University of Pittsburg Medical Center

Pittsburgh, PA, United States

University of Pittsburg Medical Center

Pittsburgh, PA, United States
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Lunyera J.,Duke University | Jonassaint C.,University of Pittsburg Medical Center | Jonassaint J.,University of Pittsburg Medical Center | Shah N.,Duke University
Journal of Primary Care and Community Health | Year: 2017

Background: Sickle cell disease (SCD) is a complex chronic disease requiring multidisciplinary care that involves primary care physicians (PCPs) working with a hematologist or SCD specialists. However, PCPs often lack access to SCD specialists and are unaware of SCD guidelines or efficacious treatment. Methods: We partnered with Community Care of North Carolina (CCNC) to identify assigned PCPs for SCD patients with Medicaid across North Carolina. CCNC network administrators distributed a web-based questionnaire for completion. The questionnaire involved 12 self-reported items on a yes-no or a 1 to 5 Likert-type scale that assessed PCP attitudes toward SCD care, awareness of recent guidelines, and comanaging hydroxyurea. Results: Of the 53 PCPs who completed the electronic survey, 73% felt they were comfortable with the number of SCD patients in their practice. Most PCPs reported having infrequent communications with an SCD specialist (67%) and most were also not aware of the 2014 SCD guidelines (66%). Many reported that they would frequently use the new SCD guidelines if provided to them (76%). Furthermore, 51% of PCPs expressed comfort with using mobile apps to access SCD guidelines and provided email contact to receive further information. The majority also reported being comfortable comanaging hydroxyurea with an SCD specialist (65%). Conclusion: Few PCPs in North Carolina were aware of the new SCD guidelines or had regular communication with an SCD specialist. The majority of PCPs, however, demonstrated a favorable attitude toward receiving the SCD guidelines and comanaging hydroxyurea with a specialist. In response to this gap in care, we have developed a mobile-based SCD toolbox specifically for PCPs to provide guidelines, algorithms, and a method to communicate with local SCD specialists. With the interest in receiving these guidelines, we are confident the toolbox will provide an easy to use platform to assist PCPs to utilize the SCD guidelines. © The Author(s) 2016.

Nguyen N.H.,University of California at San Diego | McCormack S.A.,University of California at San Diego | Yee B.E.,University of California at San Diego | Devaki P.,Wayne State University | And 3 more authors.
Hepatology International | Year: 2014

Background: Hepatitis C virus genotype 6 (HCV-6) is common in patients from Southeast Asia and the surrounding regions. Optimal treatment duration for HCV-6 is unknown given the inconclusive evidence from studies with varying methodologies and small sample sizes.Methods: A literature search for ‘genotype 6’ in MEDLINE and EMBASE in October 2013 produced 161 and 251 articles, respectively. Additional abstracts were identified from four major international GI/liver conferences in 2012/2013. Inclusion criteria were original studies with ≥10 HCV-6 treatment-naïve patients treated with pegylated interferon + ribavirin (PEG IFN+RBV). Exclusion criteria were coinfections with HBV, HIV, other HCV genotypes, and/or other liver diseases. Primary outcome was pooled sustained virologic response (SVR). Heterogeneity was defined by Cochrane Q test (p value of 0.10) and I2 statistic (≥50 %).Results: A total of 13 studies with 641 patients were included. The pooled SVR estimate was 77 % (CI 70–83 %) (Q value = 38.4, p value <0.001, I2 = 68.7 %) overall, 79 % (CI 73–84 %) for the 48-week group and 59 % (CI 46–70 %) for 24-week group, respectively. In studies with direct comparison of the two groups, SVR was superior in patients treated for 48 versus 24 weeks, OR 1.9 (CI 1.08–3.2, p = 0.026). In studies with direct comparison of patients with rapid virologic response (RVR), there was no difference in SVR between 48 versus 24 weeks, OR 1.74 (CI 0.65–4.64, p = 0.27).Conclusion: Hepatitis C virus genotype 6 patients should be treated for 48 weeks, and those who achieve RVR may receive the shorter 24-week treatment duration. The high SVR (~80 %) with 48 weeks of PEG IFN+RBV therapy may be a cost-effective option for HCV-6 patients from resource-poor regions. © 2014, Asian Pacific Association for the Study of the Liver.

