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Implementation of an Electronic Data Collection Tool to Monitor Nursing-Sensitive Indicators in a Large Academic Health Sciences Centre. - Nursing leadership (Toronto, Ont.)
Monitoring the quality of nursing care is essential to identify patients at risk, measure adherence to hospital policies and evaluate the effectiveness of best practice interventions. However, monitoring nursing-sensitive indicators (NSI) is a challenge. Prevalence surveys are one method used by some organizations to monitor NSI, which are patient outcomes that are directly affected by the quantity or quality of nursing care that the patient receives.The aim of this paper is to describe the development of an innovative electronic data collection tool to monitor NSI.In the preliminary development work, we designed a mobile computing application with pre-populated patient census information to collect the nursing quality data. In subsequent phases, we refined this process by designing an electronic trigger using The Ottawa Hospital's Patient Safety Learning System, which automatically generated a case report form for each inpatient based on the hospital's daily patient census on the day of the prevalence survey.Both of these electronic data collection tools were accessible on tablet computers, which substantially reduced data collection, analysis and reporting time compared to previous paper-based methods. The electronic trigger provided improved completeness of the data.This work leveraged the use of tablet computers combined with a web-based application for patient data collection at point of care. Overall, the electronic methods improved data completeness and timeliness compared to traditional paper-based methods. This initiative has resulted in the ability to collect and report on NSI organization-wide to advance decision-making support and identify quality improvement opportunities within the organization.Copyright Â© 2015 Longwoods Publishing.
Assessment of the responsiveness of the Cats' Assessment Tool for Cardiac Health (CATCH) Questionnaire. - Journal of veterinary cardiology : the official journal of the European Society of Veterinary Cardiology
To evaluate the responsiveness and optimal timing of a validated health-related quality of life questionnaire, and to assess the relationship between quality of life, severity of disease, and N-terminal pro B-type natriuretic peptide (NT-proBNP) in cats with acute congestive heart failure (CHF).Thirty client-owned cats with acute CHF.Echocardiography, International Small Animal Cardiac Health Council (ISACHC) stage, and NT-proBNP were assessed in cats within 36Â h of admission. The Cats' Assessment Tool for Cardiac Health (CATCH) Questionnaire (range of 0-80, with 80 being the worst possible score) was completed by cat owners and ISACHC stage was assessed at the time of hospital discharge, 3 days after discharge, and 7-14 days after discharge. NT-proBNP concentration was reassessed 7-14 days after discharge.The ISACHC stage at time of admission improved significantly by reevaluation 7-14 days after discharge (PÂ <Â 0.001). The decrease in median NT-proBNP concentration from time of admission (655Â pmol/L; range, 188 to >1500Â pmol/L) to reevaluation (583Â pmol/L; range, 41 to >1500Â pmol/L) was not significant (PÂ =Â 0.59). Median CATCH score was 26 (range, 0-70) at baseline, 19 (range, 0 to 61) at discharge, and 19 (range, 2-49) 7-14 days after discharge (PÂ =Â 0.89). CATCH scores did not correlate with NT-proBNP concentrations or ISACHC stage.These results suggest that the CATCH questionnaire requires further refinement for uses requiring a responsive instrument in cats with acute CHF.Copyright Â© 2015 Elsevier B.V. All rights reserved.
Pilot study of a myostatin antagonist in dogs with cardiac cachexia. - Journal of veterinary cardiology : the official journal of the European Society of Veterinary Cardiology
Cardiac cachexia, a loss of lean body mass caused byÂ heart disease, often accompanies congestive heart failure (CHF). Blocking myostatin, which is a protein that inhibits muscle growth, appears to greatly enhance muscle size and strength in rodent models and human clinical trials. The objective of this study was to evaluate a dog-specific myostatin antagonist (CAP-031) in a pilot study to test its safety and efficacy in dogs with CHF and cardiac cachexia.Dogs with CHF and cardiac cachexia.Eligible dogs received four weekly subcutaneous injections of CAP-031. Endpoints were body weight, body condition score (BCS, on a 1-9 scale), muscle condition score (MCS, on a five-point scale, where 0Â =Â no muscle loss and 4Â =Â severe muscle loss), appetite, and a quality of life (QOL) score.Seven dogs with CHF and moderate-to-severe cachexia were enrolled in the study. For the six dogs that completed the study, the median age was 8.8 years (range 6.4-10.6). At baseline, the median body weight was 27.0Â kg (range 17.3-62.0), the median BCS was 4 (2-5), and median MCS was 3 (3-4). There were no significant changes in body weight, BCS, appetite, or QOL score. The change in MCS (from a median of 3 at baseline to a median of 2.5 at week 4) was not statistically significant (pÂ =Â 0.06).The myostatin antagonist appeared to be well tolerated in most dogs. Earlier identification of cachexia is important, and randomized, controlled trials of myostatin antagonists or other drugs to treat cardiac cachexia are needed.Copyright Â© 2015 Elsevier B.V. All rights reserved.
