Atlantic Health System

About: Atlantic Health System is a healthcare organization based out in Morristown, New Jersey, United States. It is known for research contribution in the topics: Catheter ablation & Antiarrhythmic agent. The organization has 277 authors who have published 299 publications receiving 6594 citations.

Periurethral Lidocaine Does Not Decrease Pain After Urodynamic Testing in Women: A Double-Blinded Randomized Control Trial.

Abstract: Objective Urodynamic testing of women is a common procedure to evaluate lower urinary tract symptoms but may cause discomfort. The objective of our study was to determine the effect of externally applied periurethral 2% lidocaine gel on pain scores after complex urodynamic testing in women. Methods This prospective, double-blinded, placebo-controlled randomized trial compared 2% lidocaine gel to water-based lubricant applied to the periurethral area before urodynamic testing in women. Discomfort was measured using a visual analog pain scale (VAS) ranging from 0 to 100. The primary outcome was the difference in VAS from baseline to 4 to 6 hours after urodynamic testing. Secondary outcomes included: VAS difference from baseline to immediately postprocedure and 24 hours after urodynamic testing; VAS scores: at baseline, immediately postprocedure, after 4-6 hours, and after 24 hours; urodynamic testing results; and any adverse events. Sixty-four women per group were needed to provide a power of 80% to detect a 10-mm difference on a 100-point VAS. Results From January 2018 to March 2019, 134 subjects were randomized, 6 subjects were excluded, which resulted in 64 subjects in both the water-based lubricant group and 2% lidocaine gel group. There was no difference in baseline demographics. There was no significant difference in the change in VAS from baseline to 4 to 6 hours after UDT (0, 0 P = 0.88). No difference in secondary outcomes was noted. Conclusions Topically applied 2% lidocaine gel does not decrease pain compared with water-based lubricant. For most women, complex urodynamic testing is not associated with any significant pain. Clinical trial registration www.ClinicalTrials.gov,-NCT03390790, "Lidocaine for Pain After Urodynamic Testing".

Serum and CSF Cytokines in Patients with Active CNS Lyme Disease, other Inflammatory CNS Diseases, Encephalopathy Following Treated Lyme Disease, other Encephalopathies, and Normal Controls (S37.007)

Abstract: Objective: To investigate the hypothesis that neurobehavioral symptoms occurring in some Lyme disease patients after treatment are not due to CNS infection/inflammation, but possibly to systemic inflammation. Background: The etiology of post-treatment symptoms in Lyme disease patients is unknown and neurobehavioral symptoms are often inaccurately attributed to CNS infection. Despite a lack of supporting evidence, symptomatic patients often receive repeated courses of antibiotics, which are ineffective. In the absence of ongoing infection, such symptoms could result from an abnormal immune response. Design/Methods: Using multiplex assays, we characterized the inflammatory profile in serum from patients with post-treatment symptoms ranging from headache to encephalopathy (n=64). Results were compared to those from patients with similar symptoms unrelated to Lyme disease (n=47), patients with active CNS infection (n=15), and healthy controls (n=50). Similar assays were conducted on CSF from a subset of these patients, and additional patients with non-Lyme neuroinflammation. Results: CSF pleocytosis and elevations in multiple cytokines and chemokines, including CXCL13, were found in patients with active CNS Lyme infection and other neuroinflammatory conditions, but not in patients with post-treatment symptoms. In serum, IL-7 levels were significantly elevated in patients with neurobehavioral symptoms following treatment for Lyme disease (4.24±0.83 pg/ml compared to 0.70±0.07 pg/ml in controls). IL-7 was similarly elevated in symptomatic patients with no history of Lyme disease. Compared to controls, symptomatic patients also had higher levels of IL-17A, IL-17F, and MIP-1alpha. Conclusions: Patients with neurobehavioral symptoms following treatment for Lyme disease do not show any evidence of nervous system infection or inflammation. Elevations in serum IL-7 and IL-17 in these patients may reflect T-cell dysregulation. Interestingly, such elevations were seen in symptomatic patients regardless of prior Lyme disease exposure. These results warrant further investigation, as IL-7 may represent a useful biomarker, and could lead to the identification of novel therapeutic targets. Disclosure: Dr. Halperin has received personal compensation in an editorial capacity for The Neurologist. Dr. Halperin holds stock and/or stock options in Abbott Labs, Bristol Myers Squib, Johnson & Johnson. Dr. Pacheco-Quinto has nothing to disclose. Dr. Herdt has nothing to disclose. Dr. Eckman has nothing to disclose.

Deep Brain Stimulation for Autism Spectrum Disorder: Current and Future Uses

Abstract: Autism spectrum disorder (ASD) is a common and often disabling neurodevelopmental disorder of childhood with limited treatments. Deep brain stimulation surgery (DBS) was recently reported to benefit self-injurious behavior in some patients with low functioning ASD. Currently understood involvement of frontal-basal ganglia circuits in the inhibitory control of movement, thoughts, perceptions, emotions and other functions suggest an important disturbance of this system in ASD. This, in turn, suggests that DBS has potential benefits for higher functioning ASD patients with disabling repetitive motor and non-motor aspects. Experience with DBS for related conditions Tourette syndrome and obsessive-compulsive disorder provides insights into potential benefits and potential DBS targets for ASD. It appears to be rational to pursue systematic research studies of DBS as a treatment for aspects of ASD beyond SIB, particularly other disabling repetitive motor and non-motor features.

Estimating Practice Expense: Are We Forever Lost in an Accounting Labyrinth?

Abstract: amount of economic information related to medical practices. The survey asks respondents to collect and report gross costs associated with medical practice expenses. In contrast to the prior approach used hy HCFA wherein individual components of practice expense were compiled and valued based on recommendations from expert panels and availahle data (the \"hottom up\" approach), this method used actual total expenditures from surveyed practices without attempting to segment expenses. This is often a telephonic survey of demographic, economic, and clinical data. It is estimated that 130 or fewer cardiology practices responded to this telephone survey and only a fraction may have included economic information. Data on the surveys have not heen made widely availahle. It is reasonable to conclude that even a limited amount of data on pacing and electrophysiology practices was probably not included. It is not clear, however, if these latter practices are distinct from the cardiology practices polled. The data collected by expert panels on practice expense were largely discarded and were used only for purposes of relative valuation of codes within a given specialty. This new methodology, when analyzed, for a prototype code such as echocardiography, valued clinical work, materials, and supplies at 30%, and equipment at 5% of the calculations based on the expert panel recommendations of practice expense. A practice expense value of $83/hour has been derived from this methodology for cardiology. This is in the upper 40th percentile for all practice expense values for all specialties. However, this value is dependent in part on a correction applied for the time expended by the physician in delivering care. Cardiology has the largest number of work hours per week, which, in turn, depressed this value. Introduction