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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.

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.

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.

Kolokythas A.,University of Illinois at Chicago | Park S.,University of Pittsburg Medical Center | Schlieve T.,University of Illinois at Chicago | Pytynia K.,University of Houston | Cox D.,Pacific University in Oregon
International Journal of Oral and Maxillofacial Surgery | Year: 2015

Abstract The purpose of this study was to investigate the applicability of the histological risk assessment model proposed by Brandwein-Gensler et al. in a cohort of oral tongue squamous cell carcinoma (OTSCC) patients treated with definitive surgery. We also examined the impact of additional histopathological features on disease acceleration. The cases of 49 OTSCC patients attending our institution between 1995 and 2009, who underwent definitive surgical resection followed by adjunct chemoradiotherapy when indicated, were reviewed retrospectively. Surgical resection specimens and complete clinical and demographic data were available for these patients; follow-up was at least 6 months. In this cohort we only identified a correlation between gender and the histopathological risk model score (P < 0.001). With regard to clinical and demographic data, histopathological parameters, and disease status at last follow-up, we identified significant correlations between disease status and (1) grade of differentiation (P = 0.0086), and (2) keratin score (P = 0.026). We found no significant correlations between the histopathological risk assessment model and disease progression or outcomes, with the exception of gender (P < 0.0001). Grade of differentiation, keratin score, and the lymphocytic host response significantly impacted disease acceleration. For OTSCC, it appears that clinical characteristics of the tumour as well as histopathological markers play an important role in the outcome. Efforts towards identifying predictive markers should be continued, especially by sub-site of the oral cavity. © 2015 International Association of Oral and Maxillofacial Surgeons.

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.

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