Shin C.H.,Rochester General Hospital
Annals of Surgery | Year: 2017
OBJECTIVE:: Evaluate the dose-response relationship between intraoperative fluid administration and postoperative outcomes in a large cohort of surgical patients. BACKGROUND:: Healthy humans may live in a state of fluid responsiveness without the need for fluid supplementation. Goal-directed protocols driven by such measures are limited in their ability to define the optimal fluid state during surgery. METHODS:: This analysis of data on file included 92,094 adult patients undergoing noncardiac surgery with endotracheal intubation between 2007 and 2014 at an academic tertiary care hospital and two affiliated community hospitals. The primary exposure variable was total intraoperative volume of crystalloid and colloid administered. The primary outcome was 30-day survival. Secondary outcomes were respiratory complications within three postoperative days (pulmonary edema, reintubation, pneumonia, or respiratory failure) and acute kidney injury. Exploratory outcomes were postoperative length of stay and total cost of care. Our models were adjusted for patient-, procedure-, and anesthesia-related factors. RESULTS:: A U-shaped association was observed between the volume of fluid administered intraoperatively and 30-day mortality, costs, and postoperative length of stay. Liberal fluid volumes (highest quintile of fluid administration practice) were significantly associated with respiratory complications whereas both liberal and restrictive (lowest quintile) volumes were significantly associated with acute kidney injury. Moderately restrictive volumes (second quintile) were consistently associated with optimal postoperative outcomes and were characterized by volumes approximately 40% less than traditional textbook estimates: infusion rates of approximately 6–7?mL/kg/hr or 1 L of fluid for a 3-hour case. CONCLUSIONS:: Intraoperative fluid dosing at the liberal and restrictive margins of observed practice is associated with increased morbidity, mortality, cost, and length of stay. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
News Article | May 15, 2017
Patrick Riggs, MD, Vascular Surgeon at The Vein Care Center Rochester, and affiliated with Rochester General Hospital, has been named a 2017 Top Doctor in Rochester, New York. Top Doctor Awards is dedicated to selecting and honoring those healthcare practitioners who have demonstrated clinical excellence while delivering the highest standards of patient care. Dr. Patrick Riggs is a highly experienced surgeon, who has been in practice for more than 28 years. His career in medicine started in 1988, when he graduated from the Wake Forest University School of Medicine in Winston-Salem, North Carolina. A residency then followed at the Alton Ochsner Medical Foundation, before Dr. Riggs completed a fellowship at the University of Rochester Strong Memorial Hospital. Dr. Riggs is board certified in Vascular Surgery by the American Board of Surgery, and he provides surgical solutions for a wide range of conditions. Conditions treated include deep vein thrombosis, aortic aneurysm, carotid artery disease, peripheral vascular disease, varicose veins, and heart disease. Expert procedures undertaken by Dr. Riggs include thrombectomy, heart surgery, and endovascular repair of the aorta. Dr. Riggs maintains a professional membership with the American College of Surgeons, and he is committed to keeping up to date with the latest technological advances in the field of vascular surgery. His dedication and expertise makes Dr. Patrick Riggs a very worthy winner of a 2017 Top Doctor Award. Top Doctor Awards specializes in recognizing and commemorating the achievements of today’s most influential and respected doctors in medicine. Our selection process considers education, research contributions, patient reviews, and other quality measures to identify top doctors.
News Article | May 23, 2017
The International Association of HealthCare Professionals is pleased to welcome Arun Chawla, MD, Nephrologist to their prestigious organization with his upcoming publication in The Leading Physicians of the World. Dr. Arun Chawla is a highly trained and qualified nephrologist with a vast expertise in all facets of his work, especially glomerulonephritis, hypertension and chronic kidney disease. Dr. Chawla has been in practice for more than a decade, and is currently serving patients within Advocare Nephrology of South Jersey at their Voorhees, Sicklerville, and Williamstown locations. Dr. Chawla was educated at the University of Delhi, Maulana Azad Medical College in New Delhi, India, where he graduated with his Medical Degree. Upon relocating to the United States, he completed his internal medicine residency at the University of Rochester School of Medicine and Dentistry Rochester General Hospital in New York. He then undertook his fellowship training at Hofstra North Shore Long Island Jewish School of Medicine. Dr. Chawla is board certified in both Internal Medicine and Nephrology by the American Board of Internal Medicine. To keep up to date with the latest advances and developments in his field, Dr. Chawla maintains a professional membership with the National Kidney Foundation. He believes that patient education, awareness, and strong communication skills are essential for providing the highest quality of care to his patients. He attributes his success to his exceptional training and mentors, as well as his hard work and persistence. In his free