Cao H.,St Marys Medical Center |
Phan H.,St Marys Medical Center |
Yang L.-X.,St Marys Medical Center
Anticancer Research | Year: 2012
Hepatocellular carcinoma (HCC) is the fifth most common cancer and it is the third leading cause of cancer-related deaths worldwide. Once diagnosed with the disease, only 30-40% of patients are deemed eligible for curative intention with treatment modalities including surgical resection, liver transplantation, and chemoembolization. Eventually, most patients will receive some forms of chemotherapy in hope of prolonging life. Sorafenib is the first molecular inhibitor to be approved by the FDA for the treatment of advanced HCC. It is a tyrosine kinase inhibitor, targeting multiple molecular pathways. Prior to the arrival of sorafenib, doxorubicin was routinely used as a single drug for advanced HCC, but has shown inefficacy, with a response rate of about 15-20%. Other chemotherapy agents, such as epirubicin, cisplatin, 5-fluorouracil, etoposide and their combinations, demonstrate even lower efficacy. While being considered an advance over conventional chemotherapy, sorafenib only improves life expectancy approximately by 3 months over placebo. With that in mind, continuous efforts have been put into finding new targets and molecular pathways for possible new drug development. In this article, we summarize the current literature over the past year on chemotherapy treatment of advanced HCC.
Ho A.,National University of Singapore |
Pinney S.J.,St Marys Medical Center |
Bozic K.,University of California at San Francisco
Journal of Bone and Joint Surgery - American Volume | Year: 2015
Mrs. A is a pleasant seventy-seven-year-old widow with an increasingly symptomatic right knee that has markedly limited her activities in the past year. Mrs. A's daughter, who lives in town, urged her to seek treatment. History, physical examination, and radiographs confirmed the diagnosis of end-stage knee arthritis. Dr. Z, the orthopaedic surgeon, presented total knee arthroplasty as a potential treatment option and provided detailed information on the surgery and recovery. Mrs. A indicated that if Dr. Z thinks that total knee arthroplasty is a good idea, she would agree to have the surgery. She lives alone and goes grocery shopping once a week, but her pain makes such endeavors frustrating for her. Her daughter visits regularly, takes her to medical appointments, and helps her with medications. Mrs. A has returned for a preoperative visit with Dr. Z, and her total knee arthroplasty has been tentatively scheduled for the following month. At this visit, Mrs. A notes that she wants to drive to the adjacent state to visit her son two weeks after the surgery and is glad she will have "a new knee" for that visit. When asked more questions about her understanding of the total knee arthroplasty and postoperative instructions, Mrs. A says Dr. Z can just talk to her daughter when she comes to pick her up from the appointment. Copyright © 2015 by the Journal of Bone and Joint Surgery, Incorporated.
Watson J.A.,St Marys Medical Center
American Journal of Infection Control | Year: 2016
Background Good hand hygiene is the single most important strategy used to prevent health care–associated infections (HAIs); however, health care workers' (HCWs') hand hygiene compliance rates range between 25% and 51%. This study aims to determine if a multimodal strategy using the World Health Organization's (WHO's) My 5 Moments for Hand Hygiene methodology increases HCWs' compliance with handwashing and awareness of the importance of good hand hygiene in the prevention of HAIs. Methods A quasi-experimental, 1-group pre-post survey design was used to test awareness and knowledge. A simple interrupted time series methodology at baseline and 3 months was used to monitor hand hygiene compliance. Results Overall, HCWs' hand hygiene compliance increased from 51.3% to 98.6%, with an odds ratio of 71.10. The pre-post survey demonstrated HCWs were aware and knowledgeable of the importance of good hand hygiene. Eight postsurvey questions focusing on the strategies used to promote hand hygiene demonstrated statistical significance using a 1-sample t test, with P values ranging from .000-.024. Conclusion A multimodal approach using the WHO's My 5 Moments for Hand Hygiene does increase HCWs' hand hygiene compliance and awareness and knowledge of the importance of hand hygiene in the prevention of HAIs. Using this approach can produce a positive social change by reducing preventable disease and decreasing HAIs not only within a facility but also in the community. © 2016 Association for Professionals in Infection Control and Epidemiology, Inc.
