Bayshore Community Hospital

Although the relationship between substance use and heightened sexual risk behaviors have been documented in samples of young men who have sex with men (YMSM) and HIV-positive adult men who have sex with men (MSM), there is a dearth of research on the role of substance use in the sexual risk behaviors of HIV-positive YMSM. We examined associations between alcohol and other drug use with sexual risk behaviors among a sample of HIV-positive YMSM (N=200). There were no significant predictors of either receptive or insertive unprotected anal intercourse (UAI) with HIV-positive partners among the substance use variables. Failure to use a condom after drinking alcohol (β=2.00, p<0.01) was significantly associated with insertive UAI with HIV-negative partners or partners of unknown status. Failure to use a condom after drinking alcohol (β=1.36, p<0.05) and age (β=0.35, p<0.05) were significantly associated with receptive UAI with HIV-negative partners or partners of unknown status. Findings from this article underscore the role of alcohol in facilitating UAI among HIV-positive YMSM and their HIV-negative and status-unknown partners.

BACKGROUND: Hydroxychloroquine has not been associated with improved survival among hospitalized COVID-19 patients in the majority of observational studies and similarly was not identified as an effective prophylaxis following exposure in a prospective randomized trial. We aimed to explore the role of hydroxychloroquine therapy in mildly symptomatic patients diagnosed in the outpatient setting. METHODS: We examined the association between outpatient hydroxychloroquine exposure and the subsequent progression of disease among mildly symptomatic non-hospitalized patients with documented SARS-CoV-2 infection. The primary outcome assessed was requirement of hospitalization. Data was obtained from a retrospective review of electronic health records within a New Jersey USA multi-hospital network. We compared outcomes in patients who received hydroxychloroquine with those who did not applying a multivariable logistic model with propensity matching. RESULTS: Among 1274 outpatients with documented SARS-CoV-2 infection 7.6% were prescribed hydroxychloroquine. In a 1067 patient propensity matched cohort, 21.6% with outpatient exposure to hydroxychloroquine were hospitalized, and 31.4% without exposure were hospitalized. In the primary multivariable logistic regression analysis with propensity matching there was an association between exposure to hydroxychloroquine and a decreased rate of hospitalization from COVID-19 (OR 0.53; 95% CI, 0.29, 0.95). Sensitivity analyses revealed similar associations. QTc prolongation events occurred in 2% of patients prescribed hydroxychloroquine with no reported arrhythmia events among those with data available. CONCLUSIONS: In this retrospective observational study of SARS-CoV-2 infected non-hospitalized patients hydroxychloroquine exposure was associated with a decreased rate of subsequent hospitalization. Additional exploration of hydroxychloroquine in this mildly symptomatic outpatient population is warranted.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Describe a method of clinical evaluation for accurate diagnosis of ulnar compression syndrome at the elbow. 2. Evaluate the accuracy and efficacy of the described method in diagnosing surgically correctable nerve entrapment. 3. Present a protocol for conservative management followed by surgical correction. 4. Discuss the results of the method and protocol in two series of patients treated by a single surgeon. BACKGROUND: This study of two patient populations addresses the effectiveness of identifying surgically correctable ulnar nerve compression at the elbow based on provocative clinical testing alone in patients with cubital tunnel syndrome after failure of conservative treatment. METHODS: Twenty-four patients were included in the preliminary study (mean age, 60 years). Three of these patients underwent bilateral procedures. Patients complaining of symptoms in the distribution of the ulnar nerve were tested by elicitation of Tinel's sign and combined flexion and pressure testing at the elbow and wrist. Two-point discrimination was determined. After a failed 6-week trial of conservative therapy, patients underwent anterior submuscular transposition of the ulnar nerve with carpal tunnel release. RESULTS: Postoperatively, the change in two-point discrimination as measured at 6 months was significantly improved, with a mean improvement per digital nerve of 2.52 mm (p < 0.001). Mean time to relief was 7.2 weeks. Complications included one hematoma and one seroma. A total of 26 of the 27 limbs chosen for surgical treatment by provocative clinical testing alone experienced relief of symptoms with anterior submuscular transposition of the ulnar nerve and carpal tunnel release. CONCLUSIONS: This study demonstrates the effectiveness of surgical therapy in patients with lesions identified by clinical examination without electrodiagnostic testing. After the completion of this study, an additional 87 patients were treated (18 bilateral) with cubital tunnel release. The data from these patients confirm the effectiveness of surgical treatment of ulnar entrapment neuropathy based on provocative clinical testing.