Katabathina V.S.,University of Texas Health Science Center at San Antonio | Kapalczynski W.,University of Texas Health Science Center at San Antonio | Dasyam A.K.,University of Pittsburg Medical Center | Anaya-Baez V.,Mayaguez Medical Center | Menias C.O.,Mayo Clinic at Scottsdale
Abdominal Imaging | Year: 2015

Approximately 20% of choledochal cysts (CC) present in adult patients and they are commonly associated with a high risk of complications, including malignancy. Additionally, children who underwent internal drainage procedures for CCs can develop complications during adulthood despite treatment. Concepts regarding classification and pathogenesis of the CCs have been evolving. While new subtypes are being added to the widely accepted Todani classification system, simplified classification schemes have also been proposed to guide appropriate management. The exact etiology of CCs is currently unknown. The two leading theories involve either the presence of an anomalous pancreatico-biliary junction with associated reflux of pancreatic juice into the biliary system or, more recently, some form of antenatal biliary obstruction with resulting proximal bile duct dilation. Imaging studies play an important role in the initial diagnosis, surgical planning, and long-term surveillance of CCs. © 2015, Springer Science+Business Media New York.

Hildebrandt T.,Mount Sinai School of Medicine | Langenbucher J.W.,Rutgers University | Flores A.,Mount Sinai School of Medicine | Harty S.,University of Pittsburg Medical Center | Berlin H.A.,Mount Sinai School of Medicine
Psychology of Addictive Behaviors | Year: 2014

A growing translational literature suggests that adolescent exposure to anabolic-androgenic steroids (AASs) leads to increased aggression and impulsivity. However, little is known about the cognitive effects of AASs among AAS users or the differences between adolescent-and adult-onset users. This study provides a test of the effects of acute naturalistic AAS use and age of onset (adolescent vs. adult) on measures of inhibitory control, planning and attention, and decision making. Seventy-one active adult male AAS users completed self-report measures of impulsivity and aggression, and a subsample (11 adolescent onset vs. 11 adult onset) matched on current age were administered 4 computerized tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) (Cambridge Cognition, 2002) and the Iowa Gambling Task (Stanton, Liening, &Schultheiss, 2011). Multiple regression analyses and a series of 2 (adolescent vs. adult) × 2 (on-cycle vs. off-cycle) analyses of variance (ANOVAs) were used to examine the differential effects of age of onset and acute drug use on cognition and behavior. Regression analyses revealed larger on-cycle effects for adolescent users than adult users. Subsample analyses indicated that on-cycle users performed less well on cognitive measures of inhibitory control and attention, but not on tests of planning or decision making. Adolescent onset was associated with greater impulsivity and more acute sensitivity to AAS effects on attention. These preliminary findings suggest the possibility that acute AAS use is associated with some differences in inhibitory control and impulsivity and to a lesser degree, aggression. These effects may be more potent for those initiating AAS use in adolescence. © 2014 American Psychological Association.

Ward N.S.,Rhode Island Hospital Brown | Afessa B.,Mayo Medical School | Kleinpell R.,Rush University Medical Center | Tisherman S.,University of Pittsburg Medical Center | And 4 more authors.
Critical Care Medicine | Year: 2013

OBJECTIVES: Increases in the number, size, and occupancy rates of ICUs have not been accompanied by a commensurate growth in the number of critical care physicians leading to a workforce shortage. Due to concern that understaffing may exist, the Society of Critical Care Medicine created a taskforce to generate guidelines on maximum intensivists/patient ratios. DATA SOURCES: A multidisciplinary taskforce conducted a review of published literature on intensivist staffing and related topics, a survey of pulmonary/Critical Care physicians, and held an expert roundtable conference. DATA EXTRACTION: A statement was generated and revised by the taskforce members using an iterative consensus process and submitted for review to the leadership council of the Society of Critical Care Medicine. For the purposes of this statement, the taskforce limited its recommendations to ICUs that use a "closed" model where the intensivists control triage and patient care. DATA SYNTHESIS AND CONCLUSIONS: The taskforce concluded that while advocating a specific maximum number of patients cared for is unrealistic, an approach that uses the following principles is essential: 1) proper staffing impacts patient care; 2) large caseloads should not preclude rounding in a timely fashion; 3) staffing decisions should factor surge capacity and nondirect patient care activities; 4) institutions should regularly reassess their staffing; 5) high staff turnover or decreases in quality-of-care indicators in an ICU may be markers of overload; 6) telemedicine, advanced practice professionals, or nonintensivist medical staff may be useful to alleviate overburdening the intensivist, but should be evaluated using rigorous methods; 7) in teaching institutions, feedback from faculty and trainees should be sought to understand the implications of potential understaffing on medical education; and 8) in academic medical ICUs, there is evidence that intensivist/patient ratios less favorable than 1:14 negatively impact education, staff well-being, and patient care. Copyright © 2013 by the Society of Critical Care Medicine and Lippincott Williams &Wilkins.

