Nivolumab and Amiodorane-Induced Interstitial Lung Disease (ILD) in a Patient with Metastatic Melanoma
Respiratory System; General & Internal Medicine
Thematic Poster Session, ATS Conference 2019. Presented as part of session A39: Drug Related Case Reports
Burgei J; Dasgupta R; Kim I; Makkar H
American Journal of Respiratory and Critical Care Medicine
2019
2019
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
https://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2019.199.1_MeetingAbstracts.A1489
Defining the Critical Elements of the Most Common Arthroscopic Procedures: A Consensus of Orthopaedic Sports Medicine Surgeons
surgery; arthroscopy; General & Internal Medicine; critical; sports medicine
Objective To define the critical elements of common procedures in arthroscopic surgery. Methods A survey was administered to surgeons associated with the American Orthopaedic Society for Sports Medicine (AOSSM) to determine the critical elements for four common arthroscopic procedures: anterior cruciate ligament (ACL) reconstruction, knee arthroscopy with meniscal debridement or repair, rotator cuff repair (RCR), and capsulorrhaphy for anterior glenohumeral instability (Bankart repair). Respondents were asked which steps necessitated their direct supervision. The level of experience and practice demographics were also recorded. Results For all applicable procedures, patient positioning and closure were not considered critical steps. Establishing arthroscopic portals was critical for all procedures, except knee arthroscopy. Diagnostic arthroscopy was only critical in ACL reconstruction. Private practice surgeons considered every step of these common procedures to be critical elements. Less experienced surgeons were more likely to regard certain aspects of a procedure critical. Surgeons with \textgreater15 years of experience considered diagnostic arthroscopy critical to all procedures, whereas those with \textless15 years of experience did not. Unlike surgeons with a resident as first assist, surgeons with a physician assistant (PA) or nurse practitioner (NP) found every step of each procedure to be critical except closure and positioning. Conclusion Across all procedures, only patient positioning and closure were consistently regarded as non-critical elements. There were significant differences in responses according to experience and practice setting. Future research is necessary to determine the implications of these findings and guide the definition of the "critical portions" of surgery.
Porter D A; Laratta J L; Shillingford J N; Trofa D; Reddy H; Uribe J W; Yagnik G P
Cureus
2019
2019-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.7759/cureus.4091" target="_blank" rel="noreferrer noopener">10.7759/cureus.4091</a>
United States Food and Drug Administration's 510(k) Pathway: Drawing Implications from the Approvals of Brachytherapy Devices
premarket approval; adverse events; cancer; General & Internal Medicine; radiotherapy; brachytherapy; radiation therapy; device malfunction; keloids; medical devices
Introduction Innovations in cancer treatment coupled with an increasing number of cancer patients have led to the growth of brachytherapy devices. The objective of this study is to characterize the development and safety of brachytherapy devices marketed in the United States (US) over the last 15 years. Methods We reviewed records from a public US Food and Drug Administration (FDA) database detailing premarket approval of brachytherapy devices. All 510(k) submissions approved between January 1, 2000 and October 31, 2018 were examined. To assess the safety of these devices, we searched the manufacturer and user facility device experience (MAUDE) database for related adverse events. Results Twenty-two brachytherapy devices received 510(k) premarket approval, with the first device approved in 2005. Of the 22 devices, 20 (91%) were marketed with specific indications. The most common indications include treatment of skin cancers and keloids (n=7), breast cancer (n=4), and gynecologic/rectal cancers (n=2). A review of the MAUDE database revealed 64 reports of adverse events associated with brachytherapy devices. Common adverse effects include poor device design, use error, and device malfunction that led to the delivery of an inaccurate dose of radiation. Discussion Although there are some single center, short-term studies demonstrating adequate local control and satisfactory cosmesis with brachytherapy, data on long-term outcomes are lacking. Further research is warranted to define appropriate practice guidelines for brachytherapy devices in the treatment of various malignancies.
