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Search Results: 1 - 10 of 231135 matches for " Michael G. Heckman "
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Physician versus Patient Perception of Physician Hospital Discharge Communication: A Preliminary Study  [PDF]
Michael J. Maniaci, Michael G. Heckman, Nancy L. Dawson
Open Journal of Internal Medicine (OJIM) , 2014, DOI: 10.4236/ojim.2014.44016
Abstract: Background: Physician discharge instructions are critical to patient care because they are the link transitioning the hospital care plan to the home. We hypothesize that physician perception of discharge instructions communication is better than patient perception. Objective: In a preliminary study, to compare patient and physician perception of communication at discharge. Design: Observational, survey-based. Setting: 330-bed adult teaching hospital. Participants: Surveys were mailed to 100 patients discharged home and 49 internal medicine physicians responsible for those patients’ care. Each physician had between 1 and 4 patients surveyed. Measurements: Patients and physicians received anonymous 5-item questionnaires concerning physician communication at discharge. Patient surveys inquired about their physicians’ communication at the specific physician encounter, while physician surveys asked about the physicians’ overall self-perception of discharge communication skills. Results: Completed questionnaires were returned by 59 patients and 40 physicians. Physicians reported a noticeably better perception of communication than their patients regarding spending adequate time reviewing the discharge plan (83% vs. 61%, P = 0.027), speaking slowly enough to understand (98% vs. 80%, P = 0.013), using wording that could be easily understood (100% vs. 68%, P < 0.001) and taking time to answer questions before discharge (85% vs. 59%, P = 0.008). Perception of discharge communication improved with physician experience for several survey items. Conclusions: This study provides evidence suggesting that physician perception of communication at discharge is better than patient perception. Future studies of larger sample size and direct patient-physician pairing focusing on patient satisfaction and outcomes are needed.
Outcomes following liver transplantation in intensive care unit patients
Lena Sibulesky,Michael G Heckman,C Burcin Taner,Juan M Canabal
World Journal of Hepatology , 2013, DOI: 10.4254/wjh.v5.i1.26
Abstract: AIM: To determine feasibility of liver transplantation in patients from the intensive care unit (ICU) by estimating graft and patient survival. METHODS: This single center retrospective study included 39 patients who had their first liver transplant directly from the intensive care unit and 927 non-ICU patients who were transplanted from hospital ward or home between January 2005 and December 2010. RESULTS: In comparison to non-ICU patients, ICU patients had a higher model for end-stage liver disease (MELD) at transplant (median: 37 vs 20, P < 0.001). Fourteen out of 39 patients (36%) required vasopressor support immediately prior to liver transplantation (LT) with 6 patients (15%) requiring both vasopressin and norepinephrine. Sixteen ICU patients (41%) were ventilator dependent immediately prior to LT with 9 patients undergoing percutaneous tracheostomy prior to transplantation. Twenty-five ICU patients (64%) required dialysis preoperatively. At 1, 3 and 5 years after LT, graft survival was 76%, 68% and 62% in ICU patients vs 90%, 81% and 75% in non-ICU patients. Patient survival at 1, 3 and 5 years after LT was 78%, 70% and 65% in ICU patients vs 94%, 85% and 79% in non-ICU patients. When formally comparing graft survival and patient survival between ICU and non-ICU patients using Cox proportional hazards regression models, both graft survival [relative risk (RR): 1.94, 95%CI: 1.09-3.48, P = 0.026] and patient survival (RR: 2.32, 95%CI: 1.26-4.27, P = 0.007) were lower in ICU patients vs non-ICU patients in single variable analysis. These findings were consistent in multivariable analysis. Although not statistically significant, graft survival was worse in both patients with cryptogenic cirrhosis (RR: 3.29, P = 0.056) and patients who received donor after cardiac death (DCD) grafts (RR: 3.38, P = 0.060). These findings reached statistical significance when considering patient survival, which was worse for patients with cryptogenic cirrhosis (RR: 3.97, P = 0.031) and patients who were transplanted with DCD livers (RR: 4.19, P = 0.033). Graft survival and patient survival were not significantly worse for patients on mechanical ventilation (RR: 0.91, P = 0.88 in graft loss; RR: 0.69, P = 0.56 in death) or patients on vasopressors (RR: 1.06, P = 0.93 in graft loss; RR: 1.24, P = 0.74 in death) immediately prior to LT. Trends toward lower graft survival and patient survival were observed for patients on dialysis immediately before LT, however these findings did not approach statistical significance (RR: 1.70, P = 0.43 in graft loss; RR: 1.46, P = 0.58 in
Evaluation of Serum Calcium as a Predictor of Biochemical Recurrence following Salvage Radiation Therapy for Prostate Cancer
Jennifer L. Peterson,Steven J. Buskirk,Michael G. Heckman,Alexander S. Parker
ISRN Oncology , 2013, DOI: 10.1155/2013/239241
Estimation of PSA Half-Life Following Salvage Radiation Therapy  [PDF]
Ajay B. Patel, Katherine S. Tzou, Michael G. Heckman, Colleen S. Thomas, Richard J. Lee, Nitesh Paryani, Thomas M. Pisansky, Jennifer L. Peterson, Robert C. Miller, Stephen J. Ko, Laura A. Vallow, Steven J. Buskirk
Journal of Cancer Therapy (JCT) , 2018, DOI: 10.4236/jct.2018.91002