Wang J.H.,Sungkyunkwan University | Kim J.G.,Korea University | Ahn J.H.,Sungkyunkwan University | Lim H.C.,Korea University | And 2 more authors.
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2012

Purpose: To analyze femoral tunnel geometry using computed tomography (CT) imaging and evaluate the anatomic factors affecting femoral tunnel length after anterior cruciate ligament (ACL) reconstruction by the transportal technique. Methods: Twenty-nine patients underwent an anatomic double-bundle ACL reconstruction with a femoral tunnel drill by the transportal technique. CT imaging with OsiriX software (version 3.8; Pixmeo, Geneva, Switzerland) was used to measure femoral tunnel length (anteromedial [AM], posterolateral [PL], and central), femoral tunnel divergent angle, and femoral condyle size and intercondylar notch size parameters. Correlations between femoral tunnel length and femoral condyle size and intercondylar notch size parameters were analyzed. Results: The mean AM, PL, and central femoral tunnel lengths were 33.3 ± 3.9 mm, 33.6 ± 3.6 mm, and 34.3 ± 3.2 mm, respectively. A femoral tunnel length of less than 30 mm developed in 7 cases (24.1%) in the AM aspect and 4 cases (13.8%) in the PL aspect. The mean femoral tunnel divergent angle was 14.4° ± 4.1°. A positive correlation was found between AM, not PL or central, femoral tunnel length and medial femoral condyle anteroposterior (AP) distance (P =.01, r = 0.46), lateral femoral condyle AP distance (P =.01, r = 0.43), medial-to-lateral epicondylar distance (P =.03, r = 0.39), middle notch width (P =.009, r = 0.47), notch height (P =.001, r = 0.57), and notch area (P <.001, r = 0.58). Conclusions: After double-bundle ACL reconstruction with the transportal technique through the accessory anteromedial portal, the AM and PL femoral tunnels showed mean tunnel length greater than 30 mm and a divergent angle. However, a femoral tunnel length of less than 30 mm developed in some cases. AM femoral tunnel length was correlated with femoral condyle size (medial femoral condyle AP distance, lateral femoral condyle AP distance, and medial-to-lateral epicondylar distance) and intercondylar notch size (notch width, notch height, and notch area). Level of Evidence: Level IV, therapeutic case series. © 2012 Arthroscopy Association of North America.

News Article | November 2, 2016
Site: adds “Primary Care Doctors Global Market Briefing 2016” new report to its research database. The report spread across 35 pages with table and figures in it. The primary care doctors Industry comprises health practitioners engaged in the practice of general medicine and not restricted to one particular field of medicine. The health practitioners in this industry hold the degree of Doctor of Medicine (M.D) or Doctor of Osteopathy (D.O) and practice in their own offices or in other facilities such as hospitals or medical centers. The Primary Care Doctors Global Market Briefing provides strategists, marketers and senior management with the critical information they need to assess the primary care doctors sector. Description The Primary Care Doctors Global Market Briefing Report from the Business Research Company covers market characteristics, size and growth, segmentation, regional breakdowns, competitive landscape, market shares, trends and strategies for this market. The market characteristics section of the report defines and explains the market. The market size section gives the primary care doctors market revenues, covering both the historic growth of the market and forecasting the future. Drivers and restraints looks at the external factors supporting and controlling the growth of the market. Market segmentations break down the key sub sectors which make up the market. The regional breakdowns section gives the size of the market geographically. Competitive landscape gives a description of the competitive nature of the market, market shares, and a description of the leading companies. Key financial deals which have shaped the market in the last three years are identified. The trends and strategies section highlights the likely future developments in the primary care doctors market and suggests approaches. Browse full table of contents and data tables at Reasons to Purchase - Get up to date information available on the primary care doctors market globally. - Identify growth segments and opportunities. - Facilitate decision making on the basis of historic and forecast data and understand the drivers and restraints on the market. - Develop strategies based on likely future developments. - Gain a global perspective on the development of the market. - Report will be updated with the latest data and delivered to you within 3-5 working days of order. Scope Markets Covered: Anesthesiologists, Cardiologists, Dermatologists, Obstetricians,Gynecologists, Geriatricians, Pediatricians, Radiologists and others Companies Mentioned: University of Pittsburg Medical Center , Mayo Clinic Geographic scope: Americas, Europe, Asia, Middle East and Africa, Oceania. Time series: Five years historic and forecast. Data: Market value in $ billions. Data segmentations: Regional breakdowns, market share of competitors, key sub segments. Sourcing and Referencing: Data and analysis throughout the report is sourced using end notes. The Primary Care Doctors Industry comprises health practitioners engaged in the practice of general medicine and not restricted to one particular field of medicine. The health practitioners in this industry hold the degree of Doctor of Medicine (M.D) or Doctor of Osteopathy (D.O) and practice in their own offices or in other facilities such as hospitals or medical centers. The Americas was the x largest geographic region in the primary care doctors market in 2015, accounting for $x billion or x% of the global market. Asia was the x largest geographic market, accounting for $x billion or x% of the global market. Europe was the x largest geographic market, accounting for $x billion or x% of the global market. The Middle East and Africa accounted for x% and $x billion, while Oceania accounted for x% of the global primary care doctors market. Telehealth  The healthcare market is witnessing huge growth in the telehealth services segment due to increasing use of mobile devices and the need for quality services. Primary care is delivered through telehealth tools such as mobile messaging, e-mails, phone calls and mobile applications. Demand for the tele visits is increasing as it eliminates travelling and provides easy access to healthcare for elderly patients and patients living in remote places . To receive personalized assistance write to us @ [email protected] with the report title in the subject line along with your questions or call us at +1 866-764-2150

