Sarasota, FL, United States
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Shah P.L.,Imperial College London | Slebos D.-J.,University of Groningen | Cardoso P.F.G.,University of Sao Paulo | Cetti E.,Imperial College London | And 7 more authors.
The Lancet | Year: 2011

Airway bypass is a bronchoscopic lung-volume reduction procedure for emphysema whereby transbronchial passages into the lung are created to release trapped air, supported with paclitaxel-coated stents to ease the mechanics of breathing. The aim of the EASE (Exhale airway stents for emphysema) trial was to evaluate safety and efficacy of airway bypass in people with severe homogeneous emphysema. We undertook a randomised, double-blind, sham-controlled study in 38 specialist respiratory centres worldwide. We recruited 315 patients who had severe hyperinflation (ratio of residual volume [RV] to total lung capacity of ≥0·65). By computer using a random number generator, we randomly allocated participants (in a 2:1 ratio) to either airway bypass (n=208) or sham control (107). We divided investigators into team A (masked), who completed pre-procedure and post-procedure assessments, and team B (unmasked), who only did bronchoscopies without further interaction with patients. Participants were followed up for 12 months. The 6-month co-primary efficacy endpoint required 12 or greater improvement in forced vital capacity (FVC) and 1 point or greater decrease in the modified Medical Research Council dyspnoea score from baseline. The composite primary safety endpoint incorporated five severe adverse events. We did Bayesian analysis to show the posterior probability that airway bypass was superior to sham control (success threshold, 0·965). Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00391612. All recruited patients were included in the analysis. At 6 months, no difference between treatment arms was noted with respect to the co-primary efficacy endpoint (30 of 208 for airway bypass vs 12 of 107 for sham control; posterior probability 0·749, below the Bayesian success threshold of 0·965). The 6-month composite primary safety endpoint was 14·4 (30 of 208) for airway bypass versus 11·2 (12 of 107) for sham control (judged non-inferior, with a posterior probability of 1·00 [Bayesian success threshold >0·95]). Although our findings showed safety and transient improvements, no sustainable benefit was recorded with airway bypass in patients with severe homogeneous emphysema. Broncus Technologies. © 2011 Elsevier Ltd.


Extermann M.,University of South Florida | Boler I.,University of South Florida | Reich R.R.,University of South Florida | Lyman G.H.,Duke University | And 7 more authors.
Cancer | Year: 2012

BACKGROUND: Tools are lacking to assess the individual risk of severe toxicity from chemotherapy. Such tools would be especially useful for older patients, who vary considerably in terms of health status and functional reserve. METHODS: The authors conducted a prospective, multicentric study of patients aged ≥70 years who were starting chemotherapy. Grade 4 hematologic (H) or grade 3/4 nonhematologic (NH) toxicity according to version 3.0 of the Common Terminology Criteria for Adverse Events was defined as severe. Twenty-four parameters were assessed. Toxicity of the regimen (Chemotox) was adjusted using an index to estimate the average per-patient risk of chemotherapy toxicity (the MAX2 index). In total, 562 patients were accrued, and 518 patients were evaluable and were split randomly (2:1 ratio) into a derivation cohort and a validation cohort. RESULTS: Severe toxicity was observed in 64% of patients. The Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score was constructed along 2 subscores: H toxicity and NH toxicity. Predictors of H toxicity were lymphocytes, aspartate aminotransferase level, Instrumental Activities of Daily Living score, lactate dehydrogenase level, diastolic blood pressure, and Chemotox. The best model included the 4 latter predictors (risk categories: low, 7%; medium-low, 23%; medium-high, 54%; and high, 100%, respectively; P trend <.001). Predictors of NH toxicity were hemoglobin, creatinine clearance, albumin, self-rated health, Eastern Cooperative Oncology Group performance, Mini-Mental Status score, Mini-Nutritional Assessment score, and Chemotox. The 4 latter predictors provided the best model (risk categories: 33%, 46%, 67%, and 93%, respectively; P trend <.001). The combined risk categories were 50%, 58%, 77%, and 79%, respectively; P trend <.001). Bootstrap internal validation and independent sample validation demonstrated stable risk categorization and P trend <.001. CONCLUSIONS: The CRASH score distinguished several risk levels of severe toxicity. The split score discriminated better than the combined score. To the authors' knowledge, this is the first score systematically integrating both chemotherapy and patient risk for older patients and has a potential for future clinical application. © 2011 American Cancer Society.


