Stony Brook Medicine

Stony Brook, NY, United States

Stony Brook Medicine

Stony Brook, NY, United States
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News Article | May 4, 2017
Site: news.yahoo.com

Having diabetes is all about maintaining a healthy blood sugar level. So, you may think it's a good thing if your blood sugar dips. However, low blood sugar can be just as worrisome as high blood sugar. "There's a happy range of blood sugar that our body likes, and having it too high or too low affects us," says Cindy Cooke, a family nurse practitioner in Huntsville, Alabama, and president of the American Association of Nurse Practitioners. Hypoglycemia, another term for low blood sugar, is when your blood sugar dips below 70 milligrams per deciliter, according to the American Diabetes Association. (If you have diabetes, you likely already use a blood glucose meter to regularly check your blood sugar.) The symptoms of hypoglycemia are shakiness, sweating, poor concentration and feeling weak or lightheaded. [See: 6 Tips to Keep Diabetics Out of the Hospital.] Just what causes hypoglycemia? One common cause is skipping meals. "In our office, we call it feeling hangry," says Lory Gonzalez, a nurse educator at the Diabetes Research Institute Foundation at the University of Miami Miller School of Medicine. Hangry cleverly combines the words hungry and angry, a feeling you've probably experienced when you haven't eaten in a while. Anyone, not just those with diabetes, can feel the effects of hypoglycemia. However, if you have diabetes, other causes of low blood sugar include increased physical activity or taking too much of your diabetes medication. For instance, you may experience hypoglycemia if your recommended medication dosage is too strong and it lowers your blood sugar, or you may take too much insulin and skip a meal, leading to hypoglycemia. How can you prevent low blood sugar and hypoglycemia? Don't skip meals and keep a high-sugar snack nearby (see examples below). "This will keep you from going south," Gonzalez says. If you think you're experiencing hypoglycemia, check your blood sugar. If it's below 70, you need to consume 15 grams of fast-acting sugar. This can include four ounces of juice or six ounces of regular soda (not diet). Many people traditionally think of orange juice to help hypoglycemia, but any type of fruit juice will work, Gonzalez says. You can also consume glucose tablets that are available over the counter. Each tablet typically has 4 grams of carbohydrates, so you'll want to take four tablets. Another approach to treat low blood sugar is the 30/30 rule, recommended by Dr. Joshua Miller, an endocrinologist and medical director of diabetes care for Stony Brook Medicine in Stony Brook, New York. With this, you consume 30 grams of fast-acting sugar, and then check your blood sugar every 30 minutes to make sure it's rising. Make sure to check your blood sugar regularly until it returns to a normal range. You want to keep a close watch on it to make sure you're not shooting it too high, Miller cautions. If your next meal is one to two hours away, have a snack that combines protein, fat and carbohydrates, like cheese and crackers, peanut butter and crackers or nuts and yogurt. Steer away from a carb-heavy snack, which may not be effective enough in lowering your blood sugar, Cooke says. It's important to keep snacks and quick sugar sources handy at all times. Stash extras around your house, at work or in your car. [Read: Don't Fall for These 6 Myths About Eating With Diabetes.] Although a one-time hypoglycemia experience may be nothing to worry about, talk to your doctor if it happens often. "One thing I counsel patients is that diabetes is a moving target," Miller says. Even if you do the right things to treat your diabetes, your body may require changes in medication to avoid drastic blood sugar changes. If you have diabetes, the effects of severe hypoglycemia can include seizures or fainting. In these situations, treatment may involve administering a shot of glucagon, a special hormone. Glucagon kits are available by prescription, and your health care provider can let you know if you need one. If you require a glucagon kit, the people around you most often should know how to give you an injection if you experience severe hypoglycemia, or they can call 911 for help. Sometimes a person living with diabetes can unknowingly have persistent low blood sugar levels -- a condition called hypoglycemia unawareness -- and it can be dangerous. "Having low blood sugar can mimic being drunk when you're driving," Gonzalez says. She recommends always carrying identification that says you have diabetes so people know what might be happening. And make sure to check your blood sugar before you drive a car so you know that you're not driving with a dangerous blood sugar level. Hyperglycemia means you have high blood sugar, generally defined as above 200 mg/dl. Uncontrolled hyperglycemia sometimes has no symptoms. Other times, symptoms can include increased thirst, urination and hunger as well as fatigue. If hyperglycemia persistently occurs -- meaning you have uncontrolled diabetes -- you're prone to the typical complications associated with diabetes, including blindness, circulation problems and kidney failure, Gonzalez says. If you are already diagnosed with diabetes, you know the risks associated with high blood sugar. If you think you've experienced hyperglycemia but don't yet have diabetes diagnosed, talk to your health care provider. "Diabetes is a lifelong disease process, but a lot of people tend to ignore it," Cooke says. However, the symptoms of hypoglycemia and hyperglycemia can be similar, so it's always best to test your blood sugar to see what's going on. If you experience several episodes of hyperglycemia within a short period, it could be that you've had too much of the wrong food or you've taken too little medication to help control your blood sugar. It could be a sign of not getting enough physical activity. Also, having a cold or infection can raise your blood sugar. In that case, your blood sugar should return to normal once you're feeling better. "I always warn my patients in this situation and tell them not to panic about their blood sugar," Cooke says. [Read: 7 Things Not to Say to Someone With Diabetes.] If you experience hyperglycemia, try drinking water. You can also take a walk to help counteract the effects of foods that spike your blood sugar. However, if your blood sugar is above 240, check your urine for ketones, the American Diabetes Association recommends. You'll want to avoid physical activity if there are ketones in your urine because they could raise your blood sugar even higher. If you experience hyperglycemia more often than usual, you may want to work with a registered dietitian on your meal planning. Vanessa Caceres is a Health freelancer for U.S. News. She's a nationally published health, travel and food writer, and she has an undergraduate degree in journalism and psychology from Hampshire College and a graduate degree in linguistics/bilingual education from Georgetown University. Connect with her on Twitter at @FloridaCulture.