Wang S; Manudhane A; Ezaldein H H; Scott J F
Cureus
2019
2019-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.7759/cureus.4230" target="_blank" rel="noreferrer noopener">10.7759/cureus.4230</a>
Simulation-based Training in Ectopic Pregnancy and Salpingostomy
ectopic; education; General & Internal Medicine; medical; obstetrics and gynecology; Pregnancy; salpingectomy; salpingostomy; simulation
Objective Ectopic pregnancy leads to approximately 3% of deaths in pregnancy. Surgical management is indicated when patients are hemodynamically unstable or have signs of a ruptured ectopic pregnancy. Salpingectomy is more commonly performed, but salpingostomy is preferred in a patient with prior salpingectomy with a desire for future pregnancy. Due to the lack of exposure, salpingostomy is not frequently performed and most residents do not feel adequately trained. Our goal was to provide a hands-on simulation about ectopic pregnancy and salpingostomy in hopes that the simulation will improve the resident's confidence and knowledge in recognizing an ectopic pregnancy, identifying an appropriate candidate for surgical management, and performing a salpingostomy. Methods The educational initiative was aimed towards postgraduate year (PGY) 1-4 OB/GYN residents (n=11). Knowledge and confidence questionnaires were given to participants prior to and post-simulation. A gynecologic mannequin was modified by taking the existing pelvic organs and creating a tubal pregnancy. In the first part of the simulation, a hemodynamically unstable patient presented with lab and imaging findings consistent with an ectopic pregnancy. Once recognized and the decision made for surgical intervention, participants were transferred to a simulated operating room where they performed salpingostomy or salpingectomy on the mannequin. The simulation was followed by a debriefing session to discuss the actions and thought processes of participants, provide reflection, and incorporate improvement opportunities for future cases. Finally, participants engaged in a didactic lecture where they were educated about the incidence, presentation, and management of tubal ectopic pregnancy. Results Analysis of the knowledge questionnaires showed the median score pre- and post-intervention was 9 and 12, respectively, with a median change of 3 (p=0.001). The median confidence value pre- and post-intervention were 28 and 42, respectively, with a median value change of 12 (p<0.001). Conclusion Our intervention improved residents' confidence and knowledge in recognizing an ectopic pregnancy, identifying an appropriate candidate for surgical management, and performing a salpingostomy.
Sabatina I A; Shah J V; Gothard D; Ballas D A
Cureus
2019
2019-07
<a href="http://doi.org/10.7759/cureus.5116" target="_blank" rel="noreferrer noopener">10.7759/cureus.5116</a>
THE BONE MARROW ENDOTHELIAL PROGENITOR CELL RESPONSE TO SEPTIC INFECTION
& Cardiology; Cardiovascular System; General & Internal Medicine; Hematology; Surgery
Shi X; Simms K J; Ewing T J; Zhang P
Shock
2019
2019-06
<a href="http://doi.org/10.1097/SHK.0000000000001374" target="_blank" rel="noreferrer noopener">10.1097/SHK.0000000000001374</a>
Dispelling Myths about Antenatal TAPS: A Call for Action for Routine MCA-PSV Doppler Screening in the United States
anemia-polycythemia sequence; cerebral-artery; clinical guidelines; diagnostic-criteria; fetal; General & Internal Medicine; laser-surgery; MCA-PSV Doppler; middle; monochorionic diamniotic twin pregnancy; peak systolic velocity; perinatal management; placental echogenicity; prevalence; screening; TAPS; twin anemia-polycythemia sequence; twin transfusion syndrome
In the United States, routine middle cerebral artery peak systolic velocity (MCA-PSV) Doppler screening for the detection of antenatal twin anemia-polycythemia sequence (TAPS) is not recommended. The current and only national clinical guideline from the highly-influential Society for Maternal-Fetal Medicine states that, "There is no evidence that monitoring for TAPS with MCA PSV Doppler at any time, including > 26 weeks, improves outcomes, so that this additional screening cannot be recommended at this time." We argue this recommendation has disproportionate influence on patients and the care they are offered and receive. We use current evidence to highlight and dispel pervasive myths surrounding antenatal TAPS and the value of routine MCA-PSV screening. An ethical framework that illustrates the importance of giving patients the opportunity for routine screening is presented. Findings demonstrate that: (1) both spontaneous and post-laser TAPS is a serious, potentially life-threatening complication, (2) treatment for TAPS is effective and includes expectant management, intrauterine transfusion (IUT), or surgery, (3) and routine MCA-PSV, which has satisfactory diagnostic accuracy, is currently the only way to provide early detection of TAPS. We conclude that routine TAPS screening is a medically proven valuable resource that should be offered to patients in need and to the clinicians who are trying to act toward their benefit.
Nicholas Lauren; Fischbein Rebecca; Aultman Julie; Ernst-Milner Stephanie
Journal of Clinical Medicine
2019
2019-07
<a href="http://doi.org/10.3390/jcm8070977" target="_blank" rel="noreferrer noopener">10.3390/jcm8070977</a>
When to suspect superficial basal cell carcinoma
General & Internal Medicine
A 52-year-old man was referred for evaluation of three mildly pruritic patches on his right lateral upper arm, left shoulder, and right posterior thigh. The lesions had been present for 4 years, and although itching had decreased, they had failed to clear after treatment with fluocinonide cream. The patient had a light complexion and a long history of sun exposure. On physical examination, each lesion measured 1.5 to 2 cm in diameter and showed erythema, scaling, and slight atrophy (figure 1). Shave biopsies were performed on all three lesions, and specimens were submitted for histopathologic examination. Sections from each lesion revealed superficial basal cell carcinoma, with a central nodular component in one sample (figure 2). The following week, electrodesiccation and curettage was performed on all three lesions, and liquid nitrogen was used to treat actinic keratoses on the patient's temples. The patient was advised to avoid exposure to the sun and to use protective measures while outdoors. Four months later, follow-up examination revealed three additional superficial basal cell carcinomas, which were subsequently treated.
