Medical Specialties Commons^™

Adjunct Primer For The Use Of National Comprehensive Cancer Network Guidelines For The Surgical Management Of Cutaneous Malignant Melanoma Patients., Edibaldo Silva

Journal Articles: Oncology and Hematology

Recently, a Surveillance Epidemiology and End Results (SEER) survey of melanoma patterns of care by the Mayo Clinic, Scottsdale showed remarkable deviations from best practice patterns throughout the country. The study, which analyzed the SEER records of 35,126 stage I to III cutaneous malignant melanoma patients treated from 2004 to 2006, showed that adherence to National Comprehensive Cancer Network (NCCN) therapeutic resection margins occurred in less than 36% of patients. Similarly, considerable variation in the quality of melanoma care in the United States when assessed using 26 quality indicators drawn by a panel of melanoma experts was independently reported. These …

Sir William Osler, M.D., C.M., Jonathan Sarik, B.S., Charles J. Yeo, Md, Pinckney J. Maxwell, Iv, Md

Department of Surgery Gibbon Society Historical Profiles

Sir William Osler impacted medical education and the practice of medicine like few other physicians. As a writer, he authored nearly 1500 publications and lent his name to numerous eponyms. As a teacher he educated vast numbers of students and through his legacy impacted countless more. Sir William Osler (Fig. 1) epitomized what a physician should be throughout his professional life.

Profiling The Ethnic Characteristics Of Domestic Injuries In Children Younger Than Age 5 Years., Tolulope A. Oyetunji, Adrienne A. Stevenson, Aderonke O. Oyetunji, Sharon K. Onguti, Sarah A. Ames, Adil H. Haider, Benedict C. Nwomeh

Manuscripts, Articles, Book Chapters and Other Papers

The home remains a very common location for deadly injuries among children younger than 5 years. The aim of this study is to describe the demographic and injury characteristics of domestic injuries in children younger than 5 years. The National Trauma Data Bank's National Sample Program data set was queried for children younger than 5 years with the injury site classified as home. Bivariate analysis was performed to determine unadjusted differences by ethnicity. Appropriate weight was applied to the sample to determine accurate national estimates. A total of 7,364 children, representing 32,033 children, were analyzed. Overall mortality was 1.6 per …

John Blair Deaver, M.D., And His Marvelous Retractor., Timothy E. Newhook, Md, Charles J. Yeo, Md, Pinckney J. Maxwell, Iv, Md

Department of Surgery Gibbon Society Historical Profiles

John Blair Deaver was born near Buck, Pennsylvania, in Lancaster County on July 25, 1855, to Dr. Joshua Montgomery Deaver and Elizabeth Clair Moore. The elder Deaver was a reputable country physician, educated at the University of Maryland, who fathered three physicians and a college president. John Blair Deaver (Fig. 1) went to boarding school at West Nottingham Academy in Maryland. After boarding school he taught in Lancaster County country schools to raise funds to attend the nation’s first medical school, the University of Pennsylvania. On receiving his M.D. degree in 1878, Dr. Deaver completed 1-year internships at both Germantown …

Association Between Triptanuse And Cardiac Contraindications In An Insured Migraine Population, Daisy Ng-Mak, Phd, Valerie P. Pracilio, Mph, Stephen Silberstein, Md, Joseph Couto, Pharmd, Mba, Cary Sennett, Md, Phd, Mary Hopkins, Rn, Jon Bumbaugh, Neil I. Goldfarb

College of Population Health Lectures, Presentations, Workshops

Background

Safety concerns exist when using triptansto treat patients with cardiac contraindications.

–Triptans cause vasoconstriction, a safety concern for migraineurswith cardiovascular (CV) disease or other cardiac risk factors.

–All triptans contain contraindications in their package inserts to avoid use in patients with cardiac conditions.

•Previous research indicates that clinicians are less likely to prescribe triptansin patients with CV disease or CV risk factors.