News Article | May 15, 2017
Site: globenewswire.com

SAN FRANCISCO, May 15, 2017 (GLOBE NEWSWIRE) -- A newly published study from researchers at the New York University (NYU) Langone Medical Center showed that brain training had significantly greater impact on improving cognition in patients with Multiple Sclerosis (MS) than the computer games used as an active comparison group. The brain training used in the study was BrainHQ from Posit Science. Cognitive impairment is reported to affect up to 70 percent of patients with MS, and there is no current, generally recommended method of treatment. While cognitive remediation has been used, it is expensive to administer in-person and requires patients to travel to appointments. The researchers at NYU’s MS Comprehensive Care Center explored whether advances in computer technology and telehealth would permit remote administration of computerized brain training. They enrolled 135 patients at Stony Brook Medicine, who were randomly assigned to either the brain-training group or the computer games active comparison group. Both groups were asked to train for an hour a day, five days a week, for 12 weeks (a total of 60 hours), according to an automated schedule. Researchers reported that compliance was high in both groups, with the games group averaging 57 hours and the brain-training group averaging 38 hours. Both groups improved in the overall cognitive measure.  However, despite training about one-third fewer hours, the brain-training group had nearly three times the gain of the games group.  The gain for the brain-training group in the overall cognitive composite score was about 29 percent. In addition to the objective neuropsychological battery, patients were asked, as a secondary measure, to self-assess whether they experienced any improvement in cognition.  In the brain-training group, 56.7 percent reported experiencing improvement, as compared to 31 percent in the games group. The researchers selected BrainHQ exercises, because most of the exercises emphasize some aspect of visual and/or auditory speed of processing. Deficits in speed of processing are a signature cognitive symptom in MS patients. “This trial demonstrates that computer-based cognitive remediation accessed from home can be effective in improving cognitive symptoms for individuals with MS,” said Dr. Leigh Charvet, the study’s lead author. “The remote delivery of an at-home test and findings of cognitive benefit may also be generalizable to other neurological conditions in which cognitive function is compromised.” The study was published in PLOS ONE Neurology in an article entitled “Cognitive Function in Multiple Sclerosis Improves with Telerehabilitation: Results from a Randomized Controlled Trial.” It is believed to be the largest study, to date, measuring the impact of brain training on cognition in MS patients. “We are encouraged by this publication of results by independent researchers in yet another clinical population,” said Dr. Henry Mahncke, CEO of Posit Science, maker of the BrainHQ exercises used in the study. “With the assistance of other researchers and investors, these results will play a part in our plan to bring digital therapies to market after obtaining appropriate regulatory approvals.”


