Medicine and Health Sciences Commons^™

Adjuvant Concurrent Chemoradiation Using Intensity-Modulated Radiotherapy And Simultaneous Integrated Boost For Resected High-Risk Adenocarcinoma Of The Distal Esophagus And Gastro-Esophageal Junction., Brian Yaremko, David Palma, Abigail Erickson, Gregory Pierce, Richard Malthaner, Richard Inculet, Rashid Dar, George Rodrigues, Edward Yu

Richard A. Malthaner

Purpose: Multimodality therapy leads to improved outcomes for adenocarcinoma of the distal esophagus and gastroesophageal junction (GEJ) over surgery alone. At our institution, adjuvant chemoradiation (chemoRT) using IMRT and SIB is standard of care for resected high-risk disease. In this study, we review our experience with a recent cohort of patients treated in this manner. Methods and materials: We identified 18 patients with resected T3 and/or N1 adenocarcinoma of the distal esophagus and GEJ who received adjuvant chemoRT. A large elective volume (PTV1) and a smaller high-risk volume (PTV2) were irradiated simultaneously using IMRT and an SIB technique. All patients …

Adjuvant Concurrent Chemoradiation Using Intensity-Modulated Radiotherapy And Simultaneous Integrated Boost For Resected High-Risk Adenocarcinoma Of The Distal Esophagus And Gastro-Esophageal Junction., Brian Yaremko, David Palma, Abigail Erickson, Gregory Pierce, Richard Malthaner, Richard Inculet, Rashid Dar, George Rodrigues, Edward Yu

Richard A. Malthaner

Purpose: Multimodality therapy leads to improved outcomes for adenocarcinoma of the distal esophagus and gastroesophageal junction (GEJ) over surgery alone. At our institution, adjuvant chemoradiation (chemoRT) using IMRT and SIB is standard of care for resected high-risk disease. In this study, we review our experience with a recent cohort of patients treated in this manner. Methods and materials: We identified 18 patients with resected T3 and/or N1 adenocarcinoma of the distal esophagus and GEJ who received adjuvant chemoRT. A large elective volume (PTV1) and a smaller high-risk volume (PTV2) were irradiated simultaneously using IMRT and an SIB technique. All patients …

Assessment Of Medical Students’ Learning Outcomes In Australia : Current Practice, Future Possibilities, David Wilkinson, Benedict Canny, Jacob Pearce, Hamish Coates, Daniel Edwards

Dr Jacob Pearce

All 19 medical schools in Australia examine and assess the performance of their students, but do so largely in isolation from each other. That is, most schools design, develop and deliver their own exams, against their own curriculum and standards, and students pass, fail and are graded with little external moderation or comparison. Accreditation of schools by the Australian Medical Council (AMC) provides some reassurance that assessment practices are appropriate in medical schools. However, very limited data are available for benchmarking performance against any national standard, or between medical schools in Australia. The Australian Medical Assessment Collaboration has been designed …

Same Admissions Tools, Different Outcomes : A Critical Perspective On Predictive Validity In Three Undergraduate Medical Schools, Daniel Edwards, Tim Friedman, Jacob Pearce

Dr Jacob Pearce

Admission to medical school is one of the most highly competitive entry points in higher education. Considerable investment is made by universities to develop selection processes that aim to identify the most appropriate candidates for their medical programs. This paper explores data from three undergraduate medical schools to offer a critical perspective of predictive validity in medical admissions. This study examined 650 undergraduate medical students from three Australian universities as they progressed through the initial years of medical school (accounting for approximately 25 per cent of all commencing undergraduate medical students in Australia in 2006 and 2007). Admissions criteria (aptitude …

Same Admissions Tools, Different Outcomes : A Critical Perspective On Predictive Validity In Three Undergraduate Medical Schools, Daniel Edwards, Tim Friedman, Jacob Pearce

Dr Tim Friedman

Admission to medical school is one of the most highly competitive entry points in higher education. Considerable investment is made by universities to develop selection processes that aim to identify the most appropriate candidates for their medical programs. This paper explores data from three undergraduate medical schools to offer a critical perspective of predictive validity in medical admissions. This study examined 650 undergraduate medical students from three Australian universities as they progressed through the initial years of medical school (accounting for approximately 25 per cent of all commencing undergraduate medical students in Australia in 2006 and 2007). Admissions criteria (aptitude …

