21 Yost Blvd Forest Hills Plaza Suite 217
Pittsburgh PA 15221
Medical School: University Of Pittsburgh School Of Medicine - 1961
Accepts Medicare: Yes
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: MD028288L
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Awards & Recognitions
Dr. Barry Tenenouser is associated with these group practices
|HCPCS Code||Description||Average Price||Average Price
Allowed By Medicare
|HCPCS Code:93000||Description:Electrocardiogram complete||Average Price:$55.00||Average Price Allowed
|HCPCS Code:99231||Description:Subsequent hospital care||Average Price:$60.00||Average Price Allowed
|HCPCS Code:99238||Description:Hospital discharge day||Average Price:$90.00||Average Price Allowed
|HCPCS Code:Q2036||Description:Flulaval vacc, 3 yrs & >, im||Average Price:$25.00||Average Price Allowed
|HCPCS Code:99223||Description:Initial hospital care||Average Price:$205.00||Average Price Allowed
|HCPCS Code:99232||Description:Subsequent hospital care||Average Price:$80.00||Average Price Allowed
|HCPCS Code:99213||Description:Office/outpatient visit est||Average Price:$78.56||Average Price Allowed
|HCPCS Code:99214||Description:Office/outpatient visit est||Average Price:$110.00||Average Price Allowed
|HCPCS Code:36415||Description:Routine venipuncture||Average Price:$8.00||Average Price Allowed
|HCPCS Code:G0008||Description:Admin influenza virus vac||Average Price:$25.00||Average Price Allowed
HCPCS Code Definitions
- Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 15 minutes are spent face-to-face with the patient and/or family.
- Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 25 minutes are spent face-to-face with the patient and/or family.
- Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of high severity. Typically, 70 minutes are spent at the bedside and on the patient's hospital floor or unit.
- Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report
- Administration of influenza virus vaccine
- Hospital discharge day management; 30 minutes or less
- Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Typically, 25 minutes are spent at the bedside and on the patient's hospital floor or unit.
- Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is stable, recovering or improving. Typically, 15 minutes are spent at the bedside and on the patient's hospital floor or unit.
- Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (flulaval)
Medical Malpractice Cases
Medical Board Sanctions
P4-34: Prevalence of HBP in urban area of LabÃ© and therapeutic evaluation of phyto medicine with Uapaca togoensis and Hymenocardia acida. - Annales de cardiologie et d'angeÌiologie
DÃ©terminer la prÃ©valence de l'HTA en zone urbaine de LabÃ©, Ã©valuer l'efficacitÃ© des trois phytomÃ©dicaments, Ã©valuer la tolÃ©rance des trois phytomÃ©dicaments. MÃ©THODES: L'Ã©tude a Ã©tÃ© rÃ©alisÃ©e en deux phases : la premiÃ¨re a consistÃ© en une enquÃªte de prÃ©valence pour dÃ©terminer les patients hypertendus ; la deuxiÃ¨me a permis de soumettre les patients hypertendus (volontaires) Ã l'Ã©valuation ethnothÃ©rapeutique. L'Ã©tude de prÃ©valence a portÃ© sur 316 patients Ã¢gÃ©s de 18 ans et plus rÃ©sidents en zone urbaine de LabÃ©. Elle a Ã©tÃ© rÃ©alisÃ©e sur base d'interwiew selon une fiche d'enquÃªte standardisÃ©e par le Centre de Recherche et de Valorisation des Plantes MÃ©dicinales de DubrÃ©ka. Concernant l'Ã©valuation ethnothÃ©rapeutique, l'accord du ComitÃ© National d'Ethique guinÃ©en a Ã©tÃ© obtenu avant le dÃ©marrage. Les phytomÃ©dicaments ont Ã©tÃ© prÃ©parÃ©s Ã partir des deux plantes : Uapaca togoensis et Hymenocardia acida. RÃ©SULTATS: La prÃ©valence de l'HTA en zone urbaine de LabÃ© a Ã©tÃ© estimÃ©e Ã 27,52 % (87/316) avec une prÃ©dominance fÃ©minine (75,86 %). L'Ã©valuation de l'efficacitÃ© et de la tolÃ©rance de 3 phytomÃ©dicaments Ã base de Uapaca togoensis et Hymenocardia acida a Ã©tÃ© rÃ©alisÃ©e. L'Ã©valuation