News Article | October 28, 2016
Site: www.prweb.com

Holcomb-Kreithen Plastic Surgery and MedSpa, PLLC (“Holcomb-Kreithen” or “HKPS” or “the Practice”), a leading plastic surgery practice in Sarasota and Tampa Florida, is pleased to announce that practice co-founder J. David Holcomb, MD has been chosen for inclusion in the highly selective list of Castle Connolly Top Doctors® for 2016 for the specialty of Plastic Surgery (cosmetic and reconstructive facial surgery, and laser surgery). This represents the 3rd consecutive year that Dr. Holcomb has been chosen for the list by Castle Connolly, America’s trusted source for identifying Top Doctors. Castle Connolly Top Doctors are considered prestigious medical leaders in their regions. They are selected by Castle Connolly Medical Ltd. after being nominated by peer physicians in an online nomination process. Nominations are open to all board certified MDs and DOs and each year tens of thousands of doctors cast many tens of thousands of nominations. Honorees are selected from the nominees by the Castle Connolly physician-led research team based on criteria including their medical education, training, hospital appointments, disciplinary histories and more. Doctors do not and cannot pay to be included in any Castle Connolly Guide or online directory. Dr. Holcomb is a pioneer and advocate of laser-assisted facial rejuvenation techniques that have helped set a new standard for beautiful, natural results with reduced downtime, less discomfort and lower cost for patients. Commenting on his selection by Castle Connolly, Dr. Holcomb said, “It is truly an honor to receive this award for the third time in a row. I am honored to be recognized among my peers for my efforts to help people attain their aesthetic goals with a commitment to providing an exceptional level of skill and professionalism to all those in my care.” Dr. Holcomb is also a respected expert and published author in medical aesthetic areas including erbium- YAG laser surgery of the skin, fiber laser surgery of the face and neck, and integration of these and other technologies with facial rejuvenation surgery. Dr. Holcomb co-developed the AccuLift™ laser facial contouring procedure, introduced the procedure on CBS’ award-winning television show “The Doctors” and integrated these techniques with aging face surgery (Laser Assisted Facelift) for his patients at HKPS. About Dr. Holcomb Dr. Holcomb has over twenty years of surgical experience and has hospital affiliation with Sarasota Memorial Hospital. Dr. Holcomb completed a surgery internship (Department of Surgery) and residency training (Department of Otolaryngology – Head and Neck Surgery) at the University of Iowa Hospitals and Clinics, which is consistently rated among the best in the country by US News and World Report. He then completed a fellowship in advanced cosmetic facial plastic surgery with the American Academy of Facial Plastic and Reconstructive Surgery. Currently a member of the Florida Medical Association, Dr. Holcomb is a past president of the Sarasota County Medical Society and of the Florida Society of Facial Plastic and Reconstructive Surgery and has received numerous accolades. The mission of Castle Connolly Medical Ltd. is to help consumers find the best healthcare by publishing its list of Castle Connolly Top Doctors® at http://www.castleconnolly.com, as well as within 50+ media partner magazines, newspapers and affiliated websites. All told, more than 47,000+ doctors- approximately 5% of the nation's licensed physicians - have been selected as Castle Connolly Top Doctors in their regions for their specialties. About Holcomb-Kreithen Plastic Surgery and MedSpa With their main office located in beautiful downtown Sarasota, and services also available at locations in Lakewood Ranch and Tampa, Holcomb-Kreithen Plastic Surgery and H|K MedSpa offers a comprehensive range of aesthetic surgical and non-surgical treatments that enhance the lives of men and women. The founding physicians of the practice include J. David Holcomb, M.D. (Facial Plastic and Cosmetic Laser Surgeon) and Joshua Kreithen, M.D. (Breast and Body Contouring Specialist). The AAAASF-accredited facility includes a private outpatient ambulatory surgical center. Holcomb-Kreithen Plastic Surgery is renowned for its expertise in facial plastic surgery, plastic surgery of the breasts and body and cosmetic laser surgery. Additional core areas of focus within H|K MedSpa include non- and minimally-invasive body contouring, facial aesthetics, medical hair restoration, laser skin rejuvenation and medical skin care. With its comprehensive range of services and dedicated staff the practice has developed a reputation as one of the most advanced centers in Florida. Receipt of the Allergan “Black Diamond Award” is an objective benchmark for the practice’ success, ranking it among the top 1% of practices in the entire country providing Botox Cosmetic, Juvederm (including Voluma) injectable gel, Latisse, Natrelle breast implants and SkinMedica skin care. The Holcomb-Kreithen Plastic Surgery and MedSpa staff is comprised of an extraordinary group of professionals whose primary goal is to safely empower individuals to reach their full potential. They are committed to treating patients and each other with kindness, compassion and dignity at all times. For more information, visit http://www.sarasota-med.com


