5204-A Rolling Road
Burke VA 22015
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Computer-Delivered Screening and Brief Intervention for Alcohol Use in Pregnancy: A Pilot Randomized Trial. - Alcoholism, clinical and experimental research
Although screening and brief intervention (SBI) for unhealthy alcohol use has demonstrated efficacy in some trials, its implementation has been limited. Technology-delivered approaches are a promising alternative, particularly during pregnancy when the importance of alcohol use is amplified. The present trial evaluated the feasibility and acceptability of an interactive, empathic, video-enhanced, and computer-delivered SBI (e-SBI) plus 3 tailored mailings, and estimated intervention effects.We recruited 48 pregnant women who screened positive for alcohol risk at an urban prenatal care clinic. Participants were randomly assigned to the e-SBI plus mailings or to a control session on infant nutrition, and were re-evaluated during their postpartum hospitalization. The primary outcome was 90-day period prevalence abstinence as measured by timeline follow-back interview.Participants rated the intervention as easy to use and helpful (4.7 to 5.0 on a 5-point scale). Blinded follow-up evaluation at childbirth revealed medium-size intervention effects on 90-day period prevalence abstinence (ORÂ =Â 3.4); similarly, intervention effects on a combined healthy pregnancy outcome variable (live birth, normal birthweight, and no neonatal intensive care unit stay) were also of moderate magnitude in favor of e-SBI participants (ORÂ =Â 3.3). As expected in this intentionally underpowered pilot trial, these effects were nonsignificant (pÂ =Â 0.19 and 0.09, respectively).This pilot trial demonstrated the acceptability and preliminary efficacy of e-SBI plus tailored mailings for alcohol use in pregnancy. These findings mirror the promising results of other trials using a similar approach and should be confirmed in a fully powered trial.Copyright Â© 2015 by the Research Society on Alcoholism.
The impact of pediatric blood and marrow transplant on parents: introduction of the parent impact scale. - Health and quality of life outcomes
Parents often experience stress-related complications when their child requires blood and marrow transplant (BMT). Previous studies have described the emotional toll BMT places on parents during the acute phase of care and within the context of clinical complications. In this paper we introduce the Parent Impact Scale (PARimpact), designed to capture physical and emotional challenges of the child's health on the parent. The primary aim of this paper is to examine psychometric properties of PARimpact, and the secondary aim is to explore factors associated with PARimpact scores for further hypothesis generation.This analysis used a merged dataset of two longitudinal studies. Accompanying parents (nâ€‰=â€‰363) of children undergoing BMT were surveyed up to six times from pre-BMT baseline to one year after their child's BMT. For this analysis, pre-BMT baseline responses to PARimpact were used to examine the factor structure with Principal Component Analysis (PCA) and Exploratory Factor Analysis (EFA). Construct validity was assessed, and multivariable regression was used to examine relationships between PARimpact and BMT clinical variables.PCA and EFA revealed a one-factor solution with acceptable item loading; Cronbach's Î± was 0.83 at baseline. Hypothesized differences in known groups were detected for BMT complications with significantly higher PARimpact scores for those with vs. without each complication. In the adjusted multivariable regression models, acute graft versus host disease (bâ€‰=â€‰5.3; pâ€‰=â€‰0.03), end organ toxicity (bâ€‰=â€‰5.9; pâ€‰<â€‰0.01), and systemic infection (bâ€‰=â€‰9.1; pâ€‰<â€‰0.01) were associated with significantly higher mean PARimpact scores in the first 3Â months following transplant. After the first 3Â months to 1Â year post BMT, systemic infection was associated with increased mean PARimpact scores (bâ€‰=â€‰19.2; pâ€‰<â€‰0.01).Initial results suggest that the PARimpact is valid and reliable. Our finding that clinical complications increase the impact of BMT on the caretaking parent indicates the need for BMT healthcare professionals to identify these events and help parents navigate the BMT course. Clinical application of the PARimpact scale should be considered to identify high-risk families and provide targeted interventions to augment care.