Concepts Of Illness Among The Swahili Of Lamu, Kenya, Rebecca Gearhart, Munib Abdulrehman

Rebecca Gearhart

The Quest For Full Text: An In-Depth Examination Of Pubget For Medical Searchers, Robin Featherstone, Denise Hersey

Denise Hersey

This article examines Pubget, a free Web-based search engine for life sciences researchers for conducting searches of the medical literature and retrieving full-text PDFs. Its search functionality and add-on features are evaluated to determine potential for library instruction and promotion. With many libraries relying on OpenURL link resolvers to connect searchers with institutional subscriptions, Pubget offers an alternative by combining search, article-level link resolving, and authentication in a single platform. The authors determine advantages and disadvantages for using Pubget based on product testing and make recommendations for institutions interested in “activating” subscriptions in Pubget.

Adult Ecmo And Gastrointestinal Bleeding From Small Bowel Arteriovenous Malformations: A Novel Treatment Using Spiral Enteroscopy., Konrad Sarosiek, Hitoshi Hirose, Harrison T Pitcher, Nicholas Cavarocchi

Nicholas C Cavarocchi MDJ

Hemorrhagic complications on extracorporeal membrane oxygenation (ECMO) are common because of the need for anticoagulation to maintain the oxygenator and circuitry. Gastrointestinal bleeding (GIB) is reported to occur in 3-6% of ECMO patients, 1 requiring frequent transfusions as well as multiple diagnostic and therapeutic interventions. Multiple transfusions can result in volume overload, coagulopathies and infections leading to significant morbidity and mortality. We present the first published case of GIB from an arteriovenous malformation (AVM) treated with a novel therapy termed spiral enteroscopy while the patient remained on venoarterial (VA) ECMO.

Invited Commentary On: Orthotopic Heart Transplantation In Patients With Metabolic Risk Factors, Nicholas Cavarocchi, Paul Mather

Nicholas C Cavarocchi MDJ

This is invited commentary to the following article: Kilic, A., Conte, J. V., Shah, A. S., & Yuh, D. D. (2012). Orthotopic heart transplantation in patients with metabolic risk factors. Annals of Thoracic Surgery, 93(3), 718-724.

Vascular Site Hemostasis In Percutaneous Extracorporeal Membrane Oxygenation Therapy., Kathleen Lamb, Hitoshi Hirose, Harrsion Pitcher, Nicholas Cavarocchi

Nicholas C Cavarocchi MDJ

Bleeding is a well described complication of percutaneous extracorporeal membrane oxygenation support (ECMO). In an effort to prevent ongoing percutaneous-cannula blood loss, we tried multiple methods to achieve hemostasis and have obtained the best results with QuikClot® Combat Gauze TM (Z-Medica Corp, Wallingford, CT). This product is made of kaolin, white alumina silicate clay, which initiates activation of the intrinsic clotting cascade. We reviewed our experience in 21 ECMO patients and found 5 patients who required 17 applications of QuikClot® Combat Gauze TM to percutaneous catheter insertion sites and demonstrated a significant reduction in both localized bleeding complications and the …

Ecmo-State Of The Art, Nicholas Cavarorocchi, Md

Nicholas C Cavarocchi MDJ

Dr. Cavarocchi is an Associate Professor of Surgery who holds a faculty appointment in the Department of Surgery at Thomas Jefferson University Hospital in Philadelphia, PA. He is also the Director of Cardiac Critical Care and Surgical Care Unit at Jefferson. In 2007, he was names as one of the countries top surgeons. He specializes in cardiothoracic surgery.

Presentation runs for 1 hour and 2 minutes.

Development Of A Reliable And Valid Organization-Specific Professional Practice Assessment Tool, Kim Hitchings, Terry Capuano, Joanna Bokovoy, Janet Houser

Terry A Capuano MBA, MSN, RN, FACHE, NE-BC

No abstract provided.

Contributor, Terry Capuano, Beverly Snyder

Terry A Capuano MBA, MSN, RN, FACHE, NE-BC

No abstract provided.