1Departments of Surgery and Medicine, Bayshore Community Hospital, Holmdel, New Jersey 2135 Maple Avenue, 07701, Red Bank, New Jersey

The vortices near the origin of an initially laminar mixing layer have a single frequency with a well-defined phase; i.e. there is little phase jitter. Further downstream, however, the phase jitter increases suddenly. Even when the flow is forced, this same transition is observed. The forcing partially loses its influence because of the decorrelation of the phase between the forcing signal and the passing coherent structures. In the present investigation, this phenomenon is documented and the physical mechanism responsible for the phase decorrelation is identified.

Journal Article Music Therapy Compensatory Technique Utilizing Song Lyrics during Dressing to Promote Independence in the Patient with a Brain Injury Get access Ann P. Gervin Ann P. Gervin Lakeshore Rehabilitation Hospital, Birmingham, Alabama Search for other works by this author on: Oxford Academic PubMed Google Scholar Music Therapy Perspectives, Volume 9, Issue 1, 1991, Pages 87–90, https://doi.org/10.1093/mtp/9.1.87 Published: 01 January 1991

BACKGROUND AND OBJECTIVES: This study investigated a novel, high-power, 532 nm frequency-doubled Nd:YAG, KTP laser with contact cooling for the treatment of spider veins of the lower extremities. STUDY: Twenty female subjects with Fitzpatrick skin types I-III, were treated to 79 sites using the 532 nm wavelength of a dual-wavelength 532/1,064 nm laser (Excel V, Cutera, Brisbane, CA) with a 5 mm-diameter spot, fluences ranging from 13 to 15 J/cm(2) , and a pulse-duration of 40 milliseconds. Two treatments were performed 12 weeks apart. Photographs were taken at baseline and 12 weeks following the final treatment. Improvement was assessed by two independent physicians reviewing photographs in a blinded fashion using a 5-point improvement scale. RESULTS: All subjects demonstrated improvement resulting in a median improvement of 2.5 (one-sample Wilcoxon signed rank test, 95% CI: 1.9-2.9, P = 0.000). The reviewers were highly consistent (kappa of 0.85), and highly accurate (kappa of 0.85) in identification of "after photograph" and they were highly consistent in grading improvement. Subjects and the treating physician reported "significant" to "very significant" (∼51 to 100%) improvement in 75% and 69% of subjects, respectively. Post-inflammatory hyper-pigmentation was seen in 2% of sites (1/64). No serious adverse effects reported. All subjects tolerated the treatments well (mean pain score of 2.9/10). CONCLUSION: Treatment of spider veins of the leg with a novel 532 nm KTP laser was found to be safe and effective, with minimal discomfort and adverse effects in Fitzpatrick skin types I-III.

Abstract Background Hydroxychloroquine has not been associated with improved survival among hospitalized COVID-19 patients in the majority of observational studies and similarly was not identified as an effective prophylaxis following exposure in a prospective randomized trial. We aimed to explore the role of hydroxychloroquine therapy in mildly symptomatic patients diagnosed in the outpatient setting. Methods We examined the association between outpatient hydroxychloroquine exposure and the subsequent progression of disease among mildly symptomatic non-hospitalized patients with documented SARS-CoV-2 infection. The primary outcome assessed was requirement of hospitalization. Data was obtained from a retrospective review of electronic health records within a New Jersey USA multi-hospital network. We compared outcomes in patients who received hydroxychloroquine with those who did not applying a multivariable logistic model with propensity matching. Results Among 1274 outpatients with documented SARS-CoV-2 infection 7.6% were prescribed hydroxychloroquine. In a 1067 patient propensity matched cohort, 21.6% with outpatient exposure to hydroxychloroquine were hospitalized, and 31.4% without exposure were hospitalized. In the primary multivariable logistic regression analysis with propensity matching there was an association between exposure to hydroxychloroquine and a decreased rate of hospitalization from COVID-19 (OR 0.53; 95% CI, 0.29, 0.95). Sensitivity analyses revealed similar associations. QTc prolongation events occurred in 2% of patients prescribed hydroxychloroquine with no reported arrhythmia events among those with data available. Conclusions In this retrospective observational study of SARS-CoV-2 infected non-hospitalized patients hydroxychloroquine exposure was associated with a decreased rate of subsequent hospitalization. Additional exploration of hydroxychloroquine in this mildly symptomatic outpatient population is warranted. Lay Summary In this observational study of 1,274 COVID-19 patients, hydroxychloroquine given as an outpatient treatment was associated with a 47% reduction in the hazard of hospitalization. Adverse events were not increased (2% QTc prolongation events, 0% arrhythmias). Further validation is required. Use of hydroxychloroquine to treat COVID-19 in the outpatient setting should be reserved for a clinical trial or after discussion with a physician regarding risks and benefits.