Weiss N.D.,St Marys Medical Center |
Molina R.A.,St Marys Medical Center |
Gwin S.,St Marys Medical Center
Journal of Hand Surgery | Year: 2011
Purpose: Proximal row carpectomy is an effective procedure for treating a variety of wrist pathologies. To date, all outcome studies have reported on the results of an open procedure, with a dorsal capsulotomy. We present our technique and early results of arthroscopic proximal row carpectomy. Methods: A total of 17 consecutive patients (10 men and 7 women) underwent arthroscopic proximal row carpectomy. After routine arthroscopy, the proximal carpal row was removed with an arthroscopic bur, with care being taken to protect the articular cartilage of the head of the capitate and the lunate fossa. The average time of the procedure was 70 minutes (range, 34-110 min). Range of motion exercise was initiated 2 days postoperatively. We assessed clinical follow-up objectively by evaluating range of motion and grip strength. We assessed subjective outcomes with the Disabilities of the Arm, Shoulder, and Hand questionnaire and with a patient-centered questionnaire assessing satisfaction, return to prior employment, and pain. Results: A total of 16 patients were available, with an average follow-up of 24 months (range, 12-48 mo). There were no complications, no revisions were required, and no arthroscopic procedure was converted to open technique. At final follow-up, the average wrist flexion-extension arc was 80% of the contralateral side, and grip strength averaged 81% of the contralateral side. The mean Disabilities of the Arm, Shoulder, and Hand score was 21. All 16 patients rated themselves as satisfied or very satisfied with the procedure. Eleven patients had no work restrictions and 13 were able to return to previous employment. Ten patients rated themselves as having mild or no pain. Conclusions: Arthroscopic proximal row carpectomy appears to be a safe, effective, and reliable procedure for a variety of wrist conditions, and it allows for rapid mobilization of the wrist compared with the open procedure. Range of motion and grip strength compare favorably with existing values in the literature for the open technique. Type of study/level of evidence: Therapeutic IV. Copyright © 2011 by the American Society for Surgery of the Hand. All rights reserved.
Kuo C.C.,St Marys Medical Center
The Journal of arthroplasty | Year: 2011
In the setting of extraarticular deformities of the knee, total knee arthroplasty (TKA) is difficult, as anatomical abnormalities obstruct identification of alignment landmarks and may preclude the use of traditional instrumentation. The long-term clinical value of computer assistance for TKA is a point of ongoing controversy. Few reports describe the use of computer-assisted orthopedic surgery as a method to decrease alignment outliers in TKA with associated posttraumatic deformities. In this report, a 70-year-old woman who had a severe distal femoral deformity from a previous open fracture underwent computer-assisted TKA for osteoarthritis. The use of a computer-assisted navigation system achieved a high degree of accuracy relative to the desired target alignment and led to improved function in a patient in which standard instrumentation was not feasible. Copyright © 2011. Published by Elsevier Inc.
Wolf E.M.,Sportsmed Orthopaedic Group Inc |
Arianjam A.,St Marys Medical Center
Journal of Shoulder and Elbow Surgery | Year: 2014
Background: This paper presents the results of arthroscopic remplissage in the treatment of traumatic anterior shoulder instability in a difficult subgroup of patients with both glenoid bone loss and a significant Hill-Sachs lesion. Methods: From March 2002 through May 2010, 270 patients were treated surgically for anterior shoulder instability. Of the surgical procedures performed, 59 patients (21.9%) with anterior instability and Bigliani grade IIIA (glenoid deficiency <25%) were treated with this technique. The average age was 33 years (range, 17-67 years); there were 48 men and 11 women. The procedure consisted of an arthroscopic posterior capsulodesis and infraspinatus tenodesis that filled the Hill-Sachs lesion and a concomitant arthroscopic anterior Bankart repair. Forty-five patients (76%) were available for follow-up ranging from 2 to 10 years (average, 58 months). All patients were evaluated by use of the Rowe and Constant scores. Twenty-seven patients were also evaluated by use of the Western Ontario Shoulder Instability Index. Results: Of the 45 patients, 2 (4.4%) had recurrent instability after traumatic dislocations; one was due to a basketball injury, and the other was reinjured by wrestling. At final follow-up, the median and mean scores ± standard deviation were as follows: Rowe score, 95, 92 ± 12; Constant score, 95, 92 ± 10; and Western Ontario Shoulder Instability Index, 110, 224 ± 261. All patients, except the traumatic dislocations, had no reoperations or complications. Conclusion: This procedure provides an effective arthroscopic approach in those cases of anterior shoulder instability that present with the combination of glenoid bone loss (grade IIIA) and a Hill-Sachs lesion. © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees.