time, Dr. Chawla enjoys studying world history and various cultures, spending time with his family, and playing tennis. Learn more about Dr. Chawla here: http://www.advocarenephrologysj.com and be sure to read his upcoming publication in The Leading Physicians of the World. FindaTopDoc.com is a hub for all things medicine, featuring detailed descriptions of medical professionals across all areas of expertise, and information on thousands of healthcare topics. Each month, millions of patients use FindaTopDoc to find a doctor nearby and instantly book an appointment online or create a review. FindaTopDoc.com features each doctor’s full professional biography highlighting their achievements, experience, patient reviews and areas of expertise. A leading provider of valuable health information that helps empower patient and doctor alike, FindaTopDoc enables readers to live a happier and healthier life. For more information about FindaTopDoc, visit http://www.findatopdoc.com
News Article | April 28, 2017
Construct-A-Lead, the industry’s most comprehensive construction lead service, announces the following medical projects will go forward. Construct-A-Lead’s newly implemented advanced search feature allows the user to find their leads or key contacts by project type, location, bid stage, dollar value, company, or keyword. Users are able to track projects status, save searches, put personalized notes on projects, email a project to a colleague or customer, reach out directly to the decision maker and download construction leads with a one-touch feature. Interested parties are invited to visit Construct-A-Lead.com and sign up for a no obligation test drive, where they will be able to experience these newly integrated features. Users will be able to receive regular alerts on new and updated construction projects, in accordance with the individual’s preference. An example of the medical projects available within the database is listed below. Reference the Project ID to utilize the new site features and to obtain direct contact information for each construction lead: New Orleans, LA – Louisiana Proton Therapy Center– Plans call for the new construction of a 30,000 SF Proton Therapy Center on the University Medical Center. Construction start: Fall, 2017, $100,000,000 Project ID: 1390815 Framingham, MA – Framingham Senior Center and Assisted Living – Plans call for a new 108 bed senior center and assisted-living facility to include 60 single and duplex units. Construction start: Q4, 2017. $20,000,000 Project ID: 1391061 Crystal Lake, IL – Mercyhealth - Plans call for the new construction of a 13 bed micro-hospital with private inpatient and intensive care beds, two operating rooms, ancillary services and a 24/7 emergency room. Construction start: Q1, Q2, 2018. $81,700,000 Project ID: 1390888 Rochester, NY – Sands Constellation Critical Care Center – Plans call for new, seven-story building connected to the existing Rochester General Hospital totaling 300,000 square feet, to contain 128 patient rooms, 20 operating rooms and a 14-bed neonatal unit. Construction start: Spring, 2017. $254,000,000. Project ID: 1390449 Colorado Springs, CO - St. Francis Medical Center – Plans call for building a new 134,000-square-foot wing addition that will allow the hospital to nearly double its ED and NICU. The emergency room will grow from 23 beds to 40, and it will move to a new, four-level structure. Plans will add a sixth floor and upgrading its emergency department to a Level III trauma center. Construction start: June, 2017, $100,000,000. Project ID: 1390840 Construct-A-Lead is an online database that connects users to large-scale commercial construction projects, including those hidden, private project leads. The service features hotel construction, office buildings, retail construction, medical facilities, school renovations and much more, to help bid on construction including those hard-to-find private project leads, from planning stage through completion. Construct-A-Lead’s daily updates of commercial construction project leads are an ideal solution for those who want to put their product or service into commercial, government and religious structures. For more information, visit Construct-A-Lead.com online or call 855-874-1491.
Keipp Talbot H.,Vanderbilt University |
Falsey A.R.,Rochester General Hospital
Clinical Infectious Diseases | Year: 2010
Viral respiratory disease in older adults has been increasingly recognized as a significant cause of hospitalizations and death. Unfortunately, the recognition and diagnosis of infection due to many viral respiratory pathogens in older adults can be elusive because of atypical clinical presentations and the insensitivity of current laboratory diagnostic tests in this population. For influenza diagnosis, rapid antigen tests followed by viral culture (if antigen test results are negative), can be useful in older adults as long as clinicians are mindful of test limitations. Although specific, rapid antigen tests are insensitive in this population. Erroneous negative results may lead to delays in timely administration of antiviral treatment and institution of appropriate isolation precautions. The increasing availability of new, rapid, and sensitive molecular diagnostics, such as polymerase chain reaction testing, should provide more accurate and timely diagnoses of viral respiratory infections in older adults in the near future. © 2010 by the Infectious Diseases Society of America. All rights reserved.
