rheumatism | Year: 2012

Objective Rheumatoid arthritis (RA) is associated with an increased cardiovascular (CV) burden similar to that of diabetes mellitus (DM). This risk may warrant preoperative CV assessment as is performed for patients with DM. We aimed to determine whether the risks of perioperative death and CV events among patients with RA differed from those among unaffected controls and patients with DM. Methods We used 1998-2002 data from the Nationwide Inpatient Sample (NIS) database of the Healthcare Cost Utilization Project (HCUP) to identify hospitalizations of patients undergoing elective noncardiac surgery. Using established guidelines, surgical procedures were categorized as either low risk, intermediate risk, or high risk of having CV events. Logistic models provided the adjusted odds of study end points in patients with RA, DM, or both relative to patients with neither condition. Results Among 7,756,570 patients undergoing a low-risk, intermediate-risk, or high-risk noncardiac procedure, 2.34%, 0.51%, and 2.12%, respectively, had a composite CV event, and death occurred in 1.47%, 0.50%, and 2.59%, respectively. Among those undergoing an intermediate-risk procedure, death was less likely in RA patients than in DM patients (0.30% versus 0.65%; P < 0.001), but the difference in mortality rates among those undergoing low-risk versus high-risk procedures was not significant. Patients with RA were less likely to have a CV event than were patients with DM for procedures of low risk (3.38% versus 5.30%; P < 0.001) and intermediate risk (0.34% versus 1.07%; P < 0.001). In adjusted models, RA was not independently associated with an increased risk of perioperative death or a CV event. Conclusion RA was not associated with adverse perioperative CV risk or mortality risk, which suggests that current perioperative clinical care does not need to be changed in this regard. Copyright © 2012 by the American College of Rheumatology. Source

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