Ganyaglo G.Y.K.,Korle Bu Teaching Hospital | Hill W.C.,Sarasota Memorial Hospital
Seminars in Perinatology | Year: 2012

A 6-year (2004-2009) review of maternal deaths is presented to establish particular trends at the eastern regional hospital (1 of 10 regional hospitals in Ghana). There were a total of 191 maternal deaths over the period, with a total of 19,965 live births, giving a maternal mortality ratio of 957 per 100,000 live births. The main causes of maternal deaths were postpartum hemorrhage (22.5%), abortion-related causes (19.3%), hypertensive disorders in pregnancy (17.8%), and puerperal sepsis (8.9%). The study revealed that the highest number of deaths was recorded in the period following termination of pregnancy (abortion or delivery). Timely referral of patients to this hospital could help reduce preventable maternal deaths. © 2012 Elsevier Inc.


Clauson K.A.,Nova Southeastern University | Elkins J.,Nova Southeastern University | Goncz C.E.,Sarasota Memorial Hospital
American Journal of Health-System Pharmacy | Year: 2010

Purpose. The characteristics of pharmacist blogs were examined. Methods. Internet search engines, blog aggregators, and blog rolls were used to identify pharmacist blogs. Six categories were developed to evaluate blogs, including practice-based topics, identifying information, positive language, critical language, professionalism, and miscellaneous. The most recent five posts on each pharmacist blog were reviewed. Descriptive statistics were used to characterize the results. Results. A total of 117 blogs were identified, 44 of which were designated as pharmacist blogs. No blogs contained patient-identifying information. Anonymity was maintained by 68.2% of bloggers. Bloggers practiced in community (43.1%) and noncommunity (43.1%) settings. Pharmacists most commonly used positive language to describe the profession (32%), other health care professionals (25%), and patients (25%). The highest rates of critical language were found in descriptions of patients (57%) and other health care professionals (44%). Almost half of pharmacist blogs contained explicit or unprofessional language. Overall, community practitioner blogs were substantially more likely than noncommunity practitioner blogs to use unprofessional and critical language. Twenty-five percent of pharmacist bloggers also maintained a microblog (e.g., Twitter) account. Conclusion. A search using Internet search engines, blog aggregators, and blog rolls identified 117 blogs, 44 of which met the study criteria for designation as pharmacist blogs. The majority of pharmacist blogs included some type of discussion of pharmacologic therapies. Pharmacists most commonly used positive language to describe the profession, other health care professionals, and patients. The highest rates of critical language were found in descriptions of patients and other health care professionals. Copyright © 2010, American Society of Health-System Pharmacists, Inc. All rights reserved.


PURPOSE:: To investigate whether positron emission tomography/computed tomography (PET/CT) initial and restaging imaging predicts for pathologic response measured by tumor regression grade (TRG) after preoperative chemoradiotherapy (CRT) in patients with locally advanced esophageal cancer. METHODS:: A retrospective review of 220 patients with stage II-III esophageal cancer treated with neoadjuvant CRT followed by surgery was performed. In total, 187 patients were eligible for statistical analysis. Pretreatment and posttreatment PET/CT scans were reviewed. Maximum standard uptake value (SUV) at the site of the primary tumor was recorded before and 6 weeks after neoadjuvant therapy. Upon completion of surgery, TRG was determined by a specialized site-specific gastrointestinal pathologist. Spearman correlation was used to compare pre, post, and change in maximum SUV, TRG, and overall survival. RESULTS:: The median follow-up was 24 months. Although no significant correlation was found between pretreatment SUV and TRG (r=0.073, P=0.32), post-CRT SUV, however, showed a significant positive correlation with TRG (r=0.374, P<0.01). There was no significant correlation between the absolute change in fluorodeoxyglucose uptake after CRT and TRG (r=0.057, P=0.44); however, the rate of SUV change showed a significant correlation with TRG (r=0.178, P=0.017). Similar to previous studies, our study showed a significant difference in overall survival between TRG groups (log-rank test, P=0.019). Patients with TRG 3 showed prominently worse survival with median survival of 27.4 months. Patients with favorable pathologic responses were those whose scans demonstrated a metabolic response defined as a decrease in SUV≥70%. CONCLUSIONS:: Changes in SUV uptake on PET/CT scans after CRT have prognostic value in predicting pathologic response of esophageal cancer after neoadjuvant therapy. Further studies are needed to validate the integration of PET/CT as a decision-making tool. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Rustagi T.,Section of Digestive Diseases | Corbett F.S.,Sarasota Memorial Hospital | Mashimo H.,Harvard University
Gastrointestinal Endoscopy | Year: 2015