The purpose of this study was to compare the effect of head posture on occlusion in subjects with craniovertebral fusion to that in normal unfused subjects. The experimental group consisted of five subjects (age range 30-76) who have all undergone previous surgical fusion of the craniovertebral region. The control group consisted of five unfused subjects matched by age, race and gender. Each subject's tooth contacts were recorded with a computerized dental instrument known as the T-scan. The tooth contacts were measured several times for each subject with the head tilted backwards (45 degrees) and forwards (30 degrees). A modification of Wilcoxon's rank sum test was used to compare the location of the tooth contacts and compare any variations between the craniovertebral-fused subjects' occlusal contact patterns and those of the normal nonfused patients. The results indicated that four of the five fused subjects had occlusal contact patterns that differed from their matched counterparts, thus suggesting that fusion of the craniovertebral region interferes with a normal mechanism that permits changes in head posture to shift tooth contact points. These results suggest that those who manage problems related to occlusion (craniofacial pain syndromes) need to consider the influence of the craniovertebral region on both occlusion and jaw position.

Immunohistochemistry for transcription factor PAX8 (paired box gene 8) has recently emerged as a powerful tool in the differential diagnosis of gynecologic malignancies, especially when encountered at a metastatic site. Previous studies have shown PAX8 expression in the majority of ovarian and endometrial carcinomas; however, data regarding PAX8 expression in cervical tumors are limited. In this study PAX8 expression was evaluated in 136 epithelial malignancies of the uterine cervix-including 103 squamous cell carcinomas (SCC), 20 adenocarcinomas of usual type, 6 endometrioid adenocarcinomas, and 7 adenosquamous carcinomas-on tissue microarray slides. PAX8 immunopositivity was defined as at least weak nuclear staining in >5% of tumor cells. The majority of SCC were PAX8 negative (92%; 95/103), whereas among the endocervical adenocarcinomas PAX8 was positive in 70% (14/20) of the usual type and in 83% (5/6) of the endometrioid-type tumors. PAX8 expression was observed in 29% (2/7) of adenosquamous carcinomas. We conclude that PAX8 immunostain is negative in most cervical SCC and is less frequently expressed in endocervical adenocarcinomas as compared with the previously reported high sensitivity for ovarian and endometrial adenocarcinomas. When evaluating possible primary sites of a metastatic lesion, a negative PAX8 immunostain does not rule out common cervical epithelial malignancies.

COVID-19 (Coronavirus Disease 2019) has sparked a remarkable public response in the United States. The following publication highlights the integral role that Emergency Medicine (EM) providers are afforded as a result of the public health circumstances. By embracing the unique outlet of direct patient coordination of care, EM providers can correct public misconceptions and promote more appropriate social distancing practices to the greater community.

No AccessJournal of Urology1 May 1951Carbuncle of Kidney S.J. Pearlman S.J. PearlmanS.J. Pearlman View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)68547-1AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 1951 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byBrugh R, Gooneratne N, Rittenberg G and Rous S (2018) Gallium-67 Scanning and Conservative Treatment in Acute Inflammatory Lesions of the Renal CortexJournal of Urology, VOL. 121, NO. 2, (232-235), Online publication date: 1-Feb-1979.Malgieri J, Kursh E and Persky L (2018) The Changing Clinicopathological Pattern of Abscesses in or Adjacent to the KidneyJournal of Urology, VOL. 118, NO. 2, (230-232), Online publication date: 1-Aug-1977.Fair W and Higgins M (2018) Renal AbscessJournal of Urology, VOL. 104, NO. 1, (179-183), Online publication date: 1-Jul-1970.Moore C and Gangai M (2018) Renal Cortical AbscessJournal of Urology, VOL. 98, NO. 3, (303-306), Online publication date: 1-Sep-1967.Doolittle K and Taylor J (2018) Renal Abscess in the Differential Diagnosis of Mass in KidneyJournal of Urology, VOL. 89, NO. 5, (649-651), Online publication date: 1-May-1963. Volume 65Issue 5May 1951Page: 754-759 Advertisement Copyright & Permissions© 1951 by The American Urological Association Education and Research, Inc.MetricsAuthor Information S.J. Pearlman More articles by this author Expand All Advertisement PDF downloadLoading ...