Pichichero M.E.,Rochester General Hospital
JAMA - Journal of the American Medical Association | Year: 2015
IMPORTANCE: Antimicrobial treatment reduces the symptoms of acute otitis media (AOM). The effect of antimicrobial treatment on the duration of middle ear effusion (MEE) and concomitant hearing impairment is not known. OBJECTIVE: To determine whether the antimicrobial treatment of AOM reduces the duration of MEE. DESIGN, SETTING, AND PARTICIPANTS: This randomized, double-blind, placebo-controlled trial involved a total of 84 children with AOM between 6 months and 15 years of age. Participants were recruited from September 14, 1999, to January 4, 2000; October 10, 2005, to December 16, 2005; and September 22, 2009, to June 4, 2012, from among children attending an AOM prevention trial and children visiting local outpatient clinics in Oulu, Finland. INTERVENTIONS: Children were randomly allocated to receive either 40mg/kg of amoxicillin-clavulanate or a placebo mixture per day for 7 days. MAIN OUTCOMES AND MEASURES: The primary outcome measure was the time to the disappearance of MEE as defined by a normal tympanogram finding (A curve) from both ears on 2 consecutive measurement days. Parents performed daily tympanometry at home. The study physician performed tympanometry and otoscopy at study entry, after 3 and 7 days, and then weekly until both ears were healthy. The main secondary outcome measures were the time to normal otoscopy findings and the proportion of children without persistent MEE at 14 days and 2 months. RESULTS: Middle ear effusion disappeared 2.0 weeks (13.7 days) earlier (P = .02) in the antimicrobial group (mean time, 2.7 weeks; 95% CI, 1.7-3.7) than in the placebo group (4.7 weeks; 95% CI, 3.6-5.7). Normal otoscopy findings were observed 1.4 weeks sooner in the antimicrobial group than in the placebo group (P = .02).On day 14, 69% of children in the antimicrobial group and 38% in the placebo group had normal tympanometry findings (number needed to treat, 3.2; 95% CI, 2.0-10.5). On day 60, 2 children (5%) in the antimicrobial group and 10 children (24%) in the placebo group had persistent MEE (P = .01). CONCLUSIONS AND RELEVANCE: Antimicrobial treatment effectively reduced the duration of MEE and possible concomitant hearing impairment in children with AOM. Antimicrobial treatment also reduced the risk for persistent MEE. Copyright 2015 American Medical Association. All rights reserved.
Pichichero M.E.,Rochester General Hospital
Human Vaccines and Immunotherapeutics | Year: 2013
The immunogenicity of polysaccharides as human vaccines was enhanced by coupling to protein carriers. Conjugation transformed the T cell-independent polysaccharide vaccines of the past to T cell-dependent antigenic vaccines that were much more immunogenic and launched a renaissance in vac-cinology. This review discusses the conjugate vaccines for prevention of infections caused by Hemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitidis. Specifically, the characteristics of the proteins used in the construction of the vaccines including CRM, tetanus toxoid, diphtheria toxoid, Neisseria meningitidis outer membrane complex, and Hemophilus influenzae protein D are discussed. The studies that established differences among and key features of conjugate vaccines including immunologic memory induction, reduction of nasopharyngeal colonization and herd immunity, and antibody avidity and avidity maturation are presented. Studies of dose, schedule, response to boosters, of single protein carriers with single and multiple polysaccharides, of multiple protein carriers with multiple polysaccharides and conjugate vaccines administered concurrently with other vaccines are discussed along with undesirable consequences of conjugate vaccines. The clear benefits of conjugate vaccines in improving the protective responses of the immature immune systems of young infants and the senescent immune systems of the elderly have been made clear and opened the way to development of additional vaccines using this technology for future vaccine products. © 2013 Landes Bioscience.
Sterns R.H.,Rochester General Hospital
New England Journal of Medicine | Year: 2015
Human cells dwell in salt water. Their well-being depends on the ability of the body to regulate the salinity of extracellular fluids. By controlling water intake and excretion, the osmoregulatory system normally prevents the plasma sodium concentration from straying outside its normal range (135 to 142 mmol per liter). Failure of the system to regulate within this range exposes cells to hypotonic or hypertonic stress. This review considers the causes and consequences of an abnormal plasma sodium concentration and offers a framework for correcting it. © 2015 Massachusetts Medical Society.
Pichichero M.E.,Rochester General Hospital
Pediatric Clinics of North America | Year: 2013
Acute otitis media (AOM) is diagnosed based on visualization of a full or bulging tympanic membrane with middle ear effusion. The distribution of bacteria causing AOM in North America under the influence of pneumococcal conjugate vaccination and antibiotic selection pressure has resulted in a predominance of β-lactamase-producing Haemophilus influenzae followed by penicillin-resistant Streptococcus pneumoniae. Although guidelines continue to endorse amoxicillin as the preferred treatment, amoxicillin/clavulanate in high dosage would be the preferred treatment based on the otopathogen mix currently. Antibiotic prophylaxis has fallen into disfavor as a preventative strategy for AOM recurrences. © 2013 Elsevier Inc.
Rochester General Hospital | Date: 2014-06-27
Disclosed are compositions and methods related to vaccination for AOM and children prone to AOM.