Nutritional analysis and microbiological evaluation of commercially available enteral diets for cats. - Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)
To determine the prevalence of nutrients less than or greater than accepted standards in commercially available enteral diets for cats, and to identify contamination incidence in enteral diets for cats.Prospective cross-sectional study.University teaching hospital.Seven commercial enteral diets for cats.Labels were evaluated to determine if diets were intended to be nutritionally complete and balanced. One diet under storage techniques partially representative of clinical conditions was sampled on days 0, 1, 3, 5, and 7 of storage for aerobic bacterial culture.All 7 diets were analyzed for key nutrients and results were compared to Association of American Feed Control Officials (AAFCO) Nutrient Profiles for Adult Cats for maintenance and National Research Council recommended allowance (NRC-RA). From label information, 4 diets were classified as complete and balanced and 3 diets were classified as not complete and balanced. All 7 diets had at least 1 nutrient less than the AAFCO minimums and the NRC-RA. The total number of nutrients less than AAFCO minimums ranged from 3 to 9 (median = 4), with iron, potassium, and manganese being the most common. Concentrations of some nutrients were undetectable. None of the samples tested had a positive aerobic culture at baseline (day 0) or on subsequent samples from days 1, 3, 5, and 7 under any storage condition.None of the diets analyzed met all of the minimum nutrient concentrations. While short-term feeding may not be of concern for an individual patient, clinicians should be aware of potential nutritional limitations when feeding enteral diets to ill or injured cats.Â© Veterinary Emergency and Critical Care Society 2015.
Salmonella bacteriuria in a cat fed a Salmonella-contaminated diet. - Journal of the American Veterinary Medical Association
A 9-year-old castrated male domestic shorthair cat was evaluated because of hematuria and weight loss after an 8-year history of intermittent signs of feline lower urinary tract disease (FLUTD). A complete diet history revealed that the cat was eating a commercial diet that does not undergo the same processing procedures as most pet foods and so might be at increased risk for bacterial contamination owing to a nonstandard industry cooking procedure.The cat had a history consistent with FLUTD, but bacteriologic culture of the urine revealed Salmonella organisms. Additional analysis revealed Salmonella enterica serotype I:ROUGH-O:g,m,s:- in samples of urine and feces as well as Salmonella enterica serotype Johannesburg and Salmonella enterica serotype Senftenberg in the diet.The cat responded positively to antimicrobial treatment for the Salmonella bacteriuria as well as to dietary and environmental management for the clinical signs associated with FLUTD.Findings in this case highlighted an additional health consequence associated with ingestion of Salmonella-contaminated food. Such contamination is of particular concern with raw meat-based diets or diets that have not undergone standard industry cooking practices. Veterinarians should obtain a diet history for every companion animal during every evaluation to help with diagnosis and optimal treatment.
Veterinary Medicine and Multi-Omics Research for Future Nutrition Targets: Metabolomics and Transcriptomics of the Common Degenerative Mitral Valve Disease in Dogs. - Omics : a journal of integrative biology
Canine degenerative mitral valve disease (DMVD) is the most common form of heart disease in dogs. The objective of this study was to identify cellular and metabolic pathways that play a role in DMVD by performing metabolomics and transcriptomics analyses on serum and tissue (mitral valve and left ventricle) samples previously collected from dogs with DMVD or healthy hearts. Gas or liquid chromatography followed by mass spectrophotometry were used to identify metabolites in serum. Transcriptomics analysis of tissue samples was completed using RNA-seq, and selected targets were confirmed by RT-qPCR. Random Forest analysis was used to classify the metabolites that best predicted the presence of DMVD. Results identified 41 known and 13 unknown serum metabolites that were significantly different between healthy and DMVD dogs, representing alterations in fat and glucose energy metabolism, oxidative stress, and other pathways. The three metabolites with the greatest single effect in the Random Forest analysis were Î³-glutamylmethionine, oxidized glutathione, and asymmetric dimethylarginine. Transcriptomics analysis identified 812 differentially expressed transcripts in left ventricle samples and 263 in mitral valve samples, representing changes in energy metabolism, antioxidant function, nitric oxide signaling, and extracellular matrix homeostasis pathways. Many of the identified alterations may benefit from nutritional or medical management. Our study provides evidence of the growing importance of integrative approaches in multi-omics research in veterinary and nutritional sciences.
Expression Profiling of Circulating MicroRNAs in Canine Myxomatous Mitral Valve Disease. - International journal of molecular sciences
MicroRNAs (miRNAs) are small non-coding RNAs that have shown promise as noninvasive biomarkers in cardiac disease. This study was undertaken to investigate the miRNA expression profile in dogs with myxomatous mitral valve disease (MMVD). 277 miRNAs were quantified using RT-qPCR from six normal dogs (American College of Veterinary Internal Medicine Stage A), six dogs with MMVD mild to moderate cardiac enlargement (ACVIM Stage B1/B2) and six dogs with MMVD and congestive heart failure (ACVIM Stage C/D). Eleven miRNAs were differentially expressed (False Discovery Rate < 0.05). Dogs in Stage B1/B2 or C/D had four upregulated miRNAs, including three cfa-let-7/cfa-miR-98 family members, while seven others were downregulated, compared to Stage A. Expression of six of the 11 miRNAs also were significantly different between dogs in Stage C/D and those in Stage B1/B2. The expression changes were greater as disease severity increased. These miRNAs may be candidates for novel biomarkers and may provide insights into genetic regulatory pathways in canine MMVD.
