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Understanding Preclerkship Medical Students' Poor Performance in Prescription Writing. - Sultan Qaboos University medical journal
This study aimed to explore reasons for poor performance in prescription writing stations of the objective structured practical examination (OSPE) and absenteeism in prescription writing sessions among preclerkship medical students at the Arabian Gulf University (AGU) in Manama, Bahrain.This descriptive study was carried out between September 2014 and June 2015 among 157 preclerkship medical students at AGU. Data were collected using focus group discussions and a questionnaire with closed- and open-ended items.All 157 students participated in the study (response rate: 100.0%). The most frequently cited reasons for poor performance in OSPE stations were an inability to select the correct drugs (79.6%), treatment duration (69.4%), drug quantity (69.4%) and drug formulation (68.2%). Additionally, students reported inadequate time for completing the stations (68.8%). During focus group discussions, students reported other reasons for poor performance, including examination stress and the difficulty of the stations. Absenteeism was attributed to the length of each session (55.4%), lack of interest (50.3%), reliance on peers for information (48.4%) and optional attendance policies (47.1%). Repetitive material, large group sessions, unmet student expectations and the proximity of the sessions to summative examinations were also indicated to contribute to absenteeism according to open-ended responses or focus group discussions.This study suggests that AGU medical students perform poorly in prescription writing OSPE stations because of inadequate clinical pharmacology knowledge. Participation in prescription writing sessions needs to be enhanced by addressing the concerns identified in this study. Strategies to improve attendance and performance should take into account the learner-teacher relationship.
Perceptions of the Feasibility and Practicalities of Text Messaging-Based Infectious Disease Surveillance: A Questionnaire Survey. - JMIR mHealth and uHealth
In Vietnam, infectious disease surveillance data are collected via a paper-based system through four government tiers leading to a large delay. Meanwhile, mobile phones are abundant and very popular in the country, and known to be a useful tool in health care worldwide. Therefore, there is a great potential for the development of a timely disease surveillance system through the use of mobile phone short message service (SMS) text messages.This study aims to explore insights about the feasibility and practicalities of the utilization of SMS text messaging-based interventions in disease-reporting systems by identifying potential challenges and barriers in the text messaging process and looking at lessons learned.An SMS text messaging-based disease tracking system was set up in Vietnam with patient reports texted by clinic staff. Two 6-month trials utilizing this disease tracking system were designed and implemented in two northern provinces of Vietnam to report two infectious diseases: diarrhea and influenza-like illness. A structured self-reported questionnaire was developed to measure the feasibility and practicalities of the system from the participants. On the completion of the second trial in 2013, participating health staff from 40 commune health centers in the two pilot provinces were asked to complete the survey (N=80).Most participants were female (61%, 49/80) and nearly half (44%, 35/80) were heads of a commune health center. Approximately two-thirds (63%, 50/80) of participants retained the basic structure of the SMS text message report and there was a strong influence (OR 28.2, 95% CI 5.3-151.2) of those people on the time they spent texting the information. The majority (88%, 70/80) felt the information conveyed in the SMS text message report was not difficult to understand. Most (86%, 69/80) believed that they could report all 28 infectious diseases asked for by the Ministry of Health by using SMS text messaging.From a health center staff perspective, a disease-reporting system utilizing text messaging technology is easy to use and has great potential to be implemented and expanded nationwide. The survey showed positive perceptions and feedback from the participants and contributed to a promising practical solution to improve the surveillance system of infectious disease in Vietnam.
A Cancer Research UK First Time in Human Phase I Trial of IMA950 (Novel Multi Peptide Therapeutic Vaccine) in Patients with Newly Diagnosed Glioblastoma. - Clinical cancer research : an official journal of the American Association for Cancer Research
To perform a two-cohort, phase 1 safety and immunogenicity study of IMA950 in addition to standard chemo-radiotherapy (CRT) and adjuvant temozolomide in patients with newly diagnosed glioblastoma (GBM). IMA950 is a novel GBM specific therapeutic vaccine containing 11 tumor-associated peptides (TUMAPs), identified on human leukocyte antigen (HLA) surface receptors in primary human GBM tissue.Patients were HLA A*02 positive and had undergone tumor resection. Vaccination comprised 11 intradermal injections with IMA950 plus GM-CSF over a 24 week period, beginning 7-14 days prior to initiation of CRT (Cohort 1) or 7 days post CRT (Cohort 2). Safety was assessed according to NCI CTCAE Version 4.0 and TUMAP specific T cell immune responses determined. Secondary observations included progression-free survival (PFS), pre-treatment regulatory T-cell (Treg) levels and the effect of steroids on T-cell responses.Forty five patients were recruited. Related adverse events included minor injection site reactions, rash, pruritus, fatigue, neutropenia and single cases of allergic reaction, anemia and anaphylaxis. Two patients experienced Grade 3 dose limiting toxicity of fatigue and anaphylaxis. Of 40 evaluable patients, 36 were TUMAP responders and 20 were multi-TUMAP responders, with no important differences between cohorts. No effect of pre-treatment Treg levels on IMA950 immunogenicity was observed and steroids did not affect TUMAP responses. PFS was 74% at 6 months and 31% at 9 months.IMA950 plus GM-CSF was well tolerated with the primary immunogenicity endpoint of observing multi-TUMAP responses in at least 30% of patients exceeded. Further development of IMA950 is encouraged.Copyright Â©2016, American Association for Cancer Research.