Cao H.,St Marys Medical Center |
Le D.,St Marys Medical Center |
Yang L.-X.,St Marys Medical Center |
Yang L.-X.,California Pacific Medical Center Research Institute
Anticancer Research | Year: 2013
Pancreatic ductal adenocarcinoma (PDA) is one of the most lethal types of cancer in the United States. Surgical resection remains the only curative treatment, but fewer than 20% of patients qualify as candidates. The past two decades saw major changes in the treatment of advanced PDA, a shift of standard protocol from 5-fluorouracil to gemcitabine and gemcitabine-based combinations, the introduction of molecular target therapy and multi-agent regimens. However, even with advancements in medicine, PDA is still extremely resistant to currently available regimens, which results in poor prognosis, with only 5.2% of patients alive at three years. This provides a challenge to scientists as they seek to find the best active regimen with the least side-effects. In this article, we review the current recommended guidelines from the National Comprehensive Cancer Network. In addition, we highlight major clinical trials since 2011.
Long T.E.,Marshall University |
Williams J.T.,Marshall University |
Williams J.T.,St Marys Medical Center
Expert Opinion on Investigational Drugs | Year: 2014
Introduction: Healthcare-associated infections caused by multi-drug resistant bacteria remain a major cause of worldwide mortality. With the recent approval of agents such as hetero-resistant cocci (i.e., ceftaroline, ceftobiprole, telavancin) for the treatment of Gram-positive infections by and drugs like fidaxomicin for treating Clostridium difficile, present-day research on antibacterials has largely shifted to developing interventions for diseases caused by Gram-negative bacilli. Cephalosporins have gained significant interest as antipseudomonals to be used in hospitals for treating device- and procedure-associated infections. With extended-spectrum activity against many enterobacterial pathogens, the introduction of new antipseudomonal cephalosporin-based treatments will mark a significant advancement in the management of hospital-borne diseases. © 2014 Informa UK.
Kuo C.C.,St Marys Medical Center |
Robb W.J.,NorthShore University HealthSystem |
Robb W.J.,University of Chicago
Clinical Orthopaedics and Related Research | Year: 2013
Background: The prevention of medical and surgical harm remains an important public health problem despite increased awareness and implementation of safety programs. Successful introduction and maintenance of surgical safety programs require both surgeon leadership and collaborative surgeon-hospital alignment. Documentation of success of such surgical safety programs in orthopaedic practice is limited. Questions/purposes: We describe the scope of orthopaedic surgical patient safety issues, define critical elements of orthopaedic surgical safety, and outline leadership roles for orthopaedic surgeons needed to establish and sustain a culture of safety in contemporary healthcare systems. Methods: We identified the most common causes of preventable surgical harm based on adverse and sentinel surgical events reported to The Joint Commission. A comprehensive literature review through a MEDLINE® database search (January 1982 through April 2012) to identify pertinent orthopaedic surgical safety articles found 14 articles. Where gaps in orthopaedic literature were identified, the review was supplemented by 22 nonorthopaedic surgical references. Our final review included 36 articles. Results: Six important surgical safety program elements needed to eliminate preventable surgical harm were identified: (1) effective surgical team communication, (2) proper informed consent, (3) implementation and regular use of surgical checklists, (4) proper surgical site/procedure identification, (5) reduction of surgical team distractions, and (6) routine surgical data collection and analysis to improve the safety and quality of surgical patient care. Conclusions: Successful surgical safety programs require a culture of safety supported by all six key surgical safety program elements, active surgeon champions, and collaborative hospital and/or administrative support designed to enhance surgical safety and improve surgical patient outcomes. Further research measuring improvements from such surgical safety systems in orthopaedic care is needed. © 2012 The Association of Bone and Joint Surgeons®.
Chatterjee R.,St Marys Medical Center
British Journal of General Practice | Year: 2014
GPs have a detailed understanding of the health needs of their catchment area and for the first time they now have the power to influence commissioning decisions for their patients.