90 Millburn Ave Suite 202
Millburn NJ 07041
Medical School: Other - Unknown
Accepts Medicare: No
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Participates In PQRS: No
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License #: TP 083-934
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Goal-Directed Transthoracic Echocardiography During Advanced Cardiac Life Support: A Pilot Study Using Simulation to Assess Ability. - Simulation in healthcare : journal of the Society for Simulation in Healthcare
Goal-directed echocardiography (GDE) is used to answer specific clinical questions that provide invaluable information to physicians managing a hemodynamically unstable patient. We studied perception and ability of house staff previously trained in GDE to accurately diagnose common causes of cardiac arrest during simulated advanced cardiac life support (ACLS); we compared their results with those of expert echocardiographers.Eleven pulmonary and critical care medicine fellows, 7 emergency medicine residents, and 5 cardiologists board certified in echocardiography were enrolled. Baseline ability to acquire 4 transthoracic echocardiography views was assessed, and participants were exposed to 6 simulated cardiac arrests and were asked to perform a GDE during ACLS. House staff performance was compared with the performance of 5 expert echocardiographers.Average baseline and scenario views by house staff were of good or excellent quality 89% and 83% of the time, respectively. Expert average baseline and scenario views were always of good or excellent quality. House staff and experts made the correct diagnosis in 68% and 77% of cases, respectively. On average, participants required 1.5 pulse checks to make the correct diagnosis. Of house staff, 94% perceived this study as an accurate assessment of ability.In an ACLS-compliant manner, house staff are capable of diagnosing management-altering pathologies the majority of the time, and they reach similar diagnostic conclusions in the same amount of time as expert echocardiographers in a simulated cardiac arrest scenario.
Biomechanical evaluation of S2 alar-iliac screws: effect of length and quad-cortical purchase as compared with iliac fixation. - Spine
A biomechanical study conducted on cadaveric specimens.(1) To compare the biomechanical strength of the S2 alar-iliac (S2AI) screw to traditional iliac fixation and (2) to examine the effect of length and trajectory on the S2AI screw.A recent technique to attain spinal fixation distal to S1 pedicle screws is the S2AI screw using either an open or a percutaneous approach with an altered S2 alar screw trajectory to obtain purchase in the ilium. A novel modification of the S2AI screw is placement with bicortical purchase in the ilium (quad-cortical screw). This may allow for a shorter-length screw with equivalent biomechanics.Seven human cadaveric spines (L2-Pelvis) were fixed at L2 proximally and the pubis distally. Pedicle screws were placed from L3-S1 with S2AI screw lengths of 65-mm, 80-mm, or 90-mm iliac screws. S2AI screws were tested with and without quad-cortical purchase. Each specimen was tested on the 6 degrees of freedom spine simulator. A load control protocol with an unconstrained pure moment of 10 Nm was used in flexion-extension, lateral bending, and axial rotation for a total of 3 load/unload cycles. The range of motion was normalized to the intact cadaveric spine (100%).All the instrumented constructs significantly reduced range of motion compared with the intact spine. The L3-S1 construct was statistically significantly less stable than all instrumented constructs in flexion-extension. There was statistically no significant difference between the S2AI screws of all lengths and the iliac screw constructs with offset connectors.S2AI screws are biomechanically as stable as the test constructs using iliac screws in all loading modes. Sixty-five-millimeter S2AI screws were biomechanically equivalent to 90-mm iliac screws and 80-mm S2AI screws. Quad-cortical purchase did not statistically significantly improve the biomechanical strength of S2AI screws.N/A.
Compliance issues in manufacturing of drugs. - The ocular surface
The therapeutic process relies on the assumption that the prescription written by the clinician is what is dispensed to the patient. In this article, we review the many factors involved in the manufacture of pharmaceutical products so that they consistently meet quality standards as approved by regulatory agencies. Industry and government agencies have developed procedures and laws to assure quality in Chemistry, Manufacturing and Controls (CMC) for pharmaceuticals, addressing conditions that may be harmful to patient health. This includes procedures for receipt of materials, production, packaging, labeling, quality control, release, storage and distribution, known as current Good Manufacturing Practice. Special control considerations for ophthalmic products include foreign particulate matter control, preservative effectiveness tests, sterility and leaching of chemicals from the packaging into the product. We also describe the "form, fill and seal" manufacture process as used in unit-dose, non-preserved ophthalmic products; product expiration dates; stages of drug development; and financial considerations for pharmaceutical companies.
The prognostic significance of horizontal plane QRS axis in elderly heart failure. - International journal of cardiology
In order to investigate whether horizontal plane QRS axis predicts the prognosis in elderly heart failure, we studied 80 consecutive patients by clinical assessment, ECG, Doppler and echocardiography. All patients were followed up for 2 years, 12 died and 68 survived. Age, gender distribution, blood pressure, co-existing diagnoses and medication were all similar between those who died and those who survived. The NYHA classification was significantly worse, left ventricular (LV) cavity size was greater, LV systolic function was lower in those who died than in survivors, despite similar LV wall thickness. On ECG, heart rate, PR interval, QT interval and frontal QRS axis did not differ between the two groups. The QRS duration was significantly longer and the horizontal QRS axis projected to a substantially more posterior direction in those who died than in survivors. The sensitivity and specificity of a horizontal QRS axis < or =-30 degrees for predicting death in 2 years were 75% and 62%, respectively. The former is above the sensitivity of a NYHA > or =3 and the latter is above the specificity of a LV shortening fraction < or =20%. The combination of a QRS horizontal axis < or =-30 degrees and NYHA > or =3 predicted 2 year mortality with a sensitivity of 75% and specificity of 91%. In conclusion, a left posterior QRS axis of the horizontal plane in elderly heart failure indicates an adverse prognosis, particularly when combined with NYHA classification and echocardiographic assessment.
The association of chronic atrial fibrillation with right atrial dilatation and left ventricular dysfunction in the elderly. - Medical science monitor : international medical journal of experimental and clinical research
Left atrial dilatation is often considered as one of the important causes for atrial fibrillation. In this study we sought to examine the relationship between right atrial dilatation and left ventricular function in patients with atrial fibrillation, and the association with the documented duration of the dysrrhythmia.56 consecutive patients with atrial fibrillation were investigated by means of clinical history, electrocardiography and echocardiography.Right atrial dilatation was found in 34, left atrial dilatation in 36 and bi-atrial dilatation in 31 patients. Patients with a dilated right atrium had a larger left atrium, lower left ventricular shortening fraction, and higher transmitral flow velocity than those with a normal right atrium. A history of atrial fibrillation of over 6 months was associated with enlarged atria, reduced left ventricular shortening fraction and increased transmitral flow compared to that of 3 months or less. Functional mitral and tricuspid regurgitation were only found in patients whose atrial fibrillation was over 6 months in duration.Dilatation of both right and left atria is common in chronic atrial fibrillation, and is associated with impaired left ventricular function. A longer duration of atrial fibrillation predisposes to atrial dilatation, left ventricular dysfunction, and functional atrio-ventricular regurgitation. These findings suggest that atrial fibrillation may have a significant contribution to morphological and functional cardiac changes, and raise the possibilities that early cardioversion or adequate rate control might prevent these changes and may improve prognosis in the elderly.
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90 Millburn Ave Suite 202 Millburn, NJ 07041
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