clinique Ã trois bras a permis de relever une baisse faible Ã modeste de la PAS et/ou de la PAD chez 37 patients soumis aux traitements soit Ã Hymenocardia acida, Uapaca togoensis ou Ã l'association Hymenocardia acida et Uapaca togoensis. Ã€ l'issue de 14 jours de traitement, le phytomÃ©dicament Ã base de Hymenocardia acida a entraÃ®nÃ© des baisses plus importantes que le phytomÃ©dicament Ã base de Uapaca togoensis et Ã l'association Hymenocardia acida et Uapaca togoensis.Les baisses les plus importantes ont Ã©tÃ© observÃ©es au niveau du groupe soumis au traitement par H. acida. La tolÃ©rance a Ã©tÃ© jugÃ©e bonne pour les trois phytomÃ©dicaments.Copyright Â© 2015 Elsevier Masson SAS. All rights reserved.
Role of ammonia-oxidizing bacteria in micropollutant removal from wastewater with aerobic granular sludge. - Water science and technology : a journal of the International Association on Water Pollution Research
Nitrifying wastewater treatment plants (WWTPs) are more efficient than non-nitrifying WWTPs to remove several micropollutants such as pharmaceuticals and pesticides. This may be related to the activity of nitrifying organisms, such as ammonia-oxidizing bacteria (AOBs), which could possibly co-metabolically oxidize micropollutants with their ammonia monooxygenase (AMO). The role of AOBs in micropollutant removal was investigated with aerobic granular sludge (AGS), a promising technology for municipal WWTPs. Two identical laboratory-scale AGS sequencing batch reactors (AGS-SBRs) were operated with or without nitrification (inhibition of AMOs) to assess their potential for micropollutant removal. Of the 36 micropollutants studied at 1 Î¼g l(-1) in synthetic wastewater, nine were over 80% removed, but 17 were eliminated by less than 20%. Five substances (bisphenol A, naproxen, irgarol, terbutryn and iohexol) were removed better in the reactor with nitrification, probably due to co-oxidation catalysed by AMOs. However, for the removal of all other micropollutants, AOBs did not seem to play a significant role. Many compounds were better removed in aerobic condition, suggesting that aerobic heterotrophic organisms were involved in the degradation. As the AGS-SBRs did not favour the growth of such organisms, their potential for micropollutant removal appeared to be lower than that of conventional nitrifying WWTPs.
Linezolid Trough Concentrations Correlate with Mitochondrial Toxicity-Related Adverse Events in the Treatment of Chronic Extensively Drug-Resistant Tuberculosis. - EBioMedicine
Long-term linezolid use is limited by mitochondrial toxicity-associated adverse events (AEs). Within a prospective, randomized controlled trial of linezolid to treat chronic extensively drug-resistant tuberculosis, we serially monitored the translational competence of mitochondria isolated from peripheral blood of participants by determining the cytochrome c oxidase/citrate synthase activity ratio. We compared this ratio with AEs associated with mitochondrial dysfunction. Linezolid trough concentrations were determined for 38 participants at both 600Â mg and 300Â mg doses. Those on 600Â mg had a significantly higher risk of AE than those on 300Â mg (HR 3Â·10, 95% CI 1Â·23-7Â Â·Â 86). Mean mitochondrial function levels were significantly higher in patients before starting linezolid compared to their concentrations on 300Â mg (PÂ =Â 0Â·004) or 600Â mg (PÂ <Â 0Â·0001). Increasing mean linezolid trough concentrations were associated with lower mitochondrial function levels (Spearman's ÏÂ =Â -Â 0.48; PÂ =Â 0.005). Mitochondrial toxicity risk increased with increasing linezolid trough concentrations, with all patients with mean linezolid trough >Â 2Â Î¼g/ml developing an AE related to mitochondrial toxicity, whether on 300Â mg or 600Â mg. Therapeutic drug monitoring may be useful to prevent the development of mitochondrial toxicity associated with long-term linezolid use.