Background Chronic radiation proctopathy (CRP) is a common sequela occurring even many years after pelvic radiation. Current ablative therapies for bleeding ectatic vessels have the potential for deep tissue injury leading to ulcerations, perforation, and fistulas. Radiofrequency ablation (RFA) therapy avoids deep tissue injury and is a promising treatment for CRP. Objective To assess the long-term safety and efficacy of RFA for the treatment of CRP. Design Multicenter, retrospective analysis of a prospectively collected database. Setting Veterans Affairs Boston Healthcare System, Massachusetts; Sarasota Memorial Hospital and Suncoast Endoscopy of Sarasota, Florida. Patients A total of 39 consecutive patients with CRP. Interventions Endoscopic RFA of CRP. Main Outcome Measurements The primary endpoint of the study was complete resolution of rectal bleeding. Secondary endpoints included visually scored improvement of CRP on endoscopic follow-up by using a rectal telangiectasia density (RTD) grading score, improvement in hemoglobin level, and adverse events related to the procedure. Results A total of 39 male patients (mean [± standard deviation {SD}] age 72.9 ± 6.6 years) were included in the study. The mean number of RFA sessions was 1.49 (median 1, interquartile range [IQR] 1-2, range 1-4), with a mean interval of 18 weeks between sessions. Rectal bleeding stopped completely in all patients during the mean follow-up of 28 months (range 7-53 months). A significant improvement occurred in the mean (± SD) hemoglobin level from 11.8 ± 2 to 13.5 ± 1.6 g % (P <.0001). Endoscopic severity also improved significantly with an improvement in the median RTD score from 3 (IQR 2-3) to 0 (IQR 0-1) (P <.0001). Treatment with RFA led to discontinuation of blood transfusion and iron therapy in 92% and 82% patients, respectively. Limitations Retrospective analysis, lack of control group. Conclusion RFA therapy led to complete resolution of rectal bleeding in all treated CRP patients, with improvement in clinical and endoscopic indices without any major adverse events. Further controlled studies are needed to establish RFA as the endoscopic therapy of choice for treatment of CRP. © 2015 American Society for Gastrointestinal Endoscopy.


Borsellino M.,Sarasota Memorial Hospital | Young M.M.,Sarasota Memorial Hospital
Clinical Journal of Oncology Nursing | Year: 2011

Many women consider hair loss to be one of the most difficult and feared side effects of chemotherapy treatments. On learning they will likely lose their hair, women immediately begin anticipating the event and its impact on themselves and others. Anticipation of an unwanted event can lead to greater anxiety, fear, or depression, particularly if women see or find no options for gaining some sense of control. Anticipatory coping is the process of anticipation and preparation for an expected altered appearance. By researching options, making deliberate choices, and taking specific actions to determine their appearance without hair, women gain a greater sense of control of their changing appearance. This greater sense of control may ease or lessen feelings of fear and depression and help women to take control of other aspects of their lives that contribute to a greater quality of life during cancer treatment. Oncology nurses are in a unique position to help women turn their anxiety about hair loss into an anticipatory coping process, one that increases women's sense of control over some of the outward changes taking place in their bodies and empowers them to make proactive choices regarding their overall response to cancer.


Brown C.,Sarasota Memorial Hospital
Clinical Journal of Oncology Nursing | Year: 2010

Cerebellar toxicity is a known potential adverse effect of high-dose cytarabine chemotherapy. Oncology nurses are expected to assess patients receiving high-dose cytarabine for cerebellar toxicity prior to administering each dose. Information regarding cerebellar assessment techniques and documentation of findings is limited in the nursing literature. This article provides nurses with a standardized approach for cerebellar function assessment and documentation of assessment finding for patients receiving high-dose cytarabine therapy.


French E.,Sarasota Memorial Hospital
Clinical Obstetrics and Gynecology | Year: 2013

Unfortunately, substance abuse is increasing in the patients that we see in labor and delivery. Many women who are abusing drugs are of childbearing age and frequently present first for care in labor. It can then be a challenge to manage them. From caring for them, we have learned much about the drug-addicted patient and how to more completely care for them. The care provided by the whole team must not only be competent but with compassion. We have also learned about our own and our colleagues' biases and how we can best manage our feelings and theirs as well. The goal of all the clinicians managing these patients has to be excellence in managing their labor physically, clinically, pharmacologically, and psychologically. © 2013, Lippincott Williams &Wilkins.

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