Abstract: Background:?We aim to estimate prostate-specific antigen (PSA) half-life after salvage radiation therapy (SRT) in patients with detectable PSA after radical prostatectomy (RP). Methods: A total of 272 patients treated with salvage radiotherapy between July 1987 and July 2010 were included in this IRB approved retrospective analysis. The median pre-salvage radiotherapy dose was 0.6 ng/mL (range, 0.2 - 21.9 ng/mL), 47 patients had at least a minimum tumor stage of T3b, 29 had a Gleason score over 7, and median dose was 66.6 Gy (range, 54.0 - 72.4 Gy). Results: The estimated PSA half-life in our cohort of patients was 3.0 months (95% CI, 2.9 - 3.2 months; range, 0.5 -
The Role of Preoperative Bilateral Breast Magnetic Resonance Imaging in Patient Selection for Partial Breast Irradiation in Ductal Carcinoma In Situ
Kristin V. Kowalchik,Laura A. Vallow,Michelle McDonough,Colleen S. Thomas,Michael G. Heckman,Jennifer L. Peterson,Cameron D. Adkisson,Christopher Serago,Steven J. Buskirk,Sarah A. McLaughlin
International Journal of Surgical Oncology , 2012, DOI: 10.1155/2012/206342
Abstract: Purpose. Women with ductal carcinoma in situ (DCIS) are often candidates for breast-conserving therapy, and one option for radiation treatment is partial breast irradiation (PBI). This study evaluates the use of preoperative breast magnetic resonance imaging (MRI) for PBI selection in DCIS patients. Methods. Between 2002 and 2009, 136 women with newly diagnosed DCIS underwent a preoperative bilateral breast MRI at Mayo Clinic in Florida. One hundred seventeen women were deemed eligible for PBI by the NSABP B-39 (National Surgical Adjuvant Breast and Bowel Project, Protocol B-39) inclusion criteria using physical examination, mammogram, and/or ultrasound. MRIs were reviewed for their impact on patient eligibility, and findings were pathologically confirmed. Results. Of the 117 patients, 23 (20%) were found ineligible because of pathologically proven MRI findings. MRI detected additional ipsilateral breast cancer in 21 (18%) patients. Of these women, 15 (13%) had more extensive disease than originally noted before MRI, and 6 (5%) had multicentric disease in the ipsilateral breast. In addition, contralateral breast cancer was detected in 4 (4%). Conclusions. Preoperative breast MRI altered the PBI recommendations for 20% of women. Bilateral breast MRI should be an integral part of the preoperative evaluation of all patients with DCIS being considered for PBI. 1. Introduction Ductal carcinoma in situ (DCIS) is a noninvasive breast cancer and represents a complex pathologic condition in which malignant epithelial cells arise and proliferate within the ducts of the breast but do not invade the basement membrane. According to the Surveillance Epidemiology and End Results program (SEER), DCIS represents 14% of all new breast cancer diagnoses in the United States [1]. Radiation therapy has historically been delivered to the whole-breast after breast-conserving surgery. Adjuvant radiation has been shown to improve local tumor control in multiple prospective, randomized clinical trials [2–4]. Partial breast irradiation (PBI) has been developed as a way to deliver radiation directly to the tumor cavity of the breast after breast-conserving surgery in lieu of whole-breast radiation therapy. PBI can be delivered by multiple techniques, including interstitial and intracavitary brachytherapy, intraoperative radiotherapy, 3-dimensional (3D) conformal or intensity-modulated radiation therapy, or proton therapy. As less breast tissue is being irradiated, the potential benefits include decreased acute toxicity to the breast and potential decreased risk of late toxicity due
Evaluation of the Role of SNCA Variants in Survival without Neurological Disease
Michael G. Heckman, Alexandra I. Soto-Ortolaza, Nancy N. Diehl, Minerva M. Carrasquillo, Ryan J. Uitti, Zbigniew K. Wszolek, Neill R. Graff-Radford, Owen A. Ross
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0042877
Abstract: Background A variety of definitions of successful aging have been proposed, many of which relate to longevity, freedom from disease and disability, or preservation of high physical and cognitive function. Many behavioral, biomedical, and psychological factors have been linked with these various measures of successful aging, however genetic predictors are less understood. Parkinson's disease (PD) is an age-related neurodegenerative disorder, and variants in the α-synuclein gene (SNCA) affect susceptibility to PD. This exploratory study examined whether SNCA variants may also promote successful aging as defined by survival without neurological disease. Methods We utilized 769 controls without neurological disease (Mean age: 79 years, Range: 33–99 years) and examined the frequency of 20 different SNCA variants across age groups using logistic regression models. We also included 426 PD cases to assess the effect of these variants on PD risk. Results There was a significant decline in the proportion of carriers of the minor allele of rs10014396 as age increased (P = 0.021), from 30% in controls younger than 60 to 14% in controls 90 years of age or older. Findings were similar for rs3775439, where the proportion of carriers of the minor allele declined from 32% in controls less than 60 years old to 19% in those 90 or older (P = 0.025). A number of SNCA variants, not including rs10014396 or rs3775439, were significantly associated with susceptibility to PD. Conclusions In addition to its documented roles in PD and α-synucleinopathies, our results suggest that SNCA has a role in survival free of neurological disease. Acknowledging that our findings would not have withstood correction for multiple testing, validation in an independent series of aged neurologically normal controls is needed.