Strange return. - Nursing standard (Royal College of Nursing (Great Britain) : 1987)
When I stepped back onto a ward for the first time after ten years of bringing up my three children I was lucky that I had been able to attend a three week 'Back To Nursing Course'.
Ethnic differences in inter- and intra-situational blood pressure variation: Comparisons among African-American, Hispanic-American, Asian-American, and European-American women. - American journal of human biology : the official journal of the Human Biology Council
The purpose of this study was to compare the daily inter- and intra-situational ambulatory blood pressure (BP) variation by ethnicity in women.The African-American (Nâ€‰=â€‰82; Ageâ€‰=â€‰39.7â€‰+â€‰8.9), Hispanic-American (Nâ€‰=â€‰25; ageâ€‰=â€‰37.5â€‰+â€‰9.4), Asian-American (Nâ€‰=â€‰22; Ageâ€‰=â€‰35.2â€‰+â€‰8.6), and European-American (Nâ€‰=â€‰122; Ageâ€‰=â€‰37.2+ 9.4) women in this study all worked in similar positions at two major medical centers in NYC. Each wore an ambulatory monitor during the course of one mid-week workday. Proportional BP changes from work or home to sleep, intra-situational BP variation (standard deviation [SD]) and mean situational BP levels were compared among the groups using ANOVA models.African-American and Asian-American women had significantly smaller proportional work-sleep systolic changes than either European- (Pâ€‰<â€‰0.05) or Hispanic-American (Pâ€‰<â€‰0.05) women, but the Asian-American women's changes tended to be smallest. The variability (SD) of diastolic BP at work was significantly greater among African- and Hispanic-American women compared to Asian- and European-American women (all Pâ€‰<â€‰0.05). African-American women had greater sleep variability than European-American women (Pâ€‰<â€‰0.05). Asian-American women had the highest level of sleep diastolic pressure (all comparisons Pâ€‰<â€‰0.05).African-American and Asian-American women have an attenuated proportional BP decline from waking environments to sleep compared to European-American and Hispanic-American women. Asian-American nocturnal BP may be elevated relative to all other groups. Am. J. Hum. Biol., 2016. Â© 2016 Wiley Periodicals, Inc.Â© 2016 Wiley Periodicals, Inc.
Fast foods - are they a risk factor for functional gastrointestinal disorders? - Asia Pacific journal of clinical nutrition
Fast-food consumption has greatly increased in Taiwan. Frequent fast food intake is associated with both allergy and obesity. The aim of this study was to describe fast food habit changes, and to assess the relationship between fast food intake and the risk of functional gastrointestinal disorders (FGIDs) among Taiwanese adolescents.This analysis used data from the Nutrition and Health Survey in Taiwan (NAHSIT) of high school students conducted in 2011. A total of 2,042 adolescents (12- 19 years) completed the questionnaire. The survey included the Rome III criteria for FGIDs, translated into Chinese for adolescents. Respondents with previously diagnosed chronic organic gastrointestinal diseases were excluded from the study.In total, 2,034 children were enrolled. 545 subjects (26.8%) had history of at least one FGID. 88.1% of the subjects reported fast foods consumption. A significantly higher prevalence of FGIDs was noted in adolescents with a history of fast foods consumption, compared with those reported not to have ingested fast foods in the past 30 days (27.6% vs 20.6%, p=0.024). An increased risk of FGIDs in children and adolescents was associated with fast food intake (OR 1.8, 95% CI: 1.78-1.83).FGIDs were common among Taiwanese adolescents. Fast-food consumption may contribute to a positive association with the development of functional gastrointestinal disorders. Lower fiber intake and more frozen desserts in the diet may be complicit in FGIDs. The findings have public health relevance in regard to the global increase in fast food consumption.