Limited research has examined the proportion of migraine patients with cardiovascular disease or those individuals who were concurrently treated with triptans.

James Marion Sims, M.D., Ll.D., Jonathan Tavares, B.S., Charles J. Yeo, Md, Pinckney J. Maxwell, Iv, Md

Department of Surgery Gibbon Society Historical Profiles

Few physicians have been as celebrated and loathed as James Marion Sims, M.D., LL.D. Dr. Sims’ modest early life and education never could have predicted that he would one day be called the ‘‘Father of American Gynecology.’’1, 2 Lauded by contemporaries and early historians as ‘‘one of the most original and gifted of American surgeons,’’ he performed the first successful operation to correct vesicovaginal fistulas (a condition that prior to 1852 was known as the ‘‘stumbling-block of gynecology’’).1 Today, the same work that earned Dr. Sims fame, fortune, and innumerable honors has been called into question, because of the unethical …

Manifestations Of Rheumatoid Arthritis: Epidural Pannus And Atlantoaxial Subluxation Resulting In Basilar Invagination., Adam L Schreiber, Do, Ma

Department of Rehabilitation Medicine Faculty Papers

Presented in part at the AAPMR 71st Annual Assembly Meeting, Seattle, WA, November 4-7, 2010.

Atlantoaxial instability results from cartilaginous destruction, periarticular erosions, and ligament and tendon attenuation. Instability affects 19%-70% of patients, and basilar invagination from vertical odontoid subluxation through the foramen magnum occurs in 38% of patients. This phenomenon occurs twice as often in women than men, whose age at diagnosis typically ranges from 30-50 years. Along with bony compression, the pannus further decreases the space available for the cord by 3mmor more in approximately 66% of patients (Figures 1-7). The earliest and most common symptom of cervical …

Conversion From Enzyme-Inducing Antiepileptic Drugs To Topiramate: Effects On Lipids And C-Reactive Protein., Scott Mintzer, Christopher T Skidmore, Sara J Rankin, Inna Chervoneva, Edward Pequinot, David M Capuzzi, Michael R Sperling

Department of Neurology Faculty Papers

PURPOSE: We previously demonstrated that converting patients from the enzyme-inducers phenytoin or carbamazepine to the non-inducers levetiracetam or lamotrigine reduces serum lipids and C-reactive protein (CRP). We sought to determine if the same changes would occur when patients were switched to topiramate, which has shown some evidence of enzyme induction at high doses. We also examined the effects of drug switch on low-density lipoprotein (LDL) particle concentration.

METHODS: We converted 13 patients from phenytoin or carbamazepine monotherapy to topiramate monotherapy (most at doses of 100-150 mg/day). Fasting lipids, including LDL particle concentration, and CRP were obtained before and ≥6 weeks …

Trends In The Utilization Of Outpatient Advanced Imaging After The Deficit Reduction Act., David C Levin, Vijay M Rao, Laurence Parker

Department of Radiology Faculty Papers

PURPOSE: After the Deficit Reduction Act (DRA) took effect in 2007, there was concern that private office-based imaging facilities would close, that advanced imaging would shift to less convenient hospital-based facilities, and that access to advanced imaging might be restricted. The aim of this study was to see if these developments occurred during the years after the DRA.

METHODS: Using Medicare data, outpatient CT, MRI, and nuclear medicine trends before and after the DRA were studied. Procedure volumes performed in private offices and hospital outpatient departments (HOPDs) were tabulated separately. Volumes were tracked from 2000 to 2006 (before the DRA) …

Association Between Hospitals Caring For A Disproportionately High Percentage Of Minority Trauma Patients And Increased Mortality: A Nationwide Analysis Of 434 Hospitals., Adil H. Haider, Sharon Ong'uti, David T. Efron, Tolulope A. Oyetunji, Marie L. Crandall, Valerie K. Scott, Elliott R. Haut, Eric B. Schneider, Neil R. Powe, Lisa A. Cooper, Edward E. Cornwell

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: To determine whether there is an increased odds of mortality among trauma patients treated at hospitals with higher proportions of minority patients (ie, black and Hispanic patients combined).