Glycemic Control after Total Pancreatectomy for Intraductal Papillary Mucinous Neoplasm: An Exploratory Study
Laith H. Jamil,Ana M. Chindris,Kanwar R. S. Gill,Daniela Scimeca,John A. Stauffer,Michael G. Heckman,Shon E. Meek,Justin H. Nguyen,Horacio J. Asbun,Massimo Raimondo,Timothy A. Woodward,Michael B. Wallace
HPB Surgery , 2012, DOI: 10.1155/2012/381328
Abstract: Background. Glycemic control following total pancreatectomy (TP) has been thought to be difficult to manage. Diffuse intraductal papillary mucinous neoplasm (IPMN) is a potentially curable precursor to pancreatic adenocarcinoma, best treated by TP. Objective. Compare glycemic control in patients undergoing TP for IPMN to patients with type 1 diabetes mellitus (DM). Design/Setting. Retrospective cohort. Outcome Measure. Hemoglobin A1C(HbA1C) at 6, 12, 18, and 24 months after TP. In the control group, baseline was defined as 6 months prior to the first HbA1c measure. Results. Mean HgbA1C at each point of interest was similar between TP and type I DM patients (6 months (7.5% versus 7.7%, =0.52), 12 months (7.3% versus 8.0%, =0.081), 18 months (7.7% and 7.6%, =0.64), and at 24 months (7.3% versus 7.8%, =0.10)). Seven TP patients (50%) experienced a hypoglycemic event compared to 65 type 1 DM patients (65%, =0.38). Limitations. Small number of TP patients, retrospective design, lack of long-termfollowup. Conclusion. This suggests that glycemic control following TP for IPMNcan be well managed, similar to type 1 DM patients. Fear of DM following TP for IPMN should not preclude surgery when TP is indicated.
Gain control mechanisms in spinal motoneurons
Michael D. Johnson,Charles J. Heckman
Frontiers in Neural Circuits , 2014, DOI: 10.3389/fncir.2014.00081
Abstract: Motoneurons provide the only conduit for motor commands to reach muscles. For many years, motoneurons were in fact considered to be little more than passive “wires”. Systematic studies in the past 25 years however have clearly demonstrated that the intrinsic electrical properties of motoneurons are under strong neuromodulatory control via multiple sources. The discovery of potent neuromodulation from the brainstem and its ability to change the gain of motoneurons shows that the “passive” view of the motor output stage is no longer tenable. A mechanism for gain control at the motor output stage makes good functional sense considering our capability of generating an enormous range of forces, from very delicate (e.g., putting in a contact lens) to highly forceful (emergency reactions). Just as sensory systems need gain control to deal with a wide dynamic range of inputs, so to might motor output need gain control to deal with the wide dynamic range of the normal movement repertoire. Two problems emerge from the potential use of the brainstem monoaminergic projection to motoneurons for gain control. First, the projection is highly diffuse anatomically, so that independent control of the gains of different motor pools is not feasible. In fact, the system is so diffuse that gain for all the motor pools in a limb likely increases in concert. Second, if there is a system that increases gain, probably a system to reduce gain is also needed. In this review, we summarize recent studies that show local inhibitory circuits within the spinal cord, especially reciprocal and recurrent inhibition, have the potential to solve both of these problems as well as constitute another source of gain modulation.