Naik N S; Brodell R T; Fatteh S
Postgraduate Medicine
1998
1998-11
Journal Article
<a href="http://doi.org/10.3810/pgm.1998.11.432" target="_blank" rel="noreferrer noopener">10.3810/pgm.1998.11.432</a>
PROGNOSIS OF ABDOMINAL AORTIC-ANEURYSMS - A POPULATION-BASED STUDY
General & Internal Medicine
Nevitt M P; Ballard D J; Hallett J W
New England Journal of Medicine
1989
1989-10
Journal Article
<a href="http://doi.org/10.1056/nejm198910123211504" target="_blank" rel="noreferrer noopener">10.1056/nejm198910123211504</a>
Contamination rates of blood cultures obtained by dedicated phlebotomy vs intravenous catheter
decision-analysis; epidemiology; febrile children; General & Internal Medicine; hospital; infection-control; management; occult bacteremia; pediatric emergency; quality-control methods; resource utilization; risk
Context Blood culture is the criterion standard for identifying children with bacteremia. However, elevated false-positive rates are common and are associated with substantial health care costs. Objective To compare contamination rates in blood culture specimens obtained from separate sites vs through newly inserted intravenous catheters. Design, Setting, and Participants Observational study conducted January 1998 through December 1999 among patients aged 18 years or younger who were seen at a US children's hospital emergency department and had a blood culture obtained as part of their care. Medical records were reviewed in all cases with a positive blood culture. Patients with indwelling vascular catheters were excluded. Intervention All phlebotomy was performed by emergency department registered nurses. During the baseline phase, blood specimens for culture were obtained simultaneously with intravenous catheter insertion. During the postintervention phase, specimens were obtained by a separate, dedicated procedure. Main Outcome Measure Contamination rate in the postintervention period compared with the baseline period. Results A total of 4108 blood cultures were evaluated, including 2108 during the baseline phase and 2000 in the postintervention phase. The false-positive blood culture rate decreased from 9.1% to 2.8% (P<.001). A statistical process control chart demonstrated a steady-state process in the baseline phase and the establishment of a significantly improved steady state in the postintervention phase. Young age was associated with increased contamination rate in both the baseline and postintervention periods. Conclusion Blood culture contamination rates were lower when specimens were drawn from a separate site compared with when they were drawn through a newly inserted intravenous catheter.
Norberg A; Christopher N C; Ramundo M L; Bower J R; Berman S A
Jama-Journal of the American Medical Association
2003
2003-02
Journal Article
<a href="http://doi.org/10.1001/jama.289.6.726" target="_blank" rel="noreferrer noopener">10.1001/jama.289.6.726</a>
Rapid diagnosis of superficial fungal infections
General & Internal Medicine
Nowak M A; Brodell R T
Postgraduate Medicine
1999
1999-02
Journal Article
<a href="http://doi.org/10.3810/pgm.1999.02.575" target="_blank" rel="noreferrer noopener">10.3810/pgm.1999.02.575</a>
Salmonella-related mycotic pseudoaneurysm
aneurysm; angioplasty; aortitis; General & Internal Medicine; therapy; thoracic aorta
Nseir B; Cutrona A F
Cleveland Clinic Journal of Medicine
2009
2009-05
Journal Article
<a href="http://doi.org/10.3949/ccjm.76a.08031" target="_blank" rel="noreferrer noopener">10.3949/ccjm.76a.08031</a>
Heparin therapy for myocardial infarction: An unusual trigger for pituitary apoplexy
anticoagulation; General & Internal Medicine; myocardial infarction; pituitary adenocarcinoma; pituitary apoplexy
A 68-year-old man with coronary artery disease was admitted for chest pain and ventricular tachycardia, After electric cardioversion, therapeutic heparinization was started for myocardial ischemia and nontransmural infarction, On day 3, headache and fever developed, followed by an altered sensorium and hyponatremia, Infectious etiology for the fever was excluded, and results of computed tomography of the brain were normal, Later magnetic resonance imaging (Day 10) demonstrated a pituitary macroadenoma with hemorrhage, Treatment for panhypopituitarism with stress-dose steroids stabilized the patient, and the fever and hyponatremia resolved, Transsphenoidal resection of the pituitary adenoma was performed without incident. This is the first reported case of pituitary apoplexy after heparin anticoagulation for acute myocardial infarction, although chronic anticoagulation in other settings has been reported as a precipitant of apoplexy, The uncommon presentation of a ''central'' fever and confusion in a patient with previously undiagnosed adenoma posed a diagnostic challenge, Subtle presentations of panhypopituitarism, knowledge of which should lead to suspicion and early diagnosis of pituitary apoplexy, will prevent anticoagulant-induced central nervous system catastrophes and potential fatalities.