Aurora kinase inhibitor nanoparticles target tumors with favorable therapeutic index in vivo. - Science translational medicine
Efforts to apply nanotechnology in cancer have focused almost exclusively on the delivery of cytotoxic drugs to improve therapeutic index. There has been little consideration of molecularly targeted agents, in particular kinase inhibitors, which can also present considerable therapeutic index limitations. We describe the development of Accurin polymeric nanoparticles that encapsulate the clinical candidate AZD2811, an Aurora B kinase inhibitor, using an ion pairing approach. Accurins increase biodistribution to tumor sites and provide extended release of encapsulated drug payloads. AZD2811 nanoparticles containing pharmaceutically acceptable organic acids as ion pairing agents displayed continuous drug release for more than 1 week in vitro and a corresponding extended pharmacodynamic reduction of tumor phosphorylated histone H3 levels in vivo for up to 96 hours after a single administration. A specific AZD2811 nanoparticle formulation profile showed accumulation and retention in tumors with minimal impact on bone marrow pathology, and resulted in lower toxicity and increased efficacy in multiple tumor models at half the dose intensity of AZD1152, a water-soluble prodrug of AZD2811. These studies demonstrate that AZD2811 can be formulated in nanoparticles using ion pairing agents to give improved efficacy and tolerability in preclinical models with less frequent dosing. Accurins specifically, and nanotechnology in general, can increase the therapeutic index of molecularly targeted agents, including kinase inhibitors targeting cell cycle and oncogenic signal transduction pathways, which have to date proved toxic in humans.Copyright Â© 2016, American Association for the Advancement of Science.
Arm-posture-dependent changes in corticospinal excitability are largely spinal in origin. - Journal of neurophysiology
Biceps brachii motor evoked potentials (MEP) from cortical stimulation are influenced by arm posture. We used subcortical stimulation of corticospinal axons to determine whether this postural effect is spinal in origin. While seated at rest, 12 subjects assumed several static arm postures, which varied in upper-arm (shoulder flexed, shoulder abducted, arm hanging to side) and forearm orientation (pronated, neutral, supinated). Transcranial magnetic stimulation over the contralateral motor cortex elicited MEPs in resting biceps and triceps brachii, and electrical stimulation of corticospinal tract axons at the cervicomedullary junction elicited cervicomedullary motor evoked potentials (CMEP). MEPs and CMEPs were normalized to the maximal compound muscle action potential (Mmax). Responses in biceps were influenced by upper-arm and forearm orientation. For upper-arm orientation, biceps CMEPs were 68% smaller (p = 0.001), and biceps MEPs 31% smaller (p = 0.012), with the arm hanging to the side compared to when the shoulder was flexed. For forearm orientation, both biceps CMEPs and MEPs were 34% smaller (both p < 0.046) in pronation compared to supination. Responses in triceps were influenced by upper-arm, but not forearm, orientation. Triceps CMEPs were 46% smaller (p = 0.007) with the arm hanging to the side compared to when the shoulder was flexed. Triceps MEPs, and biceps and triceps MEP/CMEP ratios were unaffected by arm posture. The novel finding is that arm-posture-dependent changes in corticospinal excitability in humans are largely spinal in origin. An interplay of multiple reflex inputs to motoneurons likely explains the results.Copyright Â© 2015, Journal of Neurophysiology.