DESIGN: Hospitals were categorized on the basis of the percentage of minority patients admitted with trauma. The adjusted odds of in-hospital mortality were compared between hospitals with less than 25% of patients who were minorities (the reference group) and hospitals with 25% to 50% of patients who were minorities and hospitals with more than 50% of patients who were minorities. Multivariate logistic regression (with generalized linear modeling and a cluster-correlated robust …

Eae/Ase Recommendations For Image Acquisition And Display Using Three-Dimensional Echocardiography., Roberto M. Lang, Luigi P. Badano, Wendy Tsang, David H. Adams, Eustachio Agricola, Thomas Buck, Francesco F. Faletra, Andreas Franke, Judy Hung, Leopoldo Pérez De Isla, Otto Kamp, Jaroslaw D. Kasprzak, Patrizio Lancellotti, Thomas H. Marwick, Marti L. Mcculloch, Mark J. Monaghan, Petros Nihoyannopoulos, Natesa G. Pandian, Patricia A. Pellikka, Mauro Pepi, David A. Roberson, Stanton K. Shernan, Girish S. Shirali, Lissa Sugeng, Folkert J. Ten Cate, Mani A. Vannan, Jose Luis Zamorano, William A. Zoghbi, American Society Of Echocardiography, European Association Of Echocardiography

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Lymph Node Ratio Is An Important And Independent Prognostic Factor For Patients With Stage Iii Melanoma., Adam C. Berger, Michael Fierro, John C Kairys, David Berd, Takami Sato, Jocelyn Andrel, Terry Hyslop, Michael J Mastrangelo

Department of Surgery Faculty Papers

INTRODUCTION: The incidence of melanoma is dramatically increasing worldwide. We hypothesized that the ratio of metastatic to examined lymph node ratio (LNR) would be the most important prognostic factor for stage III patients.

METHODS: We retrospectively reviewed our institutional database of melanoma patients and identified 168 patients who underwent lymph node dissection (LND) for stage III disease between 1993 and 2007. Patients were divided into three groups based on LNR (≤10%, n = 93; 10-≤25%, n = 45; and >25%, n = 30). Univariate and multivariate analysis was performed using Cox proportional hazards model.

RESULTS: The median survival time of …

Eae/Ase Recommendations For Image Acquisition And Display Using Three-Dimensional Echocardiography., Roberto M. Lang, Luigi P. Badano, Wendy Tsang, David H. Adams, Eustachio Agricola, Thomas Buck, Francesco F. Faletra, Andreas Franke, Judy Hung, Leopoldo Pérez De Isla, Otto Kamp, Jaroslaw D. Kasprzak, Patrizio Lancellotti, Thomas H. Marwick, Marti L. Mcculloch, Mark J. Monaghan, Petros Nihoyannopoulos, Natesa G. Pandian, Patricia A. Pellikka, Mauro Pepi, David A. Roberson, Stanton K. Shernan, Girish S. Shirali, Lissa Sugeng, Folkert J. Ten Cate, Mani A. Vannan, Jose Luis Zamorano, William A. Zoghbi, American Society Of Echocardiography, European Association Of Echocardiography

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Treatment Of Chronic Mental Illness, Anu A. Matorin, Md

Jefferson Journal of Psychiatry

RESIDENT'S GUIDE TO TREATMENT OF PEOPLE WITH CHRONIC MENTAL ILLNESS

(GAP Report 136; 1993)

Formulated by the Committee on Psychiatry and the Community, Group for the Advancement of Psychiatry American Psychiatric Press, Inc., 1993, 230 pages, $30.00

A Mesmerizing Book, Daniel A. Monti, Md

Jefferson Journal of Psychiatry

HYPNOSIS IN THE RELIEF OF PAIN

Ernest R. Hilgard and Josephine R. Hilgard

Brunner/Maze!, Inc., New York 1994, paperback, $28 .95, 294 pgs.