Integration Of Health Protection And Health Promotion: Rationale, Indicators, And Metrics, Glorian Sorenson, Deborah Mcclellan, Jack Dennerlein, Nicolaas Pronk, Jennifer Allen, Leslie Boden, Cassadra Okechukwu, Dean Hashimoto, Anne Stoddard, Gregory Wagner

Dean M. Hashimoto

Objective: To offer a definition of an “integrated” approach to worker health and operationalize this definition using indicators of the extent to which integrated efforts are implemented in an organization.

Methods: Guided by the question—How will we know it when we see it?—we reviewed relevant literature to identify available definitions and metrics, and used a modified Delphi process to review and refine indicators and measures of integrated approaches.

Results: A definition of integrated approaches to worker health is proposed and accompanied by indicators and measures that may be used by researchers, employers, and workers.

Conclusions: A shared understanding of what …

Results Of A Pilot Intervention To Improve Health And Safety For Health Care Workers, Caitlin Caspi, Jack Dennerlein, Christopher Kenwood, Anne Stoddard, Karen Hopcia, Dean Hashimoto, Glorian Sorensen

Dean M. Hashimoto

Objective: To test the feasibility of a multicomponent pilot intervention to improve worker safety and wellness in two Boston hospitals. Methods: A 3-month intervention was conducted on seven hospital units. Pre- (374 workers) and postsurveys (303 workers) assessed changes in safety/ergonomic behaviors and practices, and social support. Wellness outcomes included self-reported pain/aching in specific body areas (musculoskeletal disorders or MSDs) and physical activity (PA). Results: Pain was reported frequently (81%), and PA averaged 4 hours per week. There was a postintervention increase in safe patient handling (P < 0.0001), safety practices (P = 0.0004), ergonomics (P = 0.009), and supervisor support (P = 0.01), but no changes in MSDs or PA. Conclusions: Safe patient handling, ergonomics, and safety practices are good targets for worker safety and wellness interventions; longer intervention periods may reduce the risk of MSDs.

Processing Of Model Calling Songs By The Prothoracic An2 Neurone And Phonotaxis Are Significantly Correlated In Individual Female Gryllus Bimaculatus, Leslie Samuel, Andreas Stumpner, Gordon Atkins, John Stout

Leslie Samuel

Syllable period (SP) selective calling song processing has been demonstrated for the prothoracic, AN2 auditory neurone that correlates very well with SP-selective phonotaxis by female cricket Gryllus bimaculatus De Geer. Both SP-selective processing by the AN2 and the phonotactic behavior of the female exhibit substantial plasticity. Thus, the question remains as to whether the selective responses of the AN2 neurone and the selective behavior of the female match in an individual female. The present study is designed to answer that question. The SP-selective phonotactic behavior of individual females is evaluated, followed immediately by measuring the SP-selective responses of the same …

Gout Patient Interview And Physical Examination, Michele Meltzer, Md, Mbe

Michele Meltzer

Although the incidence of gout is increasing worldwide, there are many misconceptions about the diagnosis and treatment of gout. The two attached videos can be used to inform medical students, residents in family practice, internal medicine, orthopedic surgery, emergency medicine, psychiatry residents as well as practicing physicians about gout. Allied health professionals including nurses, nurse practitioners and physicians assistants will also find the videos helpful.

In the first video I interview and exam a patient with gout. This scenario is used to describe how to obtain a history and synthesize a differential diagnosis. As I exam the patient, I describe …

Gout: Diagnosis And Treatment, Michele Meltzer, Md, Mbe

Michele Meltzer

Although the incidence of gout is increasing worldwide, there are many misconceptions about the diagnosis and treatment of gout. The two attached videos can be used to inform medical students, residents in family practice, internal medicine, orthopedic surgery, emergency medicine, psychiatry residents as well as practicing physicians about gout. Allied health professionals including nurses, nurse practitioners and physicians assistants will also find the videos helpful. The second video I review the causes of gout and show several pictures to demonstrate what an acute attack can look like. The recommendations for the diagnosis and treatment of gout are reviewed. At the …

Elders With Serious Mental Illness: Lost Opportunities And New Policy Options, Darlene O'Connor, Faith Little, Richard Mcmanus

