Showing papers by "Atlantic Health System published in 2013"

Prospective study of an ultra-lightweight polypropylene Y mesh for robotic sacrocolpopexy.

Abstract: To prospectively evaluate the use of a particular polypropylene Y mesh for robotic sacrocolpopexy. This was a prospective study of 120 patients who underwent robotic sacrocolpopexy. We compared preoperative and 12-month postoperative objective and subjective assessments via the Pelvic Organ Prolapse Quantification (POP-Q), the Pelvic Floor Distress Inventory, Short Form 20 (PFDI-20); the Pelvic Floor Impact Questionnaire, Short Form 7 (PFIQ-7); and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire 12 (PISQ-12). Objective “anatomical success” was defined as POP-Q stage 0 or 1 at all postoperative intervals. We further defined “clinical cure” by simultaneously considering POP-Q points and subjective measures. To be considered a “clinical cure,” a given patient had to have all POP-Q points ≤0, apical POP-Q point C ≤5, no reported pelvic organ prolapse symptoms on the PFDI-20, and no reoperation for prolapse at all postoperative intervals. Of the 120 patients, 118 patients completed the 1-year follow-up. The objective “anatomical success” rate was 89 % and the “clinical cure” rate was 94 %. The PFDI-20 mean score improved from 100.4 at baseline to 21.0 at 12 months (p < 0.0001); PFIQ-7 scores improved from 61.6 to 8.0 (p < 0.0001); and PISQ-12 scores improved from 35.7 to 38.6 (p < 0.0009). No mesh erosions or mesh-related complications occurred. The use of this ultra-lightweight Y mesh for sacrocolpopexy, eliminated the mesh-related complications in the first postoperative year, and provided significant improvement in subjective and objective outcomes.

Random unstimulated pediatric luteinizing hormone levels are not reliable in the assessment of pubertal suppression during histrelin implant therapy

Abstract: Background Gonadotropin-releasing hormone agonist (GnRHa)-stimulated luteinizing hormone (LH) is the standard hormonal assessment for both diagnosis and therapeutic monitoring of children with central precocious puberty (CPP). Use of unstimulated (random) LH levels may be helpful in diagnosis and has gained popularity in monitoring GnRHa therapy despite lack of validation against stimulated values. The objective of this investigation was to assess the suitability of random LH for monitoring pubertal suppression during GnRHa treatment.

Nerve protecting dissection device

Abstract: The present invention provides an energy based dissection device that automatically provides a nerve protection function. Specifically, the present invention operatively connects nerve monitoring technology and energy based dissection technology to provide a device that provides energy based dissection functionality that cannot operate, or operates differently, upon receipt of real time information from the nerve monitoring functionality that nerve damage may be imminent in the absence of such safety shutdown. The present invention also creates a real-time graphical display of the nerve, including size and location relative to the energy based dissection device to enable the operator to safely and accurately avoid damaging the nerve. Accordingly, the present invention provides a surgical device that removes human error and reaction time issues which prevent unintended dissection and concomitant nerve damage.

Augmentation in restless legs syndrome: poor response to sudden withdrawal of dopaminergic therapy

Abstract: License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Ltd, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Ltd. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Journal of Parkinsonism and Restless Legs Syndrome 2013:3 49–52 Journal of Parkinsonism and Restless Legs Syndrome Dovepress

Subjective and objective outcomes 1 year after robotic-assisted laparoscopic sacrocolpopexy.

Abstract: We aimed to assess the subjective and objective outcomes 1 year after robotic sacrocolpopexy using a type I polypropylene mesh. This was a case series of 64 patients who underwent a robotic-assisted laparoscopic sacrocolpopexy using a type I monofilament polypropylene mesh coated with hydrophilic porcine collagen. Objective and subjective outcomes were assessed using the pelvic organ prolapse quantification (POP-Q), the short forms of the Pelvic Floor Impact Questionnaire (PFIQ 7) and the Pelvic Floor Distress Inventory (PFDI-20). Outcome measures were collected pre-operatively and 1 year post-operatively on all but one patient, who was lost to follow-up. Paired comparisons between pre- and post-operative outcomes were performed using the Wilcoxon signed rank test. At 1 year, POP-Q stage II or greater and loss of follow-up were considered to be surgical failure. The “surgical cure” rate was 89%. We observed three distal anterior failures, two distal posterior failures and one apical failure, and one patient was lost to follow-up. We found significant differences between pre- and post-operative POP-Q measurements (p < 0.001) and PFDI-20/PFIQ-7 total scores (p < 0.001). Robotic sacrocolpopexy using this polypropylene mesh resulted in significant improvements in subjective and objective outcome measures at 1 year.