Evaluation of marketing claims, ingredients, and nutrient profiles of over-the-counter diets marketed for skin and coat health of dogs. - Journal of the American Veterinary Medical Association
To evaluate marketing claims, ingredients, and nutrient profiles of over-the-counter diets marketed for skin and coat health of dogs.Cross-sectional study.24 over-the-counter dry and canned diets marketed for skin and coat health of dogs.Data on marketing claims and ingredients were collected from diet packaging and manufacturer websites. Concentrations of selected nutrients were obtained by contacting the manufacturers and were compared against minimum values for Association of American Feed Control Officials Dog Food Nutrient Profiles for adult dog maintenance based on calorie content.Most diets incorporated marketing terms such as digestive health, sensitive, or premium that are poorly defined and may have limited relevance to skin, coat, or general health. The types and numbers of major ingredients (ie, potential to contribute protein to the diet) differed. The total number of unique major ingredients in each diet ranged from 3 to 8 (median, 5.5), but the total number of unique ingredients in each diet ranged from 28 to 68 (median, 38). Concentrations of nutrients associated with skin and coat condition also differed widely.Results indicated that the large variation among over-the-counter diets marketed for skin and coat health may cause confusion for owners during diet selection. Owners of a dog with dermatologic problems should consult their veterinarian to select a good-quality diet that meets specific nutrient goals.
A pilot study comparing a protocol using intermittent administration of glargine and regular insulin to a continuous rate infusion of regular insulin in cats with naturally occurring diabetic ketoacidosis. - Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)
The goal of this pilot study was to compare regular insulin administered by continuous rate infusion (CRI) to an approach using insulin glargine and regular insulin administered intermittently.Prospective randomized clinical trial.University teaching hospital.Sixteen cats with diabetic ketoacidosis (DKA).Cats with DKA were randomized to either low-dose regular insulin CRI (CRI group; n = 8) or intermittent short- and long-acting insulin injections (subcutaneous [SC] glargine plus intramuscular [IM] regular insulin; SC/IM group; n = 8).Time of normalization of pH, bicarbonate, hyperglycemia, ketonemia, and appetite, as well as duration of hospitalization were recorded. Eleven of 16 cats (59%) survived to discharge, with no difference in survival between groups (P = 0.99). Times of resolution of hyperglycemia (P = 0.02) and ketonemia (P = 0.04), and normalization of pH (P = 0.04), and bicarbonate (P = 0.03) were significantly shorter in the SC/IM group. Cats in the SC/IM group also had a significantly shorter duration of hospitalization (SC/IM: median = 54 hr [range, 19-118 hr]; CRI: median = 111 hr [range, 58-271 hr]; P = 0.04). Time of first meal was not significantly different between groups.Although further research is required, an approach using intermittent short- and long-acting insulin injections appeared to be an effective option for treatment of DKA in cats.Â© Veterinary Emergency and Critical Care Society 2014.
Survey of dietary and medication practices of owners of cats with chronic kidney disease. - Journal of feline medicine and surgery
The objective of this study was to describe the dietary and medication patterns of cats with chronic kidney disease (CKD). In this prospective, cross-sectional descriptive study, owners of cats with CKD were asked to complete a web-based survey. The study was advertised on CKD-, pet-, veterinary- and breed-associated websites and list serves. Owners of 1089 cats with CKD participated in the study. The mean reported age of the cats with CKD was 13.7 Â± 4.2 years. Forty percent (430/1089) of cats had concurrent diseases, with hyperthyroidism, heart disease and inflammatory bowel disease being the most common. Veterinarian recommendation was the most common reason reported (684/1032; 66%) for diet selection, and 51% (556/1089) of owners fed a veterinary therapeutic diet formulated for kidney disease as some component of the diet. Many owners (466/1079; 43%) reported that their cats had an abnormal appetite; of these owners, 52% responded that their cats had a poor appetite or required coaxing to eat 5-7 days per week. Forty-seven percent and 51% of cats were receiving subcutaneous fluids and oral medications, respectively; however, most cats (811/1036; 78%) were not receiving phosphorus-binding medications. Fifty-six percent and 38% of cats received commercial cat treats and dietary supplements, respectively. Anorexia or hyporexia is a common problem in cats with CKD and may lead to cats being fed suboptimal diets for their disease. This information may be useful for treating or designing nutritional studies for cats with CKD.Â© ISFM and AAFP 2014.
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