Alcohol Withdrawal Treatment in the Medically Hospitalized Patient: A Pilot Study Assessing Predictors for Medical or Psychiatric Complications. - Psychosomatics
Optimizing alcohol withdrawal treatment is a clinical priority, yet it is difficult to predict on presentation which patients would require benzodiazepines or in which patients withdrawal would be complicated. Detoxification studies typically exclude patients with medical comorbidities, psychiatric comorbidities, or multiple substance use disorders; therefore, it is difficult to generalize their conclusions to all types of patients.This retrospective study with no exclusion criteria identifies the risk factors for complicated withdrawal.A retrospective medical record review of 47 veterans admitted to a tertiary veteran's medical hospital for alcohol detoxification. Demographics, blood alcohol level, Charlson Comorbidity Index, drinks per drinking day, pre-psychiatry consult benzodiazepine administration, and length of stay were compared for veterans with complications vs those without.Overall, 21% patients experienced significant complications during their medically-managed detoxification, including behavioral disruptions and delirium tremens. Of the patients, 79% were initially assessed using the Clinical Institute Withdrawal Assessment for Alcohol-Revised scale, and 34% continued to be monitored with the Clinical Institute Withdrawal Assessment for Alcohol-Revised scale during their hospital stay. A Clinical Institute Withdrawal Assessment for Alcohol-Revised scale score â‰¥15 at presentation was significantly associated with increased odds of complications (p = 0.005). There was a trend toward significance of association of complications with tachycardia, history of delirium tremens, and benzodiazepines being administered before psychiatric consultation. The groups did not significantly differ with respect to age, admission blood alcohol level, Charlson Comorbidity Index, comorbid recent substance abuse, or length of stay.Clinical Institute Withdrawal Assessment for Alcohol-Revised scale scores â‰¥15 at presentation was significantly associated with increased odds of complicated alcohol withdrawal (odds ratio = 28, 95% CI: 2.5-317.6, p = 0.005), which supports findings from previous studies.Copyright Â© 2015 The Academy of Psychosomatic Medicine. All rights reserved.
Predictors of frequent emergency department use among patients with psychiatric illness. - General hospital psychiatry
To identify the patient characteristics associated with frequent emergency department (ED) use and develop a tool to predict risk for returning in the next month.Prospective cohort study of 863 adults with psychiatric illness presenting to one of four general hospital EDs. ED visits and relevant clinical information in the year before and one month after the index visit were abstracted.One hundred sixty-seven of the patients (19%) were considered frequent users. Characteristics associated with frequent user status were homelessness, cocaine-positive toxicology screen, Medicare insurance, a personality disorder and hepatobiliary disease (all P<.05). Patients scoring in the highest risk category had nearly five times the odds of returning to the ED in the month subsequent to the index visit.Psychiatric patients with frequent ED use are a heterogeneous group, but there are specific target conditions which, if confirmed, may facilitate reduced ED use and be replaced by more appropriate treatment.Published by Elsevier Inc.
Screening for alcohol and drug use during pregnancy. - Obstetrics and gynecology clinics of North America
The use of alcohol and other substances is not infrequent during pregnancy and may be associated with adverse effects on pregnancy outcome. Many pregnant women may continue these practices throughout pregnancy and even after delivery, unless they are recognized and assessed. Screening may be one way to achieve consistent and early identification. Prenatal health care providers may wish to screen all pregnant patients for their use of alcohol and other drugs using an approach that works best in their setting. A positive screen is an opportunity for the clinician and patient to discuss health practices and behaviors.Published by Elsevier Inc.
Cognitive and other predictors of change in quality of life one year after treatment for chronic myelogenous leukemia or myelodysplastic syndrome. - The Journal of neuropsychiatry and clinical neurosciences
The role of cognitive function in quality of life is important among the growing numbers of survivors after cancer treatment. The authors conducted a prospective cohort study of 106 adults evaluated 5.6 months (median) after diagnosis and 77 of 83 (93%) survivors 12 months later with neuropsychological assessments yielding information about simple reaction time to stimuli and other aspects of cognitive function and with two quality of life measures. The two most consistent predictors of change in quality of life were baseline quality of life ratings and simple reaction time. This novel finding about simple reaction time warrants further confirmation.