Patient Directed Healthcare System

Abstract: The present invention provides a system allowing an individual to actively manage, oversee, direct, and interact with their healthcare. Specifically, the present invention provides a system that allows for the continuous input of updated information from the team of healthcare providers and the patient with full access to the patient history all with real time continuous analysis to provide feedback of likely critical data to consider in the decision of next best steps to provide the only participant whose only motive is to get better as expeditiously as possible with the knowledge necessary to actively manage, oversee and direct their own healthcare. In particular, the present invention provides a system whereby the individual's personal health records are selectively inputted and shared with others and compared with databases of stored information, and the information returned is used by the individual, or others to provide efficient healthcare and manage public health emergencies.

Pseudoparkinsonism: A review of a common nonparkinsonian hypokinetic movement disorder

Abstract: This article reviews the syndrome pseudoparkinsonism, a movement disorder described in the literature that resembles parkinsonism but differs qualitatively. Patients with this disorder have apraxic slowness, paratonic rigidity, frontal gait disorder and elements of akinesia that, taken together, may be mistaken for true parkinsonism. Pseudoparkinsonism appears to be common and is most often due to Alzheimer’s disease or vascular dementia. It seems that patients with even mild cognitive deficits can present with pseudoparkinsonism and that the primary dementing disorder may be overlooked. The authors emphasize the importance of pseudoparkinsonism and implications for clinical diagnosis, treatment and research.

Cost-effectiveness analysis comparing robotic sacrocolpopexy to a vaginal mesh hysteropexy for treatment of uterovaginal prolapse

Abstract: Objective: To compare costs and QoL associated with 2 minimally invasive operations to treat uterovaginal prolapse. Study Design: A decision analytic cost-effectiveness model comparing vaginal mesh hysteropexy to robotic-assisted sacrocolpopexy. Costs were derived from a hospital perspective. QoL estimates focused on: recurrent prolapse; erosion; infection; transfusion; cystotomy; chronic pain; lower urinary tract symptoms; and mortality. Actual procedural costs at our institution were calculated. Costs and quality adjusted life years were examined over 1 year. Results: The costs ($21,853) and QALYs (0.9645) for robotic sacrocolpopexy produced a CE Ratio of $22,657 per QALY. The costs ($14,890) and QALYs (0.9309) for vaginal mesh produced a CE Ratio of $15,995 per QALY. The incremental cost per QALYs for robotic surgery was $207,232. Sensitivity analysis on all utilities, cost estimates, and complication estimates didn’t cross any thresholds. Conclusion: Vaginal mesh was more cost-effective than robotic sacrocolpopexy even when the cost of the robot was not factored.

Complementary, Integrative, and Holistic Medicine: Integrative Approaches to Pediatric Ulcerative Colitis

Abstract: 1. Alycia Leiby, MD* 2. Minal Vazirani, MD† 1. *Pediatric Gastroenterology and Nutrition, Goryeb Children's Hospital/Atlantic Health System, Morristown, NJ, and Department of Pediatrics, Mount Sinai School of Medicine, New York, NY. 2. †Integrative Medicine, Barnabas Health Ambulatory Care Center, Siegler Center for Integrative Medicine, Livingston, NJ. * Abbreviations: IBD: : inflammatory bowel disease UC: : ulcerative colitis 5-ASA: : 5-aminosalicylate CAM: : complementary and alternative medicine QoL: : quality of life ECN: : E Coli Nissle Twenty-five percent of inflammatory bowel disease (IBD) occurs in childhood, with 2 of 100,000 children age 1 to 17 years diagnosed as having ulcerative colitis (UC) in North America. (1) In a genetically predisposed individual, environmental factors lead to a dysregulated adaptive immune response to luminal commensal bacterial antigens, resulting in IBD. Although diet, infections, medications, and lack of breastfeeding have been implicated, further research is needed to elucidate the complex environmental and genetic interaction producing IBD. (2)(3)(4) Pediatric UC is often more extensive at initial presentation, with a 20% colectomy rate at 1 year in severe disease. (5) The risk of colorectal cancer, a potential long-term complication, is increased in those with a longer duration and earlier age of disease onset and greater extent of inflammation. (6) Conventional treatment of UC includes the use of corticosteroids to induce remission in moderate to severe disease and topical 5-aminosalicylate (5-ASA) as maintenance therapy. Recent prospective data confirmed the steroid-sparing effects of maintenance therapy with the immune-modulating thiopurine drugs 6-mercaptopurine and azathioprine in moderate to severe disease unresponsive to 5-ASA agents. (7) In children in whom conventional therapy fails, infliximab, a monoclonal antibody directed against tumor necrosis factor α, has been effective. (8) Despite evidence of benefit, the risk of infection and malignancy affect acceptance of administering these immune-modifying agents. The incidence of complementary and alternative medicine (CAM) use in pediatric IBD patients ranges from 40% to 70%. (9)(10)(11)(12) The common reason for using CAM is concern about adverse effects and the lack of efficacy of conventional therapies. Use of CAM was increased, particularly in patients with worse quality of life (QoL). (11)(13) This …