A Qualitative Analysis of Post-operative Nutritional Barriers and Useful Dietary Services Reported by Bariatric Surgical Patients. - Obesity surgery
Outcomes studies show many bariatric patients fail to lose optimal weight or regain significant weight post-surgery. One reason for weight regain may be difficulty adhering to the postoperative diet.Cross-sectional survey methodology collected text data on perceived postoperative nutritional barriers and helpful dietary services reported by bariatric patients. Participants were solicited from an online obesity support website, and 440 responses related to perceived barriers and 330 responses regarding postoperative services were examined using inductive content analysis.Barriers were categorized as being Internal, External, and None. Internal barriers were classified as Psychological, Physiological, and Psychophysiological, with Psychophysiological being the most commonly reported (85.9Â %). Helpful services reported included categories of None, Provided, and On their Own. Sixty-two percent of participants reported receiving at least one Provided service that was helpful, including knowledge and support from professionals like registered dietitian nutritionists (RDNs). However, 22Â % of participants reported seeking out at least one service On their Own such as through the Internet, and 27Â % of participants reported not receiving or not using any helpful services.The physiological nature of post-surgical changes and the mental stamina required of positive eating habits contribute to postoperative adherence difficulties. Many patients likely exhibit poor habits pre-surgery, and without added help to change these behaviors may regain weight. Participants in this study indicated that convenient access to an RDN was helpful. Bariatric facilities should include staff well-trained in the specific nutritional barriers patients face and provide availability of staff beyond the initial postoperative phase.
Nonpharmacologic Versus Pharmacologic Treatment of Adult Patients With Major Depressive Disorder: A Clinical Practice Guideline From the American College of Physicians. - Annals of internal medicine
The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the comparative effectiveness of treatment with second-generation antidepressants versus nonpharmacologic treatments for major depressive disorder in adults.This guideline is based on a systematic review of published, English-language, randomized, controlled trials from 1990 through September 2015 identified using several databases and through hand searches of references of relevant studies. Interventions evaluated include psychotherapies, complementary and alternative medicines (including acupuncture, Ï‰-3 fatty acids, S-adenosyl-l-methionine, St. John's wort [Hypericum perforatum]), exercise, and second-generation antidepressants. Evaluated outcomes included response, remission, functional capacity, quality of life, reduction of suicidality or hospitalizations, and harms. The target audience for this guideline includes all clinicians, and the target patient population includes adults with major depressive disorder. This guideline grades the evidence and recommendations using ACP's clinical practice guidelines grading system.ACP recommends that clinicians select between either cognitive behavioral therapy or second-generation antidepressants to treat patients with major depressive disorder after discussing treatment effects, adverse effect profiles, cost, accessibility, and preferences with the patient (Grade: strong recommendation, moderate-quality evidence).
Responsiveness of PROMIS(Â®) Pediatric Measures to Hospitalizations for Sickle Pain and Subsequent Recovery. - Pediatric blood & cancer
The Patient-Reported Outcomes Measurement Information System(Â®) (PROMIS(Â®) ) created pediatric self-report scales measuring a variety of health attributes (domains), but their responsiveness to changes in health status has not yet been determined in children with sickle cell disease (SCD).A convenience cohort of symptomatic SCD children, aged 8-17 years, was asked to complete PROMIS pediatric scales at an initial clinic visit, at the end of a subsequent hospitalization for sickle pain, at a subsequent clinic visit or at home 2-3 weeks after hospitalization, and at a clinic visit 1-2 years after their initial assessment.A total of 121 participants (mean age 12.5 Â± 3.1 years, 56.2% female) participated in the study. Pain interference and fatigue domain scores were elevated at baseline, increased substantially during hospitalization, and largely returned to baseline by the recovery period, whereas the depressive symptoms, anger, and anxiety domain scores displayed a less pronounced elevation during hospitalizations and a slower return to baseline levels. The two physical functioning scales showed a substantial decline in response to hospitalization, but only modest improvements at the recovery assessment, likely representing incomplete recovery.Several PROMIS pediatric measures were responsive to changes in health status associated with occurrence and resolution of acute vaso-occlusive pain requiring hospitalization. The substantial differences in these domains during SCD-related pain exacerbations support their potential usefulness in clinical research or in clinical practice. Further studies to characterize variations in symptom patterns over time may provide insights into strategies for more effective management of sickle pain.Â© 2016 Wiley Periodicals, Inc.