Fulminant phlegmasia cerulea dolens with concurrent cholangiocarcinoma and a lupus anticoagulant: a case report and review of the literature. - Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis
Phlegmasia cerulea dolens (PCD) is an aggressive and life-threatening form of venous thrombosis complicated by ischemic necrosis. Massive thrombosis extends to collateral veins resulting in venous congestion with fluid sequestration in the interstitium causing collapse of arterioles, which progresses to ischemia and, if severe, circulatory collapse and shock. The mortality rate for PCD is as high as 40%, especially when gangrene develops. PCD has been associated with acquired thrombophilias, including malignancy and antiphospholipid syndrome (APS). We present a unique case of a patient with PCD refractory to anticoagulant and thrombolytic therapy, whose fulminant course was attributed to concurrent cholangiocarcinoma and antiphospholipid antibodies identified by a positive lupus anticoagulant assay. This case highlights the importance of uncovering precipitating causes of thromboembolism, which may offer prognostic information and may necessitate therapy beyond anticoagulation and thrombolysis to reduce the morbidity of PCD. The current literature on PCD and APS, along with their associations with malignancy, is reviewed.
Acceptability of a computerized brief intervention for alcohol among abstinent but at-risk pregnant women. - Substance abuse
Limitations in time and training have hindered widespread implementation of alcohol-based interventions in prenatal clinics. Also, despite the possibility of underreporting or relapse, many at-risk women report that they quit drinking after pregnancy confirmation so that interventions focusing on current drinking may seem unnecessary. The Computerized Brief Intervention for Alcohol Use in Pregnancy (C-BIAP) was designed to (a) be implemented via a handheld device in prenatal clinics, and (b) use a modified brief intervention strategy with women who screen at-risk but report no current drinking.The authors administered the C-BIAP to 18 T-ACE (Tolerance, Annoyance, Cut Down, and Eye Opener)-positive pregnant African American women who provided quantitative and qualitative feedback.The C-BIAP received high ratings of acceptability; qualitative feedback was also positive overall and suggested good acceptance of abstinence themes.Technology may be a feasible and acceptable method for brief intervention delivery with pregnant women who do not report current drinking.
In vitro fertilization outcomes and alcohol consumption in at-risk drinkers: the effects of a randomized intervention. - The American journal on addictions / American Academy of Psychiatrists in Alcoholism and Addictions
Women's use of alcohol in pregnancy is associated with an increased risk of fetal loss and birth defects. Also, alcohol use in women decreases the success of infertility treatment, such as in vitro fertilization (IVF). Our goal was to determine if there were differences in IVF outcomes and alcohol use parameters among at-risk drinkers randomized to a brief intervention (BI) versus assessment only (AO).We conducted a randomized controlled trial to determine the effect of BI or AO among at-risk drinkers on IVF. We studied 37 women (AO = 21; BI = 16).While the BI group had a significantly greater decrease in the number of drinks/drinking day compared to the AO group (p =â€‰.04), there were no differences in the likelihood of implantation failure, chemical pregnancy, spontaneous abortion, preterm birth, or live birth.BI and AO contributed to a decrease in alcohol use and did not demonstrate differences in IVF outcomes. A larger study may confirm these preliminary findings.Our results will assist care providers in treating alcohol use in pregnancy in an effective way, such that IVF cycles and the chance of pregnancy are optimized.Copyright Â© American Academy of Addiction Psychiatry.
Brief intervention for risk-drinking women: a mixed methods analysis of content and process. - The American journal on addictions / American Academy of Psychiatrists in Alcoholism and Addictions
Although brief interventions (BIs) are among the most highly promoted treatments for alcohol problems, their effective components are unknown. This may be particularly important when considering women since some reviews have suggested that BIs are more efficacious among men. The purpose of this pilot study is to utilize a mixed methods and gender analysis approach to generate hypotheses about the effective components of BIs given to women with medical problems exacerbated by problem drinking.Random sample of 20 BIs given to women with diabetes, hypertension, infertility, or osteoporosis. Quantitative and qualitative analytic methods were undertaken in a stepwise progression, followed by a gender analysis using the Worldview Assessment Framework.Main findings include that a worldview encompassing drinking as an entitlement may be a moderator limiting the effectiveness of a BI, that understanding the impact of alcohol on infertility problems as distinct from prenatal alcohol use may be a mediator for BI effectiveness, and that providing information about sensible drinking limits in the context of a specific medical problem was feasible.Content and process areas are important to consider when offering BI for risk-drinking women with medical problems and may help to improve treatment efficacy in this group.Copyright Â© American Academy of Addiction Psychiatry.
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