4860 Y Street, Suite 0100
Sacramento CA 95817
Medical School: Other - Unknown
Accepts Medicare: No
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: G29028
Request Appointment Information
Awards & Recognitions
Medical Malpractice Cases
Medical Board Sanctions
Inaccuracies in the Use of Magnification Markers in Digital Hip Radiographs. - Clinical orthopaedics and related research
With the ubiquity of digital radiographs, the use of digital templating for arthroplasty has become commonplace. Although improved accuracy with digital radiographs and magnification markers is assumed, it has not been shown.We wanted to (1) evaluate the accuracy of magnification markers in estimating the magnification of the true hip and (2) determine if the use of magnification markers improves on older techniques of assuming a magnification of 20% for all patients.Between April 2013 and September 2013 we collected 100 AP pelvis radiographs of patients who had a THA prosthesis in situ and a magnification marker placed per the manufacturer's instructions. Radiographs seen during our standard radiographic review process, which met our inclusion criteria (AP pelvic view that included a well-positioned and observed magnification marker, and a prior total hip replacement with a known femoral head size), were included in the analysis. We then used OrthoView(TM) software program to calculate magnification of the radiograph using the magnification marker (measured magnification) and the femoral head of known size (true magnification).The mean true magnification using the femoral head was 21% (SD, 2%). The mean magnification using the marker was 15% (SD, 5%). The 95% CI for the mean difference between the two measurements was 6% to 7% (p < 0.001). The use of a magnification marker to estimate magnification at the level of the hip using standard radiographic techniques was shown in this study to routinely underestimate the magnification of the radiograph using an arthroplasty femoral head of known diameter as the reference. If we assume a magnification of 20%, this more closely approximated the true magnification routinely. With this assumption, we were within 2% magnification in 64 of the 100 hips and off by 4% or more in only four hips. In contrast, using the magnification marker we were within 2% of true magnification in only 20 hips and were off by 4% or more in 59 hips.We found the use of a magnification marker with digital radiographs for preoperative templating to be generally inaccurate, with a mean error of 6% and range from -5% to 15%. Additionally, these data suggest that the use of a magnification marker while taking preoperative radiographs of the hip may be unnecessary, as simply setting the software to assume a 20% magnification actually was more accurate.Level III, diagnostic study.
Individual-level factors associated with variation in mycobacterial-specific immune response: Gender and previous BCG vaccination status. - Tuberculosis (Edinburgh, Scotland)
A more effective tuberculosis (TB) vaccine is needed to eliminate TB disease. Many new vaccine candidates enhance the immunogenicity of the existing vaccine, Bacillus Calmette-GuÃ©rin (BCG). Understanding BCG induced immune variation is key to developing a new vaccine.We aimed to establish if individual-level covariates were associated with cell-mediated immune response (interferon gamma (IFN-Î³)) at vaccine trial enrolment (baseline) in a long-term retrospective analysis (LTR) and after BCG vaccination in a short-term prospective analysis (STP).Four covariates were analysed: gender, country, BCG vaccination history and monocyte/lymphocyte cell count ratio. Univariable and multivariable linear regression were conducted on IFN-Î³ response at baseline for LTR, and area under the curve (AUC), 24 week and peak IFN-Î³ response for STP.Previous BCG vaccination was strongly associated with higher IFN-Î³ response at baseline (LTR analysis) (p-valuesÂ <Â 0.05). Being male showed a weak association with higher baseline response (p-valueÂ =Â 0.1). BCG revaccination was strongly associated with a larger response increase than primary-vaccination (AUC & peak p-valuesÂ <Â 0.01), but did not differ at 24 weeks (STP analysis). All other covariates were non-significant (p-valuesÂ >Â 0.1).This analysis suggests that previous BCG vaccination and gender are associated with durable IFN-Î³ responses. Vaccine trials may need to stratify by BCG vaccination history and gender.Copyright Â© 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.
The epidemiology of venous thromboembolism. - Journal of thrombosis and thrombolysis
Venous thromboembolism (VTE) is categorized by the U.S. Surgeon General as a major public health problem. VTE is relatively common and associated with reduced survival and substantial health-care costs, and recurs frequently. VTE is a complex (multifactorial) disease, involving interactions between acquired or inherited predispositions to thrombosis and VTE risk factors, including increasing patient age and obesity, hospitalization for surgery or acute illness, nursing-home confinement, active cancer, trauma or fracture, immobility or leg paresis, superficial vein thrombosis, and, in women, pregnancy and puerperium, oral contraception, and hormone therapy. Although independent VTE risk factors and predictors of VTE recurrence have been identified, and effective primary and secondary prophylaxis is available, the occurrence of VTE seems to be relatively constant, or even increasing.
Mapping of arterial location for the design of automated identification and analysis algorithms in whole body MRA. - Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference
Technological and medical advances have led to the realisation of full body imaging, with systemic diagnostic approaches becoming increasingly more prevalent. In the imaging of atherosclerotic disease, contrast -enhanced whole-body MRA has been demonstrated to enable detection of stenosis with a high sensitivity and specificity. Characterization of the systemic cardiovascular disease burden has significant prognostic value. A whole-body acquisition does however generate a large volume of three-dimensional data and as such there are expected to be significant advantages in developing automated techniques for the analysis of these images. Improved radiological workflow, reduced analysis time and increased analytical standardization are expected to be among the benefits offered by this approach. As part of a process of automated software development this study aimed to collect and validate arterial location ground truth. The data will be used to inform the development of semi-automated vascular identity tools, and allow the potential for the further development of semi-automated anatomically informed cardiovascular disease analysis and reporting.