Sexton M.,University of Washington | Woodruff G.,University of Washington | Horne E.A.,University of Washington | Lin Y.H.,University of Washington | And 5 more authors.
Chemistry and Biology | Year: 2011

High-throughput screening (HTS) of chemical libraries is often used for the unbiased identification of compounds interacting with G protein-coupled receptors (GPCRs), the largest family of therapeutic targets. However, current HTS methods require removing GPCRs from their native environment, which modifies their pharmacodynamic properties and biases the screen toward false positive hits. Here, we developed and validated a molecular imaging (MI) agent, NIR-mbc94, which emits near infrared (NIR) light and selectively binds to endogenously expressed cannabinoid CB2 receptors, a recognized target for treating autoimmune diseases, chronic pain and cancer. The precision and ease of this assay allows for the HTS of compounds interacting with CB 2 receptors expressed in their native environment. © 2011 Elsevier Ltd. All rights reserved.

Moseley B.D.,Mayo Medical School | Ghearing G.R.,University of Pittsburg Medical Center | Benarroch E.E.,Mayo Medical School | Britton J.W.,Mayo Medical School
Epilepsy Research | Year: 2011

To evaluate the association between cerebral hypoperfusion and seizure termination, we compared seizure duration in seven patients with syncopal ictal asystole (IA), seven with non-syncopal ictal bradycardia, and ten with non-bradycardic seizures. Mean seizure duration was 34.4 ± 13. s in IA, 67 ± 28.9. s in ictal bradycardia, and 82.1 ± 31.1 in non-bradycardic seizures. These were significantly different (ANOVA, p< 0.02). This suggests cerebral hypoxia-ischemia favors seizure termination. © 2011 Elsevier B.V.

Moseley B.D.,Mayo Medical School | Ghearing G.R.,University of Pittsburg Medical Center | Munger T.M.,Mayo Medical School | Britton J.W.,Mayo Medical School
Epilepsia | Year: 2011

Ictal asystole may contribute to seizure-related injury and mortality. The purpose of this study was to evaluate the effect of cardiac pacing on seizure-related injury rates in ictal asystole patients. A survey was conducted to determine seizure-related fall rate and other morbidity in all seven patients with ictal asystole who underwent cardiac pacing at our institution between 1990 and 2004. The rate of seizure-related falls and other morbidities before and after pacing were compared using the Wilcoxon rank-sum test. The mean fall rate was 3.28 falls/month pre-pacemaker implantation. Following pacemaker implantation, this was reduced to 0.005 falls/month (p = 0.001). Seizure-related fractures and motor vehicle accidents were also reduced following cardiac pacing. These findings may have implications in mitigating the potential morbidity associated with ictal asystole. © Wiley Periodicals, Inc. 2011 International League Against Epilepsy.

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