Oo M M; Krishna A Y; Bonavita G J; Rutecki G W
American Journal of the Medical Sciences
1997
1997-11
Journal Article
<a href="http://doi.org/10.1097/00000441-199711000-00016" target="_blank" rel="noreferrer noopener">10.1097/00000441-199711000-00016</a>
A controlled study of leukocyte activation in septic patients
alpha; burst; chemi-luminescence; chemi-luminescence; formyl-methionyl-leucyl-phenyl alanine; General & Internal Medicine; leukocytes; luminol; neutrophils; opsonized zymosan; oxidative burst; phagocytes; phorbol myristate acetate; polymorphonuclear; respiratory burst; sepsis; septic shock; shock; tumor-necrosis-factor
Objective: Qualitative and quantitative evaluation of leukocyte activation in septic patients in comparison to two control groups. Design: A prospective clinical study in which the leukocyte oxidative output of whole blood was measured in three groups of patients. Two chemiluminescence markers (luminol or lucigenin), indicative of either total oxidant output or superoxide production, and three stimuli (opsonized zymosan, formyl-methionyl-leucyl-phenylalanine (fMLP), phorbol myristate acetate) (PMA), representing different pathways of leukocyte activation, were used. Tumor necrosis factor, interleukin-6 and C-reactive protein (TNF, IL-6, and CRP) were determined to evaluate the severity of the inflammatory process. Setting: Intensive care and surgical units of a university hospital. Patients: Seventy-four healthy patients, ten ICU patients without signs of sepsis or systemic inflammatory response syndrome and 19 septic patients were studied. Measurement and main results: With all three stimuli, whole blood total oxidative output and superoxide production were generally increased in septic patients. This was most likely due to the increased leukocyte numbers in these patients. When the chemiluminescence values were normalized per phagocyte (granulocytes and monocytes), the total oxidative output of septic phagocytes decreased with opsonin and fMLP but increased with PMA, while superoxide output decreased regardless of the stimuli used. TNF, IL-6 and CRP, although increased in septic patients as compared to ICU controls, correlated weakly with oxidant output. Conclusions: The oxidative output of whole blood was increased in septic patients compared to controls because of elevated leukocyte numbers. However, oxidant output normalized for phagocyte numbers generally decreases during sepsis for most stimuli. Cytokines and CRP do not appear to be associated with the extent of oxidant output during sepsis.
Pascual C; Karzai W; Meierhellmann A; Bredle D L; Reinhart K
Intensive Care Medicine
1997
1997-07
Journal Article
<a href="http://doi.org/10.1007/s001340050403" target="_blank" rel="noreferrer noopener">10.1007/s001340050403</a>
High Risk for OSA: An Independent Risk Factor for Development of New-Onset Atrial Fibrillation After Cardiac Surgery
General & Internal Medicine; Respiratory System
Patel S; Rodriguez R; Gill H; Rajabalan A; Patel P; Singh T; Bautista M
Chest
2016
2016-10
Journal Article
<a href="http://doi.org/10.1016/j.chest.2016.08.1384" target="_blank" rel="noreferrer noopener">10.1016/j.chest.2016.08.1384</a>
Handlebar hernia: A rare traumatic abdominal wall hernia
General & Internal Medicine; Surgery
Perez V M; McDonald A D; Ghani A; Bleacher J H O
Journal of Trauma-Injury Infection and Critical Care
1998
1998-03
Journal Article
<a href="http://doi.org/10.1097/00005373-199803000-00032" target="_blank" rel="noreferrer noopener">10.1097/00005373-199803000-00032</a>
Staphylococcus aureus Bacteremia (SAB) With Associated S-aureus Bacteriuria (SABU) as a Predictor of Complications and Mortality
adults; blood-stream infections; complications and mortality; complications from Staphylococcus aureus bacteremia; endocarditis; General & Internal Medicine; management; predictor of; Staphylococcus aureus bacteremia; Staphylococcus aureus bacteriuria; susceptibility; therapy; urinary-tract-infection
BACKGROUND AND OBJECTIVES: Staphylococcus aureus (SA) bacteremia (SAB) is associated with a high rate of complications, most of which are related to hematogenous seeding into deep tissues or prosthetic material. SA bacteriuria (SABU) has been described in association with SAB, but has not been evaluated as a predictor for complicated bacteremia, which was the objective of our study. METHODS (DESIGN, SETTING, AND PATIENTS): We conducted a retrospective study of patients admitted to the hospital with SAB. The 118 patients included in the study were divided in 2 cohorts: a group with SABU and a group without SA in the urine. We followed the 2 cohorts for an average of 8 months and evaluated the differences in complications and mortality. RESULTS: SABU was found in 28 of 118 patients with SAB. Eighteen patients (64%) in this group had complications from the bacteremia, while in the group without SABU only 33% (30/90 patients) had complications (P = 0.004). The SABU group also had more deaths (32% vs. 14%; P = 0.036). CONCLUSIONS: In this population of hospitalized patients with SAB, the presence of SABU was associated with an increased risk of early complications, including septic shock, and with higher mortality. A routine urine culture in search of SABU may be a helpful tool for detection of those patients with SAB who are at increased risk of complications and death. Journal of Hospital Medicine 2010;5:208-211. (C) 2010 Society of Hospital Medicine.