News Article | May 15, 2017
Site: globenewswire.com

SAN FRANCISCO, May 15, 2017 (GLOBE NEWSWIRE) -- A newly published study from researchers at the New York University (NYU) Langone Medical Center showed that brain training had significantly greater impact on improving cognition in patients with Multiple Sclerosis (MS) than the computer games used as an active comparison group. The brain training used in the study was BrainHQ from Posit Science. Cognitive impairment is reported to affect up to 70 percent of patients with MS, and there is no current, generally recommended method of treatment. While cognitive remediation has been used, it is expensive to administer in-person and requires patients to travel to appointments. The researchers at NYU’s MS Comprehensive Care Center explored whether advances in computer technology and telehealth would permit remote administration of computerized brain training. They enrolled 135 patients at Stony Brook Medicine, who were randomly assigned to either the brain-training group or the computer games active comparison group. Both groups were asked to train for an hour a day, five days a week, for 12 weeks (a total of 60 hours), according to an automated schedule. Researchers reported that compliance was high in both groups, with the games group averaging 57 hours and the brain-training group averaging 38 hours. Both groups improved in the overall cognitive measure.  However, despite training about one-third fewer hours, the brain-training group had nearly three times the gain of the games group.  The gain for the brain-training group in the overall cognitive composite score was about 29 percent. In addition to the objective neuropsychological battery, patients were asked, as a secondary measure, to self-assess whether they experienced any improvement in cognition.  In the brain-training group, 56.7 percent reported experiencing improvement, as compared to 31 percent in the games group. The researchers selected BrainHQ exercises, because most of the exercises emphasize some aspect of visual and/or auditory speed of processing. Deficits in speed of processing are a signature cognitive symptom in MS patients. “This trial demonstrates that computer-based cognitive remediation accessed from home can be effective in improving cognitive symptoms for individuals with MS,” said Dr. Leigh Charvet, the study’s lead author. “The remote delivery of an at-home test and findings of cognitive benefit may also be generalizable to other neurological conditions in which cognitive function is compromised.” The study was published in PLOS ONE Neurology in an article entitled “Cognitive Function in Multiple Sclerosis Improves with Telerehabilitation: Results from a Randomized Controlled Trial.” It is believed to be the largest study, to date, measuring the impact of brain training on cognition in MS patients. “We are encouraged by this publication of results by independent researchers in yet another clinical population,” said Dr. Henry Mahncke, CEO of Posit Science, maker of the BrainHQ exercises used in the study. “With the assistance of other researchers and investors, these results will play a part in our plan to bring digital therapies to market after obtaining appropriate regulatory approvals.”