Richard H. McManus

This article reviews key federal Medicaid policies affecting older adults with serious, long-term mental illness: (a) the Medicaid exclusion of coverage for Institutions for Mental Diseases, (b) the Preadmission Screening and Resident Review Process, and (c) the Medicaid Home and Community Based Services waiver policy. Documenting the incentives and restrictions in these policies provides an historical context for understanding the current gaps in treatment for elders with mental illness. New federal options under the Deficit Reduction Act may provide opportunities for reducing the institutional bias for older adults with mental illness and for improving mental health services for elders under …

Increase In The Proportion Of Patients Hospitalized With Acute Myocardial Infarction With Do-Not-Resuscitate Orders Already In Place Between 2001 And 2007: A Nonconcurrent Prospective Study, Jane Saczynski, Ezra Gabbay, David Mcmanus, Richard Mcmanus, Joel Gore, Jerry Gurwitz, Darleen Lessard, Robert Goldberg

Richard H. McManus

BACKGROUND AND OBJECTIVE: Shared decision making and advance planning in end-of-life decisions have become increasingly important aspects of the management of seriously ill patients. Here, we describe the use and timing of do-not-resuscitate (DNR) orders in patients hospitalized with acute myocardial infarction (AMI). STUDY DESIGN AND SETTING: The nonconcurrent prospective study population consisted of 4182 patients hospitalized with AMI in central Massachusetts in four annual periods between 2001 and 2007. RESULTS: One-quarter (25%) of patients had a DNR order written either prior to or during hospitalization. The frequency of DNR orders remained constant (24% in 2001; 26% in 2007). Among …

Transitions, Risks, And Actions In Coronary Events--Center For Outcomes Research And Education (Trace-Core): Design And Rationale, Molly Waring, Richard Mcmanus, Jane Saczynski, Milena Anatchkova, David Mcmanus, Randolph Devereaux, Robert Goldberg, Jeroan Allison, Catarina Kiefe

Richard H. McManus

Background: Cardiovascular disease continues to cause significant morbidity, mortality, and impaired quality of life, with unrealized health gains from the underuse of available evidence. The Transitions, Risks, and Actions in Coronary Events Center for Outcomes Research and Education (TRACE-CORE) aims to advance the science of acute coronary syndromes by examining the determinants and outcomes of the quality of transition from hospital to community and by quantifying the impact of potentially modifiable characteristics associated with decreased quality of life, rehospitalization, and mortality. Methods and Results: TRACE-CORE comprises a longitudinal multiracial cohort of patients hospitalized with acute coronary syndromes, 2 research projects, …

Elders With Serious Mental Illness: Lost Opportunities And New Policy Options, Darlene O'Connor, Faith Little, Richard Mcmanus

Richard H. McManus

This article reviews key federal Medicaid policies affecting older adults with serious, long-term mental illness: (a) the Medicaid exclusion of coverage for Institutions for Mental Diseases, (b) the Preadmission Screening and Resident Review Process, and (c) the Medicaid Home and Community Based Services waiver policy. Documenting the incentives and restrictions in these policies provides an historical context for understanding the current gaps in treatment for elders with mental illness. New federal options under the Deficit Reduction Act may provide opportunities for reducing the institutional bias for older adults with mental illness and for improving mental health services for elders under …

Increase In The Proportion Of Patients Hospitalized With Acute Myocardial Infarction With Do-Not-Resuscitate Orders Already In Place Between 2001 And 2007: A Nonconcurrent Prospective Study, Jane Saczynski, Ezra Gabbay, David Mcmanus, Richard Mcmanus, Joel Gore, Jerry Gurwitz, Darleen Lessard, Robert Goldberg

Richard H. McManus

BACKGROUND AND OBJECTIVE: Shared decision making and advance planning in end-of-life decisions have become increasingly important aspects of the management of seriously ill patients. Here, we describe the use and timing of do-not-resuscitate (DNR) orders in patients hospitalized with acute myocardial infarction (AMI). STUDY DESIGN AND SETTING: The nonconcurrent prospective study population consisted of 4182 patients hospitalized with AMI in central Massachusetts in four annual periods between 2001 and 2007. RESULTS: One-quarter (25%) of patients had a DNR order written either prior to or during hospitalization. The frequency of DNR orders remained constant (24% in 2001; 26% in 2007). Among …