Viral load monitoring and antiretroviral treatment outcomes in a pediatric HIV cohort in Ghana. - BMC infectious diseases
HIV-infected children in sub-Saharan Africa may be at a high risk of staying on a failing first-line regimen and developing drug-resistance HIV variants due to lack of routine viral load monitoring. We investigated whether cumulative viral load, measured as viremia copy-years (VCY) could predict morbidity in a setting where viral load is not routinely monitored.This was a single-center prospective observational longitudinal study of HIV-infected children initiating antiretroviral therapy (ART) at the Pediatric HIV/AIDS Care program at Korle-Bu Teaching Hospital in Accra, Ghana. The main outcome was morbidity measured as frequency of hospitalizations, opportunistic infections, and outpatient sick visits. The main explanatory variable was viral load measured as VCY.The study included 140 children who initiated ART between September 2009 and May 2013 and had at least 2 viral load measurements. There were 184 hospitalizations, with pneumonia being the most common cause (22.8Â %). A total of 102 opportunistic infections was documented, with tuberculosis being the most common opportunistic infection (68Â %). A total of 823 outpatient sick visits was documented, with upper respiratory infections (14.2Â %) being the most common cause. Forty-four percent of our study participants had >4 log10 VCY. Children in this sub-cohort had a higher frequency of sick visits compared with those with <4 log10 VCY (pâ€‰=â€‰0.03). Only 6.5Â % of children with >4 log10 VCY had been identified as treatment failure using WHO clinical and immunological treatment failure criteria.High level of cumulative viral load may translate to virological failure and subsequent increased all-cause morbidity. Our finding of potential utility of VCY in pediatrics warrants further investigations. VCY may be a good alternate to routine viral load measurement as its determination may be less frequent and could be personalized to save cost.
Differentiation of Vascular Stem Cells Contributes to Ectopic Calcification of Atherosclerotic Plaque. - Stem cells (Dayton, Ohio)
The cellular and molecular basis of vascular calcification (VC) in atherosclerosis is not fully understood. Here, we investigate role of resident/circulating progenitor cells in VC and contribution of inflammatory plaque environment to this process. VSCs and MSCs isolated from atherosclerotic ApoE(-/-) mice showed significantly more in vitro osteogenesis and chondrogenesis than cells generated from control C57BL/6 mice. To assess their ability to form bone in vivo, cells were primed chondrogenically or cultured in control medium on collagen glycosaminoglycan scaffolds in vitro prior to subcutaneous implantation in ApoE(-/-) and C57BL/6 mice using a crossover study design. Atherosclerotic ApoE(-/-) MSCs and VSCs formed bone when implanted in C57BL/6 mice. In ApoE(-/-) mice, these cells generated more mature bone than C57BL/6 cells. The atherosclerotic in vivo environment alone promoted bone formation by implanted C57BL/6 cells. Un-primed C57BL/6 VSCs were unable to form bone in either mouse strain. Treatment of ApoE(-/-) VSC chondrogenic cultures with interleukin (IL)-6 resulted in significantly increased glycosaminoglycan deposition and expression of characteristic chondrogenic genes at 21 days. In conclusion, resident vascular cells from atherosclerotic environment respond to the inflammatory milieu and undergo calcification. IL-6 may have a role in aberrant differentiation of VSCs contributing to vascular calcification in atherosclerosis. This article is protected by copyright. All rights reserved.Â© 2016 AlphaMed Press.
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21 Yost Blvd Forest Hills Plaza Suite 217 Pittsburgh, PA 15221
807 Wallace Ave Wilkinsburg Family Health Center
712 South Ave