Knowledge and awareness about diabetes mellitus and diabetic retinopathy in suburban population of a South Indian state and its practice among the patients with diabetes mellitus: A population-based study. - Indian journal of ophthalmology
Ocular complications due to diabetes mellitus (DM) were on the rise despite good literacy levels in South India.To assess the knowledge and attitude toward DM and diabetic retinopathy of the general population in a suburban town of South India.Door-to-door population survey in suburban town of South India in May 2013.A 30-point questionnaire was prepared and the data were collected and analyzed to determine statistically the knowledge, attitude, and practice (KAP) scores of the general and diabetic population and also to determine significant demographic associations.In this study, 6211 people (3528 [56.8%] women and 2683 [43.2%] men) with a mean age of 55.6 Â± 11.7 years (range 21-98 years) were included. Good knowledge and positive attitude were observed in 3457 (55.6%) and 3280 (52.8%) people. Among 1538 (25.4%) people known to have DM, only 619 (40.7%) had good knowledge, 828 (53.8%) had a positive attitude, and 886 (57.6%) had good practice patterns. Although half of them followed general diabetic care, only 9.6% had undergone screening for retinopathy. Literacy showed a significant association with good KAP (P < 0.001 each) in general population and those with DM. Overall, women had significantly better knowledge (P < 0.001).Better literacy, especially among women, is contributory to better public awareness; however, the trend for poor practice patterns needs to be radically changed with aggressive public motivation emphasizing on the necessity of retinopathy screening and periodic follow-ups.
Towards monitoring dysplastic progression in the oral cavity using a hybrid fiber-bundle imaging and spectroscopy probe. - Scientific reports
Intraepithelial dysplasia of the oral mucosa typically originates in the proliferative cell layer at the basement membrane and extends to the upper epithelial layers as the disease progresses. Detection of malignancies typically occurs upon visual inspection by non-specialists at a late-stage. In this manuscript, we validate a quantitative hybrid imaging and spectroscopy microendoscope to monitor dysplastic progression within the oral cavity microenvironment in a phantom and pre-clinical study. We use an empirical model to quantify optical properties and sampling depth from sub-diffuse reflectance spectra (450-750â€‰nm) at two source-detector separations (374 and 730â€‰Î¼m). Average errors in recovering reduced scattering (5-26â€‰cm(-1)) and absorption coefficients (0-10â€‰cm(-1)) in hemoglobin-based phantoms were approximately 2% and 6%, respectively. Next, a 300â€‰Î¼m-thick phantom tumor model was used to validate the probe's ability to monitor progression of a proliferating optical heterogeneity. Finally, the technique was demonstrated on 13 healthy volunteers and volume-averaged optical coefficients, scattering exponent, hemoglobin concentration, oxygen saturation, and sampling depth are presented alongside a high-resolution microendoscopy image of oral mucosa from one volunteer. This multimodal microendoscopy approach encompasses both structural and spectroscopic reporters of perfusion within the tissue microenvironment and can potentially be used to monitor tumor response to therapy.
Correction: Relative Importance and Additive Effects of Maternal and Infant Risk Factors on Childhood Asthma. - PloS one
[This corrects the article DOI: 10.1371/journal.pone.0151705.].
Primer ID ultra-deep sequencing reveals dynamics of drug resistance-associated variants in breakthrough hepatitis C viruses: relevance to treatment outcome and resistance screening. - Antiviral therapy
Use of direct-acting antiviral drugs (DAAs) that target the Hepatitis C virus may be hampered by the rapid selection of viral strains that harbour drug resistance-associated variants (RAVs). These RAVs are often associated with a fitness cost and tend to occur on low frequency strains within treatment naÃ¯ve subjects. To address the clinical relevance of low frequency RAVs in the setting of DAAs, this study utilised a Primer ID ultra-deep sequencing approach to mitigate PCR errors and bias to accurately quantify viral sequences in subjects that failed DAA treatment.Subjects were enrolled in the follow-up study P05063 of previous treatment with boceprevir and all had detectable RAVs at virological failure (VF) based on Sanger-based population sequencing. Twelve subjects had three time-points available: baseline, VF, and follow-up (median 830.5 days). Viral RNA was amplified using unique primer identifiers (primer IDs) and sequenced using 454 ultra-deep sequencing.The sequencing strategy used in this study improved the detection of clinically relevant low frequency strains bearing RAVs compared to population sequencing and showed that these strains can persist for up to two years post-treatment failure. Strains carrying multiple RAVs were common in breakthrough viruses. Putative compensatory mutations were identified.The Primer ID ultra-deep sequencing approach identifies RAVs that can reduce drug sensitivity at levels below the detection threshold for population sequencing. The approach also removes PCR errors and biases, suggesting this sequencing strategy should become the standard approach by which to perform temporal quasispecies studies and resistance screening.
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