Perez-Jorge E V; Burdette S D; Marked R J; Beam W B
Journal of Hospital Medicine
2010
2010-04
Journal Article
<a href="http://doi.org/10.1002/jhm.623" target="_blank" rel="noreferrer noopener">10.1002/jhm.623</a>
Effect of Transendocardial Delivery of Autologous Bone Marrow Mononuclear Cells on Functional Capacity, Left Ventricular Function, and Perfusion in Chronic Heart Failure The FOCUS-CCTRN Trial
acute myocardial-infarction; cells; coronary-artery-disease; f-18; fluorodeoxyglucose; General & Internal Medicine; intramyocardial injection; metabolic-activity; progenitor; randomized controlled-trial; research network cctrn; stem-cells; transcoronary transplantation
Context Previous studies using autologous bone marrow mononuclear cells (BMCs) in patients with ischemic cardiomyopathy have demonstrated safety and suggested efficacy. Objective To determine if administration of BMCs through transendocardial injections improves myocardial perfusion, reduces left ventricular end-systolic volume (LVESV), or enhances maximal oxygen consumption in patients with coronary artery disease or LV dysfunction, and limiting heart failure or angina. Design, Setting, and Patients Aphase 2 randomized double-blind, placebo-controlled trial of symptomatic patients (New York Heart Association classification II-III or Canadian Cardiovascular Society classification II-IV) with a left ventricular ejection fraction of 45% or less, a perfusion defect by single-photon emission tomography (SPECT), and coronary artery disease not amenable to revascularization who were receiving maximal medical therapy at 5 National Heart, Lung, and Blood Institute-sponsored Cardiovascular Cell Therapy Research Network (CCTRN) sites between April 29, 2009, and April 18, 2011. Intervention Bone marrow aspiration (isolation of BMCs using a standardized automated system performed locally) and transendocardial injection of 100 million BMCs or placebo (ratio of 2 for BMC group to 1 for placebo group). Main Outcome Measures Co-primary end points assessed at 6 months: changes in LVESV assessed by echocardiography, maximal oxygen consumption, and reversibility on SPECT. Phenotypic and functional analyses of the cell product were performed by the CCTRN biorepository core laboratory. Results Of 153 patients who provided consent, a total of 92 (82 men; average age: 63 years) were randomized (n=61 in BMC group and n=31 in placebo group). Changes in LVESV index (-0.9 mL/m(2) [95% CI, -6.1 to 4.3]; P=.73), maximal oxygen consumption (1.0 [95% CI, -0.42 to 2.34]; P=.17), and reversible defect (-1.2 [95% CI, -12.50 to 10.12]; P=.84) were not statistically significant. There were no differences found in any of the secondary outcomes, including percent myocardial defect, total defect size, fixed defect size, regional wall motion, and clinical improvement. Conclusion Among patients with chronic ischemic heart failure, transendocardial injection of autologous BMCs compared with placebo did not improve LVESV, maximal oxygen consumption, or reversibility on SPECT.
Perin E C; Willerson J T; Pepine C J; Henry T D; Ellis S G; Zhao D X M; Silva G V; Lai D J; Thomas J D; Kronenberg M W; Martin A D; Anderson R D; Traverse J H; Penn M S; Anwaruddin S; Hatzopoulos A K; Gee A P; Taylor D A; Cogle C R; Smith D; Westbrook L; Chen J; Handberg E; Olson R E; Geither C; Bowman S; Francescon J; Baraniuk S; Piller L B; Simpson L M; Loghin C; Aguilar D; Richman S; Zierold C; Bettencourt J; Sayre S L; Vojvodic R W; Skarlatos S I; Gordon D J; Ebert R F; Kwak M; Moye L A; Simari R D; Cardiovasc Cell Therapy Res Networ
Jama-Journal of the American Medical Association
2012
2012-04
Journal Article
<a href="http://doi.org/10.1001/jama.2012.418" target="_blank" rel="noreferrer noopener">10.1001/jama.2012.418</a>
HISTORICAL-PERSPECTIVE ON THE EVOLUTION OF TODAYS MILITARY FIELD ANESTHESIA MACHINE
General & Internal Medicine
Petty C
Military Medicine
1990
1990-02
Journal Article
<a href="http://doi.org/10.1093/milmed/155.2.66" target="_blank" rel="noreferrer noopener">10.1093/milmed/155.2.66</a>
Noninvasive ventilation to facilitate extubation in a pediatric intensive care unit
children; face mask; General & Internal Medicine; insufficiency; intermittent; management; mechanical ventilation; nasal ventilation; positive-pressure ventilation; respiratory-failure; support
Noninvasive ventilation has been used extensively to treat chronic respiratory failure associated with neuromuscular and other restrictive thoracic diseases, and is also effective in the treatment of acute respiratory failure, allowing some patients to avoid intubation. Noninvasive positive pressure ventilation is a potentially effective way to transition selected patients off endotracheal mechanical ventilation. The authors present a retrospective chart review of pediatric patients extubated with the use of noninvasive ventilation. Extubation with noninvasive positive pressure ventilation was attempted in 25 patients. The patients had a variety of diagnoses, including neuromuscular diseases, cerebral palsy with chronic respiratory insufficiency, asthma, and acute respiratory distress syndrome (ARDS), reflecting the diversity of patients with respiratory failure seen in our pediatric intensive care unit (ICU). Indications for noninvasive ventilation-assisted extubation were chronic respiratory insufficiency, clinical evidence the patient was failing extubation, or failure of a previous attempt to extubate. Extubation was successfully facilitated in 20 of 25 patients. Of the five patients failing an initial attempt at noninvasive ventilation-assisted extubation, two required tracheostomy, two were subsequently extubated with the aid of noninvasive ventilation, and one was subsequently extubated without the use of noninvasive ventilation. Risk factors for failure to successfully extubate with the assistance of noninvasive positive pressure ventilation included the patient's inability to manage respiratory tract secretions, severe upper airway obstruction, impaired mental status, and ineffective cough with mucus plugging of the large airways. All patients had mild to moderate skin irritation due to the mask interface. No patient had any serious or long-term adverse effect of noninvasive positive pressure ventilation. All patients left the hospital alive. Noninvasive positive pressure ventilation can facilitate endotracheal extubation in pediatric patients with diverse diagnoses who have failed or who are at risk of failing extubation, including those with neuromuscular weakness.