Prediction Of Treatment Response And Diagnosis In Psychiatry, Eduardo Dunayevich, Md

Jefferson Journal of Psychiatry

The lack of diagnostic gold standards and the multiplicity of vantage points used to conceptualize mental illness renders psychiatric diagnostic and therapeutic approaches susceptible to individual and cultural biases. Developments in therapeutic approaches have often provided vantage points from which to conceptualize psychopathology. The identification of predictors of treatment response may be a useful element for clinicians to select between multiple treatment tools in an expanding therapeutic armamentarium while fostering refinements in current diagnostic systems.

The Forgotten Evaluation: Taking Competence Seriously, Seth E. Tabb, Md, Scott A. West, Md

Jefferson Journal of Psychiatry

The medical literature devotes little attention to the application of competency to the general medical patient. Commonly, the only cases recognized as necessitating a competency evaluation are overtly psychotic patients, patients requiring written informed consent, and those patients who refuse treatments strongly recommended by their physician. Clarifying terminology and redefining competency provides a practical screening method for assessing competency in all patients. When physicians neglect the evaluation of competency, patient autonomy is compromised. Not only are all physicians capable of performing a competency evaluation, they are ethically and professionally required to do so.

Transition To Psychiatric Residency: Unique Stresses; Unique Rewards, Catherine A. Belitsky, Md, Frcp(C), Sidney H. Kennedy, Md, Frcp(C)

Jefferson Journal of Psychiatry

An individual's decision to pursue a psychiatric residency following medical school training is shaped by many factors. Beginning residents are often ill prepared for the relative impact that the shift from medical doctor to psychiatric resident entails. This paper reviews the literature regarding demographic and psychological factors relating to recruitment, dynamic and practical issues confronting the beginning resident, and various coping styles adopted. These factors are considered in the context of an inpatient setting where the majority of residents begin their training. Much of the resident response is seen as adaptive and a number of strategies for coping are suggested.

Patients Who Request A Female Psychotherapist, Timothy C. Smith, Md, Melinda Fudge, Md, Salman Akhtar, Md, Steven Samuel, Phd

Jefferson Journal of Psychiatry

Upon arriving at an outpatient clinic, many patients request to see a female psychotherapist. Yet little has been written on this topic. The aim of this study was to explore the demographic and clinical characteristics of such patients. We compared patients who voiced a preference for a female therapist with controls on the demographic variables of age, sex, race, marital and financial status and the clinical characteristics of diagnosis, history of sexual abuse, sexual preference, overt presence of sexual or social difficulties, history of prior treatment, gender of the previous therapist, and treatment drop out rate. A chi square analysis …

Non-Neuroleptic Pharmacotherapy Of Schizophrenia, Sajiv John, Md, Atul Mahableshwarkar, Md

Jefferson Journal of Psychiatry

Patients with schizophrenia are typically treated with a neuroleptic and some form of psychosocial intervention. In spite of optimum treatment, up to one-third of patients continue to remain severely disabled due to persistent positive or negative symptoms. A variety of drugs have been tried as alternatives or additions to traditional neuroleptics in these patients. This paper is a review of these nonneuroleptic treatment alternatives and an attempt to establish some guidelines for their use.

A Case Study Of Obsessive-Compulsive Disorder: Some Diagnostic Considerations, Jeanette M. Stumbo Zaimes, Md

Jefferson Journal of Psychiatry

Obsessive-Compulsive Disorder (OCD) was considered a rare disorder prior to 1984 when the initial results from the Epidemiologic Catchment Area survey demonstrated a substantial prevalence of the disorder (1). Thus there may be many patients today who entered treatment prior to 1984 with undiagnosed OCD. This paper gives the history of one such patient and reviews the current literature on OCD as it pertains to the diagnostic evidence in this case.