News Article | May 15, 2017
Site: globenewswire.com

SAN FRANCISCO, May 15, 2017 (GLOBE NEWSWIRE) -- A newly published study from researchers at the New York University (NYU) Langone Medical Center showed that brain training had significantly greater impact on improving cognition in patients with Multiple Sclerosis (MS) than the computer games used as an active comparison group. The brain training used in the study was BrainHQ from Posit Science. Cognitive impairment is reported to affect up to 70 percent of patients with MS, and there is no current, generally recommended method of treatment. While cognitive remediation has been used, it is expensive to administer in-person and requires patients to travel to appointments. The researchers at NYU’s MS Comprehensive Care Center explored whether advances in computer technology and telehealth would permit remote administration of computerized brain training. They enrolled 135 patients at Stony Brook Medicine, who were randomly assigned to either the brain-training group or the computer games active comparison group. Both groups were asked to train for an hour a day, five days a week, for 12 weeks (a total of 60 hours), according to an automated schedule. Researchers reported that compliance was high in both groups, with the games group averaging 57 hours and the brain-training group averaging 38 hours. Both groups improved in the overall cognitive measure.  However, despite training about one-third fewer hours, the brain-training group had nearly three times the gain of the games group.  The gain for the brain-training group in the overall cognitive composite score was about 29 percent. In addition to the objective neuropsychological battery, patients were asked, as a secondary measure, to self-assess whether they experienced any improvement in cognition.  In the brain-training group, 56.7 percent reported experiencing improvement, as compared to 31 percent in the games group. The researchers selected BrainHQ exercises, because most of the exercises emphasize some aspect of visual and/or auditory speed of processing. Deficits in speed of processing are a signature cognitive symptom in MS patients. “This trial demonstrates that computer-based cognitive remediation accessed from home can be effective in improving cognitive symptoms for individuals with MS,” said Dr. Leigh Charvet, the study’s lead author. “The remote delivery of an at-home test and findings of cognitive benefit may also be generalizable to other neurological conditions in which cognitive function is compromised.” The study was published in PLOS ONE Neurology in an article entitled “Cognitive Function in Multiple Sclerosis Improves with Telerehabilitation: Results from a Randomized Controlled Trial.” It is believed to be the largest study, to date, measuring the impact of brain training on cognition in MS patients. “We are encouraged by this publication of results by independent researchers in yet another clinical population,” said Dr. Henry Mahncke, CEO of Posit Science, maker of the BrainHQ exercises used in the study. “With the assistance of other researchers and investors, these results will play a part in our plan to bring digital therapies to market after obtaining appropriate regulatory approvals.”


News Article | May 15, 2017
Site: globenewswire.com

SAN FRANCISCO, May 15, 2017 (GLOBE NEWSWIRE) -- A newly published study from researchers at the New York University (NYU) Langone Medical Center showed that brain training had significantly greater impact on improving cognition in patients with Multiple Sclerosis (MS) than the computer games used as an active comparison group. The brain training used in the study was BrainHQ from Posit Science. Cognitive impairment is reported to affect up to 70 percent of patients with MS, and there is no current, generally recommended method of treatment. While cognitive remediation has been used, it is expensive to administer in-person and requires patients to travel to appointments. The researchers at NYU’s MS Comprehensive Care Center explored whether advances in computer technology and telehealth would permit remote administration of computerized brain training. They enrolled 135 patients at Stony Brook Medicine, who were randomly assigned to either the brain-training group or the computer games active comparison group. Both groups were asked to train for an hour a day, five days a week, for 12 weeks (a total of 60 hours), according to an automated schedule. Researchers reported that compliance was high in both groups, with the games group averaging 57 hours and the brain-training group averaging 38 hours. Both groups improved in the overall cognitive measure.  However, despite training about one-third fewer hours, the brain-training group had nearly three times the gain of the games group.  The gain for the brain-training group in the overall cognitive composite score was about 29 percent. In addition to the objective neuropsychological battery, patients were asked, as a secondary measure, to self-assess whether they experienced any improvement in cognition.  In the brain-training group, 56.7 percent reported experiencing improvement, as compared to 31 percent in the games group. The researchers selected BrainHQ exercises, because most of the exercises emphasize some aspect of visual and/or auditory speed of processing. Deficits in speed of processing are a signature cognitive symptom in MS patients. “This trial demonstrates that computer-based cognitive remediation accessed from home can be effective in improving cognitive symptoms for individuals with MS,” said Dr. Leigh Charvet, the study’s lead author. “The remote delivery of an at-home test and findings of cognitive benefit may also be generalizable to other neurological conditions in which cognitive function is compromised.” The study was published in PLOS ONE Neurology in an article entitled “Cognitive Function in Multiple Sclerosis Improves with Telerehabilitation: Results from a Randomized Controlled Trial.” It is believed to be the largest study, to date, measuring the impact of brain training on cognition in MS patients. “We are encouraged by this publication of results by independent researchers in yet another clinical population,” said Dr. Henry Mahncke, CEO of Posit Science, maker of the BrainHQ exercises used in the study. “With the assistance of other researchers and investors, these results will play a part in our plan to bring digital therapies to market after obtaining appropriate regulatory approvals.”