Pope J F; Birnkrant D J
Journal of Intensive Care Medicine
2000
2000-03
Journal Article
<a href="http://doi.org/10.1046/j.1525-1489.2000.00099.x" target="_blank" rel="noreferrer noopener">10.1046/j.1525-1489.2000.00099.x</a>
Letters to the editor
General & Internal Medicine; Surgery
Porter J M
Journal of Trauma-Injury Infection and Critical Care
1999
1999-08
Journal Article
<a href="http://doi.org/10.1097/00005373-199908000-00047" target="_blank" rel="noreferrer noopener">10.1097/00005373-199908000-00047</a>
Untitled
General & Internal Medicine; Surgery
Porter J M
Journal of Trauma-Injury Infection and Critical Care
2001
2001-06
Journal Article
<a href="http://doi.org/10.1097/00005373-200106000-00036" target="_blank" rel="noreferrer noopener">10.1097/00005373-200106000-00036</a>
Stem Cell Therapy for Heart Disease
acute myocardial-infarction; bone-marrow-cells; cardiac repair; cells; coronary-artery-disease; Function; General & Internal Medicine; Health Care Sciences & Services; Heart failure; intracoronary injection; ischemic-heart; left-ventricular; mononuclear-cells; myocardial infarction; paracrine; progenitor; randomized phase-1 trial; stem cell; ventricular function
Coronary artery disease is the leading cause of death in Americans. After myocardial infarction, significant ventricular damage persists despite timely reperfusion and pharmacological management. Treatment is limited, as current modalities do not cure this damage. In the past decade, stem cell therapy has emerged as a promising therapeutic solution to restore myocardial function. Clinical trials have demonstrated safety and beneficial effects in patients suffering from acute myocardial infarction, heart failure, and dilated cardiomyopathy. These benefits include improved ventricular function, increased ejection fraction, and decreased infarct size. Mechanisms of therapy are still not clearly understood. However, it is believed that paracrine factors, including stromal cell-derived factor-1, contribute significantly to stem cell benefits. The purpose of this article is to provide medical professionals with an overview on stem cell therapy for the heart and to discuss potential future directions.
Puliafico S B; Penn M S; Silver K H
Journal of General Internal Medicine
2013
2013-10
Journal Article
<a href="http://doi.org/10.1007/s11606-013-2508-z" target="_blank" rel="noreferrer noopener">10.1007/s11606-013-2508-z</a>
Futility: Another Way?
General & Internal Medicine
Radwany S M
Annals of Internal Medicine
2014
2014-06
Journal Article
<a href="http://doi.org/10.7326/l14-5012-5" target="_blank" rel="noreferrer noopener">10.7326/l14-5012-5</a>
Influence of High-Risk for OSA on Outcomes of Open Heart Surgery: A Retrospective Analysis
General & Internal Medicine; Respiratory System
Rajabalan A; Rodriguez R; Patel S; Gill H; Shahi D; Singh T; Bautista M
Chest
2016
2016-10
Journal Article
<a href="http://doi.org/10.1016/j.chest.2016.08.036" target="_blank" rel="noreferrer noopener">10.1016/j.chest.2016.08.036</a>
Higher Pneumococcal Disease Vaccination Rates Needed to Protect More At-Risk US Adults
changing epidemiology; community-acquired; community-acquired pneumonia; conjugate vaccine; General & Internal Medicine; H1N1 influenza; invasive pneumococcal disease; meningitis; older-adults; pneumococcal disease; pneumonia; PPSV23; united-states
Pneumococcal disease, which includes pneumococcal pneumonia, meningitis, and bacteremia, is associated with substantial morbidity, mortality, and health care costs in adults. Advanced age, chronic lung or cardiovascular disease, immunosuppressive conditions, and smoking increase the risk for infection. Despite the availability of an effective pneumococcal polysaccharide vaccine (PPSV23), vaccination rates among adults remain suboptimal. This is of immediate concern given the current H1N1 pandemic, since secondary bacterial infection with Streptococcus pneumoniae is common and can contribute to morbidity and mortality. The Centers for Disease Control and Prevention has recently called for increased efforts to vaccinate recommended persons against pneumococcal disease. Long-term trends including the growth of the elderly population and an increase in the number of patients with chronic conditions also underscore the importance of improving pneumococcal vaccination rates. It is important for health care providers, public health officials, and policy makers to recognize the serious health impact of pneumococcal disease in adults and to ensure increased coverage; at present, this is the best way to protect against invasive pneumococcal infection and its consequences.