Evaluation of Serum Calcium as a Predictor of Biochemical Recurrence following Salvage Radiation Therapy for Prostate Cancer
Jennifer L. Peterson,Steven J. Buskirk,Michael G. Heckman,Alexander S. Parker,Nancy N. Diehl,Katherine S. Tzou,Nitesh N. Paryani,Stephen J. Ko,Larry C. Daugherty,Laura A. Vallow,Thomas M. Pisansky
ISRN Oncology , 2013, DOI: 10.1155/2013/239241
Abstract: Background. Previous reports have shown a positive association between serum calcium level and prostate cancer mortality. However, there is no data regarding whether higher serum calcium levels are associated with increased risk of biochemical recurrence (BCR) following salvage radiation therapy (SRT) for prostate cancer. Herein, we evaluate the association between pretreatment serum calcium levels and BCR in a cohort of men who underwent SRT. Methods. We evaluated 165 patients who underwent SRT at our institution. Median dose was 65.0?Gy (range: 54.0–72.4?Gy). We considered serum calcium as both a continuous variable and a 3-level categorical variable (low [≤9.0?mg/dL], moderate [>9.0?mg/dL and ≤9.35?mg/dL], and high [>9.35?mg/dL]) based on sample tertiles. Results. We observed no evidence of a linear association between serum calcium and BCR (relative risk (RR): 0.96, ). Compared to men with low calcium, there was no significantly increased risk of BCR for men with moderate (RR: 0.94, ) or high (RR: 1.08, ) serum calcium levels. Adjustment for clinical, pathological, and SRT characteristics in multivariable analyses did not alter these findings. Conclusion. Our results provide evidence that pretreatment serum calcium is unlikely to be a useful tool in predicting BCR risk following SRT. 1. Introduction Approximately, one-third of men treated with a radical prostatectomy (RP) for prostate cancer will have biochemical recurrence (BCR) within 10 years, and in two-thirds of these men on active surveillance, metastatic disease develops within 10 years [1]. Salvage external beam radiation therapy (SRT) appears to positively affect this natural history when it is initiated early in the course of postoperative BCR [2–4]. A key clinical issue centers on the need to predict which patients with a detectable serum prostate-specific antigen (PSA) after RP have local recurrence versus micrometastatic disease. Accurate means of distinguishing these two groups of men would allow for better selection of patients as candidates for local SRT. We developed and published a scoring algorithm based on readily available clinicopathologic features to help predict which men will experience BCR after SRT and thus provide a guide for clinicians when counseling patients [2]. More recently, we evaluated RP specimens for the ability of specific tumor-based biomarkers (e.g., Ki-67 and B7-H3) to predict which men will respond to SRT [5–7]. Based on our reports, information on clinicopathologic features and tumor-based biomarkers can assist in the appropriate selection of men as good
Luminous Thermal Flares from Quiescent Supermassive Black Holes
Suvi Gezari,Tim Heckman,S. Bradley Cenko,Michael Eracleous,Karl Forster,Thiago S. Goncalves,D. Chris Martin,Patrick Morrissey,Susan G. Neff,Mark Seibert,David Schiminovich,Ted K. Wyder
Physics , 2009, DOI: 10.1088/0004-637X/698/2/1367
Abstract: A dormant supermassive black hole lurking in the center of a galaxy will be revealed when a star passes close enough to be torn apart by tidal forces, and a flare of electromagnetic radiation is emitted when the bound fraction of the stellar debris falls back onto the black hole and is accreted. Here we present the third candidate tidal disruption event discovered in the GALEX Deep Imaging Survey: a 1.6x10^{43} erg s^{-1} UV/optical flare from a star-forming galaxy at z=0.1855. The UV/optical SED during the peak of the flare measured by GALEX and Palomar LFC imaging can be modeled as a single temperature blackbody with T_{bb}=1.7x10^{5} K and a bolometric luminosity of 3x10^{45} erg s^{-1}, assuming an internal extinction with E(B-V)_{gas}=0.3. The Chandra upper limit on the X-ray luminosity during the peak of the flare, L_{X}(2-10 keV)< 10^{41} erg s^{-1}, is 2 orders of magnitude fainter than expected from the ratios of UV to X-ray flux density observed in active galaxies. We compare the light curves and broadband properties of all three tidal disruption candidates discovered by GALEX, and find that (1) the light curves are well fitted by the power-law decline expected for the fallback of debris from a tidally disrupted solar-type star, and (2) the UV/optical SEDs can be attributed to thermal emission from an envelope of debris located at roughly 10 times the tidal disruption radius of a ~10^{7} M_sun central black hole. We use the observed peak absolute optical magnitudes of the flares (-17.5 > M_{g} > -18.9) to predict the detection capabilities of upcoming optical synoptic surveys. (Abridged)
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