News Article | May 15, 2017
Site: globenewswire.com

SAN FRANCISCO, May 15, 2017 (GLOBE NEWSWIRE) -- A newly published study from researchers at the New York University (NYU) Langone Medical Center showed that brain training had significantly greater impact on improving cognition in patients with Multiple Sclerosis (MS) than the computer games used as an active comparison group. The brain training used in the study was BrainHQ from Posit Science. Cognitive impairment is reported to affect up to 70 percent of patients with MS, and there is no current, generally recommended method of treatment. While cognitive remediation has been used, it is expensive to administer in-person and requires patients to travel to appointments. The researchers at NYU’s MS Comprehensive Care Center explored whether advances in computer technology and telehealth would permit remote administration of computerized brain training. They enrolled 135 patients at Stony Brook Medicine, who were randomly assigned to either the brain-training group or the computer games active comparison group. Both groups were asked to train for an hour a day, five days a week, for 12 weeks (a total of 60 hours), according to an automated schedule. Researchers reported that compliance was high in both groups, with the games group averaging 57 hours and the brain-training group averaging 38 hours. Both groups improved in the overall cognitive measure.  However, despite training about one-third fewer hours, the brain-training group had nearly three times the gain of the games group.  The gain for the brain-training group in the overall cognitive composite score was about 29 percent. In addition to the objective neuropsychological battery, patients were asked, as a secondary measure, to self-assess whether they experienced any improvement in cognition.  In the brain-training group, 56.7 percent reported experiencing improvement, as compared to 31 percent in the games group. The researchers selected BrainHQ exercises, because most of the exercises emphasize some aspect of visual and/or auditory speed of processing. Deficits in speed of processing are a signature cognitive symptom in MS patients. “This trial demonstrates that computer-based cognitive remediation accessed from home can be effective in improving cognitive symptoms for individuals with MS,” said Dr. Leigh Charvet, the study’s lead author. “The remote delivery of an at-home test and findings of cognitive benefit may also be generalizable to other neurological conditions in which cognitive function is compromised.” The study was published in PLOS ONE Neurology in an article entitled “Cognitive Function in Multiple Sclerosis Improves with Telerehabilitation: Results from a Randomized Controlled Trial.” It is believed to be the largest study, to date, measuring the impact of brain training on cognition in MS patients. “We are encouraged by this publication of results by independent researchers in yet another clinical population,” said Dr. Henry Mahncke, CEO of Posit Science, maker of the BrainHQ exercises used in the study. “With the assistance of other researchers and investors, these results will play a part in our plan to bring digital therapies to market after obtaining appropriate regulatory approvals.”


Tan M.,National University of Singapore | Law L.S.-C.,National University of Singapore | Gan T.J.,Stony Brook Medicine
Canadian Journal of Anesthesia | Year: 2015

Purpose: The optimal management of postoperative pain using multimodal analgesia is a key component of Enhanced Recovery After Surgery (ERAS). Pain has adverse clinical implications on postoperative recovery, including prolonging the time to recovery milestones and length of hospital stay. Moreover, the ubiquity of opioids in postoperative analgesic regimens results in adverse effects, such as sedation, postoperative nausea and vomiting, urinary retention, ileus, and respiratory depression, which can delay discharge. Thus, multimodal analgesia, i.e., the use of more than one analgesic modality to achieve effective pain control while reducing opioid-related side effects, has become the cornerstone of enhanced recovery. The purpose of this review is to address the analgesic techniques used as part of multimodal analgesic regimens to optimize postoperative pain control and to summarize the evidence for their use in reducing opioid requirements and side effects.Principal findings: There is a wide variety of analgesic techniques available for multimodal postoperative analgesia. These modalities are divided into pharmacological and non-pharmacological techniques. Systemic pharmacological modalities involve opioids and non-opioids such as acetaminophen, non-steroidal anti-inflammatory drugs, N-methyl-D-aspartate receptor antagonists, anticonvulsants (e.g., gamma-aminobutyric acid analogues), beta-blockers, alpha-2 agonists, transient receptor potential vanilloid receptor agonists (capsaicin), and glucocorticoids. Other pharmacological modalities include central neuraxial techniques, surgical-site infiltration, and regional anesthesia. Evidence supports the use of these pharmacological techniques as part of multimodal analgesia, but each has its own advantages and specific safety profile, which highlights the importance of selecting the appropriate analgesics for each patient. Adjunctive non-pharmacological techniques include acupuncture, music therapy, transcutaneous electrical nerve stimulation, and hypnosis. There is mixed evidence regarding such techniques, although a lack of harm is associated with their use.Conclusion: There are continuing advancements in multimodal analgesic techniques; however, postoperative pain in general continues to be undermanaged. Furthermore, a continuing challenge in multimodal pain research related to ERAS is the difficulty in carrying out randomized trials to determine the relative importance of any one component, including analgesia. © 2014, Canadian Anesthesiologists' Society.