Rehm S J; Farley M M; File T M; Hall W J; Hopkins R; Levine O S; Nichol K L; Nuorti P; Zimmerman R K; Schaffner W
Postgraduate Medicine
2009
2009-11
Journal Article
<a href="http://doi.org/10.3810/pgm.2009.11.2069" target="_blank" rel="noreferrer noopener">10.3810/pgm.2009.11.2069</a>
Identifying Barriers to Adult Pneumococcal Vaccination: An NFID Task Force Meeting
adult vaccination; care; disease; General & Internal Medicine; influenza; pneumococcal disease; pneumococcal vaccine; pneumonia; Streptococcus pneumoniae; united-states
Pneumococcal infection is common in adults, and invasive disease is associated with a high mortality rate. Pneumococcal polysaccharide vaccine can prevent invasive pneumococcal disease and is recommended for people aged >= 65 years and for younger adults with high-risk chronic conditions; however, vaccination rates are suboptimal in all of these groups. A multidisciplinary task force meeting examined ways to increase vaccination rates in the target populations. Barriers to vaccination include lack of awareness of the disease or vaccine among vaccination candidates and health care providers, failure to assume responsibility for vaccination, competing priorities, incomplete or inaccessible documentation of previous vaccines, and health care system delivery challenges. Efforts to address these barriers should use appropriate methods. For example, potential vaccine recipients might be motivated by a message from a community leader, whereas health care providers are more apt to offer a vaccine when reminded that it is a recommended best practice. All health care providers need to accept responsibility for vaccination so that this preventive measure becomes a high priority in the care of patients at risk for serious pneumococcal infection.
Rehm S J; File T M; Metersky M; Nichol K L; Schaffner W; Natl Fdn Infect Dis Pneumococcal D
Postgraduate Medicine
2012
2012-05
Journal Article
<a href="http://doi.org/10.3810/pgm.2012.05.2550" target="_blank" rel="noreferrer noopener">10.3810/pgm.2012.05.2550</a>
RENAL VENOUS THROMBOSIS IN CHILDREN - CHANGES IN MANAGEMENT
General & Internal Medicine
Reimold E W; Wittel R A
Southern Medical Journal
1983
1983
Journal Article
<a href="http://doi.org/10.1097/00007611-198310000-00021" target="_blank" rel="noreferrer noopener">10.1097/00007611-198310000-00021</a>
ZINC CHANGES AFTER RENAL ALLOTRANSPLANTATION
General & Internal Medicine
Reimold E W
Southern Medical Journal
1980
1980
Journal Article
<a href="http://doi.org/10.1097/00007611-198011000-00011" target="_blank" rel="noreferrer noopener">10.1097/00007611-198011000-00011</a>
RESPIRATORY DYSKINESIA - AN UNDERRECOGNIZED PHENOMENON
basal ganglia; clonidine; disturbance; double-blind crossover; General & Internal Medicine; induced movement-disorders; parkinsons-disease; prevalence; psychiatric-patients; Respiratory System; tardive-dyskinesia; tetrabenazine; therapy
Rich M W; Radwany S M
Chest
1994
1994-06
Journal Article
<a href="http://doi.org/10.1378/chest.105.6.1826" target="_blank" rel="noreferrer noopener">10.1378/chest.105.6.1826</a>
Sneddon syndrome and dementia
General & Internal Medicine
Rich M W
Mayo Clinic Proceedings
1999
1999-12
Journal Article
<a href="http://doi.org/10.4065/74.12.1306" target="_blank" rel="noreferrer noopener">10.4065/74.12.1306</a>
INFECTIONS DUE TO CORYNEBACTERIUM GROUP-D2 - REPORT OF A CASE
General & Internal Medicine
Roncikoenig T J; Tan J S; File T M; Thomson R B
Archives of Internal Medicine
1990
1990-09
Journal Article
<a href="http://doi.org/10.1001/archinte.150.9.1965" target="_blank" rel="noreferrer noopener">10.1001/archinte.150.9.1965</a>
Does the presence of ultrasound really affect computed tomographic scan use? A prospective randomized trial of ultrasound in trauma
blunt abdominal-trauma; emergency; experience; fluid; General & Internal Medicine; hemoperitoneum; indicator; intraperitoneal; learning-curve; sonography; surgeon-performed ultrasound; Surgery; Ultrasonography