The Impact and Cost-Effectiveness of a Four-Month Regimen for First-Line Treatment of Active Tuberculosis in South Africa. - PloS one
A 4-month first-line treatment regimen for tuberculosis disease (TB) is expected to have a direct impact on patient outcomes and societal costs, as well as an indirect impact on Mycobacterium tuberculosis transmission. We aimed to estimate this combined impact in a high TB-burden country: South Africa.An individual based M. tb transmission model was fitted to the TB burden of South Africa using a standard TB natural history framework. We measured the impact on TB burden from 2015-2035 of introduction of a non-inferior 4-month regimen replacing the standard 6-month regimen as first-line therapy. Impact was measured with respect to three separate baselines (Guidelines, Policy and Current), reflecting differences in adherence to TB and HIV treatment guidelines. Further scenario analyses considered the variation in treatment-related parameters and resistance levels. Impact was measured in terms of differences in TB burden and Disability Adjusted Life Years (DALYs) averted. We also examined the highest cost at which the new regimen would be cost-effective for several willingness-to-pay thresholds.It was estimated that a 4-month regimen would avert less than 1% of the predicted 6 million person years with TB disease in South Africa between 2015 and 2035. A similarly small impact was seen on deaths and DALYs averted. Despite this small impact, with the health systems and patient cost savings from regimen shortening, the 4-month regimen could be cost-effective at $436 [NA, 5983] (mean [range]) per month at a willingness-to-pay threshold of one GDP per capita ($6,618).The introduction of a non-inferior 4-month first-line TB regimen into South Africa would have little impact on the TB burden. However, under several scenarios, it is likely that the averted societal costs would make such a regimen cost-effective in South Africa.
Surgical Decision Making in the BRCA-Positive Population: Institutional Experience and Comparison with Recent Literature. - The breast journal
A retrospective study was performed to document the uptake and extent of surgical intervention in patients with a known mutation in the BRCA1/2 genes and associated outcomes. Data were collected retrospectively on BRCA-positive patients with and without cancer at the time of genetic testing. Our findings were compared to those published in the current literature. Of patients with cancer at testing, 61% chose bilateral mastectomies. Of patients without cancer, 54% chose risk-reducing surgery (RRS) including risk-reducing mastectomy (RRM), risk-reducing salpingo-oophorectomy (RRSO), or both. Time to surgery was significantly shorter to RRSO than to RRM. The literature suggests and our data support that acceptance of RRM in the BRCA-positive population has gradually increased over time. Consistently high rates of RRSO uptake and short intervals from time-of-testing to RRSO demonstrate that RRSO is still more acceptable to this population than RRM.Â© 2015 Wiley Periodicals, Inc.
NHS generic project: response from the wound care community. - British journal of community nursing
This series of letters outlines the response from MA Healthcare, key opinion leaders, and industry to the news that the Government is planning to introduce a generic project for wound dressings, limiting products to three main suppliers.
Research design considerations for single-dose analgesic clinical trials in acute pain: IMMPACT recommendations. - Pain
This article summarizes the results of a meeting convened by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) on key considerations and best practices governing the design of acute pain clinical trials. We discuss the role of early phase clinical trials, including pharmacokinetic-pharmacodynamic (PK-PD) trials, and the value of including both placebo and active standards of comparison in acute pain trials. This article focuses on single-dose and short-duration trials with emphasis on the perioperative and study design factors that influence assay sensitivity. Recommendations are presented on assessment measures, study designs, and operational factors. Although most of the methodological advances have come from studies of postoperative pain after dental impaction, bunionectomy, and other surgeries, the design considerations discussed are applicable to many other acute pain studies conducted in different settings.
NHS generic project: response from the wound care community. - British journal of nursing (Mark Allen Publishing)
This series of letters outlines the response from MA Healthcare, key opinion leaders and industry to the news that the Government is planning to introduce a generic project for wound dressings.
The PRIDE (Partnership to Improve Diabetes Education) Toolkit: Development and Evaluation of Novel Literacy and Culturally Sensitive Diabetes Education Materials. - The Diabetes educator
Patients with low literacy, low numeracy, and/or linguistic needs can experience challenges understanding diabetes information and applying concepts to their self-management. The authors designed a toolkit of education materials that are sensitive to patients' literacy and numeracy levels, language preferences, and cultural norms and that encourage shared goal setting to improve diabetes self-management and health outcomes. The Partnership to Improve Diabetes Education (PRIDE) toolkit was developed to facilitate diabetes self-management education and support.The PRIDE toolkit includes a comprehensive set of 30 interactive education modules in English and Spanish to support diabetes self-management activities. The toolkit builds upon the authors' previously validated Diabetes Literacy and Numeracy Education Toolkit (DLNET) by adding a focus on shared goal setting, addressing the needs of Spanish-speaking patients, and including a broader range of diabetes management topics. Each PRIDE module was evaluated using the Suitability Assessment of Materials (SAM) instrument to determine the material's cultural appropriateness and its sensitivity to the needs of patients with low literacy and low numeracy. Reading grade level was also assessed using the Automated Readability Index (ARI), Coleman-Liau, Flesch-Kincaid, Fry, and SMOG formulas.The average reading grade level of the materials was 5.3 (SD 1.0), with a mean SAM of 91.2 (SD 5.4). All of the 30 modules received a "superior" score (SAM >70%) when evaluated by 2 independent raters. The PRIDE toolkit modules can be used by all members of a multidisciplinary team to assist patients with low literacy and low numeracy in managing their diabetes.Â© 2015 The Author(s).
Map & Directions
4860 Y Street, Suite 0100 Sacramento, CA 95817
4860 Y St 2500, Acc
4400 V St
2221 Stockton Blvd
2315 Stockton Blvd
2425 Stockton Blvd Dept Of Orthopaedic Surgery