Mehls O.,University of Heidelberg | Fine R.N.,Stony Brook Medicine
Pediatric Nephrology | Year: 2013

Growth retardation remains a clinical problem in children with chronic kidney disease (CKD) prior to and during end-stage renal disease. The growth of approximately 40 % of children on dialysis is stunted. Even so, growth hormone treatment (GH) is not used in the majority of small children prior to transplantation. Also, GH is effective in improving growth after transplantation, but again, it is only rarely used in this situation mainly for fear of triggering rejection episodes. In controlled studies, the number of patients who developed rejection episodes with GH was no greater than the number in untreated controls. However, patients with prior frequent rejection episodes developed further repeated subsequent rejection episodes. Many patients with repeated rejection episodes before GH treatment have reduced renal function and are expected to proceed to dialysis or retransplantation. We believe that in these patients, early individual decisions for or against GH treatment should be made as soon as other treatment strategies, such as steroid withdrawal, have failed or are not indicated. Decisions for GH treatment at a later pubertal age come too late for significant growth response and/or improvement of final height. © 2012 IPNA.


Parikh P.Y.,Stony Brook Medicine | Lillemoe K.D.,Harvard University
Seminars in Oncology | Year: 2015

Distal pancreatectomy is the standard procedure for tumors located in the body and tail of the pancreas. In the last three decades, significant progress has been made with regard to technical aspects as well as perioperative care so that excellent mortality and morbidity rates can be achieved. Recently, there is growing evidence that distal pancreatectomy may be performed laparoscopically in selected patients, offering the advantages of minimally invasive surgery. Unfortunately, the oncologic outcomes for pancreatic adenocarcinoma remain poor, in part due to the late stage of presentation in most patients. We review the history of distal pancreatectomy, discuss current indications for performing this procedure, compare operative techniques in performing distal pancreatectomy, and review both the early complications seen in patients who have undergone a distal pancreatectomy and the long-term metabolic and oncologic outcomes of these patients. © 2015 Elsevier Inc. All rights reserved.


Pediatric dental patients who cannot receive dental care in the clinic due to uncooperative behavior are often referred to receive dental care under general anesthesia (GA). At Stony Brook Medicine, dental patients requiring treatment with GA receive dental care in our outpatient facility at the Stony Brook School of Dental Medicine (SDM) or in the Stony Brook University Hospital ambulatory setting (SBUH). This study investigates the time and cost for ambulatory American Society of Anesthesiologists (ASA) Class I pediatric patients receiving full-mouth dental rehabilitation using GA in these 2 locations, along with a descriptive analysis of the patients and dental services provided. In this institutional review board-approved cross-sectional retrospective study, ICD-9 codes for dental caries (521.00) were used to collect patient records between July 2009 and May 2011. Participants were limited to ASA I patients aged 36-60 months. Complete records from 96 patients were reviewed. There were significant differences in cost, total anesthesia time, and recovery room time (P < .001). The average total time (anesthesia end time minus anesthesia start time) to treat a child at SBUH under GA was 222 ± 62.7 minutes, and recovery time (time of discharge minus anesthesia end time) was 157 ± 97.2 minutes; the average total cost was $7,303. At the SDM, the average total time was 175 ± 36.8 minutes, and recovery time was 25 ± 12.7 minutes; the average total cost was $414. After controlling for anesthesia time and procedures, we found that SBUH cost 13.2 times more than SDM. This study provides evidence that ASA I pediatric patients can receive full-mouth dental rehabilitation utilizing GA under the direction of dentist anesthesiologists in an office-based dental setting more quickly and at a lower cost. This is very promising for patients with the least access to care, including patients with special needs and lack of insurance.

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