Objective. There is a paucity of evidence demonstrating that emergency department (ED) ultrasound changes clinical practice in trauma patients. We hypothesized that the presence of ultrasound would affect clinical decision making as evidenced through abdominal computed tomographic WT) scan use in blunt multiple trauma patients. Methods. This study used a prospective randomized format in an urban county ED with Level II trauma center status (ED census, 72,000 patients per year). Participants were patients with multiple blunt injuries meeting trauma center triage criteria. Patients were randomized to receive either abdominal ultrasound or no ultrasound (control) during initial ED resuscitation. The primary outcome variable was use of abdominal CT scan in patients with and without ultrasound. Results. Two hundred eight patients were enrolled. The mean age was 40 +/- 18 years, and 62% were men. Mechanism of injury was motor vehicle crash, 56%; automobile versus pedestrian, 18%; motorcycle crash, 16%; falls, 10%; and other, 10%. One hundred four ultrasound and 104 control patients were analyzed. There were no apparent differences between ultrasound and control groups in demographics, injury type, or Injury Severity Score. Fifty-four of 104 (52%) of the control group received abdominal CT scans versus 37 of 104 (36%) abdominal CT scans for the ultrasound group; mean difference in proportions was 15.9 (p < 0.01; 95% confidence interval, 2.6-29.1). Conclusion. In this trial, the routine use of abdominal ultrasound in the evaluation of patients with multiple blunt injuries resulted in significantly fewer abdominal CT scans being obtained. A larger trial is needed to more clearly define the clinical and financial impact of ultrasound in the management of blunt abdominal trauma.
Rose J S; Levitt M A; Porter J; Hutson A; Greenholtz J; Nobay F; Hilty W
Journal of Trauma-Injury Infection and Critical Care
2001
2001-09
Journal Article
<a href="http://doi.org/10.1097/00005373-200109000-00022" target="_blank" rel="noreferrer noopener">10.1097/00005373-200109000-00022</a>
INTENSIVE INSULIN-TREATMENT IN PATIENTS WITH RECURRENT HYPOGLYCEMIA
General & Internal Medicine
Rosman P M
Annals of Internal Medicine
1994
1994-08
Journal Article
<a href="http://doi.org/10.7326/0003-4819-121-4-199408150-00016" target="_blank" rel="noreferrer noopener">10.7326/0003-4819-121-4-199408150-00016</a>
Challenges in performing surveillance for central line associated bacteraemia in haematology-oncology units Reply
General & Internal Medicine
Rothschild B
Internal Medicine Journal
2013
2013-04
Journal Article
<a href="http://doi.org/10.1111/imj.12091" target="_blank" rel="noreferrer noopener">10.1111/imj.12091</a>
Cost savings and prescribing protocols for nonsteroidal anti-inflammatory drugs
General & Internal Medicine
Rothschild B M
Jama-Journal of the American Medical Association
1996
1996-08
Journal Article
<a href="http://doi.org/10.1001/jama.276.7.525" target="_blank" rel="noreferrer noopener">10.1001/jama.276.7.525</a>
Importance of assessing musculoskeletal disease in older women
General & Internal Medicine
Rothschild B
Mayo Clinic Proceedings
2003
2003-11
Journal Article
<a href="http://doi.org/10.4065/78.11.1430" target="_blank" rel="noreferrer noopener">10.4065/78.11.1430</a>
Mesozoic neoplasia: origins of haemangioma in the Jurassic age
General & Internal Medicine
Rothschild B M; Tanke D; Hershkovitz I; Schultz M
Lancet
1998
1998-06
Journal Article
<a href="http://doi.org/10.1016/s0140-6736(05)78809-7" target="_blank" rel="noreferrer noopener">10.1016/s0140-6736(05)78809-7</a>
Metastatic cancer in the Jurassic
General & Internal Medicine
Recognition of cancer in extreme antiquity has been limited to osteomas in mosasaurs and haemangiomas and growths of unclear origin in dinosaurs. We describe a metastatic cancer in a dinosaur.
Rothschild B M; Witzke B J; Hershkovitz I
Lancet
1999
1999-07
Journal Article
<a href="http://doi.org/10.1016/s0140-6736(99)01019-3" target="_blank" rel="noreferrer noopener">10.1016/s0140-6736(99)01019-3</a>
Non-steroidal anti-inflammatory drugs and risk of serious coronary heart disease
General & Internal Medicine
Rothschild B M
Lancet
2002
2002-07
Journal Article
<a href="http://doi.org/10.1016/s0140-6736(02)09351-0" target="_blank" rel="noreferrer noopener">10.1016/s0140-6736(02)09351-0</a>
Two sides of the warfarin issue: Diligence versus potency
General & Internal Medicine; management
Rothschild B M; Helbling M E
American Journal of Medicine
2001
2001-06
Journal Article
<a href="http://doi.org/10.1016/s0002-9343(01)00712-4" target="_blank" rel="noreferrer noopener">10.1016/s0002-9343(01)00712-4</a>