Transitions, Risks, And Actions In Coronary Events--Center For Outcomes Research And Education (Trace-Core): Design And Rationale, Molly Waring, Richard Mcmanus, Jane Saczynski, Milena Anatchkova, David Mcmanus, Randolph Devereaux, Robert Goldberg, Jeroan Allison, Catarina Kiefe

Richard H. McManus

Background: Cardiovascular disease continues to cause significant morbidity, mortality, and impaired quality of life, with unrealized health gains from the underuse of available evidence. The Transitions, Risks, and Actions in Coronary Events Center for Outcomes Research and Education (TRACE-CORE) aims to advance the science of acute coronary syndromes by examining the determinants and outcomes of the quality of transition from hospital to community and by quantifying the impact of potentially modifiable characteristics associated with decreased quality of life, rehospitalization, and mortality. Methods and Results: TRACE-CORE comprises a longitudinal multiracial cohort of patients hospitalized with acute coronary syndromes, 2 research projects, …

A Double-Blind Randomized Controlled Trial Of Olanzapine Plus Sertraline Vs Olanzapine Plus Placebo For Psychotic Depression: The Study Of Pharmacotherapy Of Psychotic Depression (Stop-Pd), Barnett Meyers, Alastair Flint, Anthony Rothschild, Benoit Mulsant, Ellen Whyte, Catherine Peasley-Miklus, Eros Papademetriou, Andrew Leon, Moonseong Heo, Paul Appelbaum, Philip Candilis, Nancy Byatt, Kristina Deligiannidis

Philip J. Candilis

CONTEXT: Evidence for the efficacy of combination pharmacotherapy has been limited and without positive trials in geriatric patients with major depression (MD) with psychotic features. OBJECTIVES: To compare remission rates of MD with psychotic features in those treated with a combination of atypical antipsychotic medication plus a serotonin reuptake inhibitor with those treated with antipsychotic monotherapy; and to compare response by age. DESIGN: Twelve-week, double-blind, randomized, controlled trial. SETTING: Clinical services of 4 academic sites. Patients Two hundred fifty-nine subjects with MD with psychotic features randomized by age ( or =60 years) (mean [standard deviation (SD)], 41.3 [10.8] years in …

Psychiatric Outcomes In A Resident-Run Multidisciplinary Hepatitis C Clinic, Nicole M. Agostino Do, Edward Norris Md, Fapm, Joseph L. Yozviak Do, Facp, Charles M. Brooks Md, Eric J. Gertner Md, Mph, Michael Kaufmann Md

Edward R Norris MD, FAPA, FAPM

No abstract provided.

Factors Related To Psychiatric Readmissions In A Large Community Academic Hospital, William Stern, Edward R. Norris Md, Fapa, Fapm, Karen Burke Rn, Julia R. Correll Ba, Michael Kaufmann Md

Edward R Norris MD, FAPA, FAPM

No abstract provided.

Select Readiness: Assessing The Clinical Learning Environment Of A Regional Branch Medical Campus, Margaret A. Hadinger Edd, Ms, Erica T. Mahady Ma, Edward Norris Md, Fapm, J Alan Otsuki Md, Mba

Edward R Norris MD, FAPA, FAPM

No abstract provided.

Training Tomorrow’S Providers And Expanding Access To Peginterferon/Ribavirin Combination Therapyfor Chronic Hepatatis C In Underinsured/Uninsured Patients: Final Outcomes Of A Pilot, Resident-Initiated, Multidisciplinary, Hepatitis C Clinic, Nicole M. Agostino Do, Suzanne J. Templer Do, Edward Norris Md, Fapm, Charles M. Brooks Md, Eric J. Gertner Md, Mph, Joseph L. Yozviak Do, Facp

Edward R Norris MD, FAPA, FAPM

No abstract provided.

A Double-Blind, Randomized, Placebo Controlled Trial Of Ramelteon For The Treatment Of Insomnia And Mood Stability In Patients With Euthymic Bipolar Disorder (Poster), Edward R. Norris Md, Fapa, Fapm, Karen Burke Rn, Julia R. Correll Ba, Ken Zemanek Md, Joel Lerman Md, Michael Kaufmann Md

Edward R Norris MD, FAPA, FAPM

No abstract provided.