Concepts And Models Of Empathy: Past, Present, And Future, Elizabeth Ann Baxter, Md

Jefferson Journal of Psychiatry

The subject of empathy has been increasing in popularity and importance; correspondingly, the theoretical aspects of empathy are in need of further development. This paper outlines key concepts and processes related to empathy, particularly the mechanisms of identification and regression as they are discussed in the models of empathy articulated by Fleiss, Greenson, and Jordan. Similarities and differences of the models are examined, in addition to each model's description of the roles of identification and regression. Although each model has made significant contributions towards a theoretical perspective of empathy, none of them have distinguished pathological from non-pathological uses of identification. …

Case Report: Sometimes A Cigar Is Just A Cigar, Zafar Y. Ibrahim, Md, Ellen F. Brooks, Md

Jefferson Journal of Psychiatry

This unusual case underscores the need for psychiatrists to consider treatable and curable causes of acute behavior changes even when historical data are not easily available. This case presentation invites physicians of mind (and body) to utilize simple and common-sense approaches while evaluating their patients.

Editor's Column, Mary E. Donovan, Md

Jefferson Journal of Psychiatry

"Sometimes a cigar is just a cigar. " Others had learned, "My son, sometimes a cigar is just a good smoke." Like many of our colleagues, we believed that these were Freud's words during a question and answer session after a lecture he gave at Clark University. The words were comforting in a way, giving us a chance to chalk at least some things up to pure coincidence, thus releasing us from relentless unconscious agendas and hidden sexual interpretations.

Editorial Staff

Jefferson Journal of Psychiatry

Editorial staff for Volume 12, Number 2, 1995 Jefferson Journal of Psychiatry.

Current Concepts-Past Contributions, Cynthia L. Theiss, Md

Jefferson Journal of Psychiatry

WOMEN BEYOND FREUD: NEW CONCEPTS OF FEMININE PSYCHOLOGY

Edited by Milton M. Berger, M.D., with chapters by Marianne Horney Eckardt, Carol Gilligan , Douglas H. Ingram, Helen Singer Kaplan, Harold I. Lief, Jean Baker Miller, Silvia W. Olarte, Susan Quinn, and Mario Rendon

Brunner/Mazel, Inc., New York , 1994, 162 pages, $26.95

Old Age No Barrier To Psychotherapy, Jeanette Oleskowicz, Md

Jefferson Journal of Psychiatry

THE PSYCHOTHERAPY OF THE ELDERLY SELF

Hyman Muslin MD

Brunner /Mazel Inc., New York 1992, Hard cover

$27.50, 220 pages

Life Under Scrutiny, Andres Martin, Md

Jefferson Journal of Psychiatry

ON KISSING, TICKLING, AND BEING BORED: PSYCHOANALYTIC ESSAYS ON THE UNEXAMINED LIFE

Adam Phillips

Harvard University Press Cambridge, Massachusettes

1993, Hardcover, 138 pages, $ 19.95

Letters To The Editor

Jefferson Journal of Psychiatry

Letters to the Editor.

Sexual Side Effects Of Psychiatric Medications In Women: A Clinical Review, Laura L. Post, Md, Faacs

Jefferson Journal of Psychiatry

Sexual side effects of psychiatric medications have been estimated to occur in 60% of male clients (1) and 30% of female clients (2). Despite a body of literature relating individual medications to specific sexual side effects, few studies have satisfactorily addressed the psychotropic-induced sexual dysfunctions in women. The spectrum of known sexual sided effects resulting from psychopharmacologic interventionswill be reviewed. Guidelines for appropriately addressing the possibility of sexual side effects within a therapeutic relationship for maximizing reporting of sexual side effects, and for possible treatment approaches to sexual side effects will be described.