BACKGROUND: Patients on rivaroxaban have variable international normalized ratios (INRs) but it is uncertain if INR impacts procedural heparin requirement during left atrial ablation. We sought to examine the determinants of heparin dosing in this patient population. METHODS: We reviewed consecutive patients who received rivaroxaban within 24 hours of left atrial ablation and compared them to patients on uninterrupted warfarin. The determinants of heparin requirement were evaluated using regression analysis. We then tested a weight-based heparin dose prospectively in rivaroxaban patients. RESULTS: There were 258 patients on rivaroxaban and 213 on warfarin. The mean INR was 1.4 in the rivaroxaban group and 2.3 in the warfarin group (P < 0.01). To achieve an activated clotting time (ACT) >350 seconds, rivaroxaban patients required significantly more heparin (166.9 vs. 78.3 units/kg, P < 0.001). In the rivaroxaban group, body weight was the strongest predictor of heparin dose (r = 0.52), while INR was weakly correlated (r = -0.21). In the prospective group, 25 patients were given an initial heparin dose of 120 units/kg with 22/25 (88%) achieving an ACT > 300 seconds. There were seven and three cases of pericardial effusion in rivaroxaban and warfarin patients, respectively (P = 0.41). The average volume drained in the rivaroxaban group was elevated (988.6 vs. 275.0 mL, P = 0.21). CONCLUSIONS: Body weight is the strongest predictor of procedural heparin requirement during left atrial ablation in patients on uninterrupted rivaroxaban, even in those with an elevated INR. A heparin dose of 120 units/kg achieves an ACT > 300 seconds in the majority of patients. In cases of pericardial effusion, bleeding may be prolonged.

Blood loss during total knee replacement (TKR) remains a significant concern. In this study, 114 patients underwent TKR, and were divided into two groups based on whether they received a new generation fibrin sealant intra-operatively, or a local infiltration containing adrenaline. Groups were then compared for mean calculated total blood volume (TBV) loss, transfusion rates, and knee range of movement. Mean TBV loss was similar between groups: fibrin sealant mean was 705 ml (281 to 1744), local adrenaline mean was 712 ml (261 to 2308) (p = 0.929). Overall, significantly fewer units of blood were transfused in the fibrin sealant group (seven units) compared with the local adrenaline group (15 units) (p = 0.0479). Per patient transfused, significantly fewer units of blood were transfused in the fibrin sealant group (1.0 units) compared with the local adrenaline group (1.67 units) (p = 0.027), suggesting that the fibrin sealant may reduce the need for multiple unit transfusions. Knee range of movement was similar between groups. From our results, it appears that application of this newer fibrin sealant results in blood loss and transfusion rates that are low and similar to previously applied fibrin sealants.

Independent Nurse Consultant whose focus is staff development programs designed to increase RN recruitment and retention. Critical Care Clinical Specialist at Bayshore Community Hospital in Holmdel, New Jersey.

This article describes a practical method for detecting the presence of both fungal spores and culturable fungi in wall cavities. Culturable fungi were collected in 25 mm cassettes containing 0.8 microm mixed cellulose ester filters using aggressive sampling conditions. Both culturable fungi and fungal spores were collected in modified slotted-disk cassettes. The sample volume was 4 L. The filters were examined microscopically and dilution plated onto multiple culture media. Collecting airborne samples in filter cassettes was an effective method for assessing wall cavities for fungal contaminants, especially because this method allowed the sample to be analyzed by both microscopy and culture media. Assessment criteria were developed that allowed the sample results to be used to classify wall cavities as either uncontaminated or contaminated. As a criterion, wall cavities with concentrations of culturable fungi below the limit of detection (LOD) were classified as uncontaminated, whereas those cavities with detectable concentrations of culturable fungi were classified as contaminated. A total of 150 wall cavities was sampled as part of a field project. The concentrations of culturable fungi were below the LOD in 34% of the samples, whereas Aspergillus and/or Penicillium were the only fungal genera detected in 69% of the samples in which culturable fungi were detected. Spore counting resulted in the detection of Stachybotrys-like spores in 25% of the samples that were analyzed, whereas Stachybotrys chartarum colonies were only detected on 2% of malt extract agar plates and on 6% of corn meal agar plates.

In the evolution of the operational technology (OT) and Industrial Internet of Things (IIoT) landscapes, one of the most commonly overlooked areas within cyber security is that of the actual values in the data. Contextually this means that when the term ‘data’ is used, the reference is to data seen beyond network metadata (ie, source address, source port, destination address, destination port, etc). With operational technology (OT) and the Industrial Internet of Things (IIoT), one of the most commonly overlooked security issues is the values in the data. The primary concern is the data elements that actually have an impact on the physical realm via values being set or modified. The objective is to not allow a hostile piece of data (ie, a value change) to reach a destination endpoint, such as a programmable logic controller (PLC), causing a negative physical action. Andres Andreu of Bayshore Networks argues that we need to have a deeper understanding of this data if we are to properly secure such environments.

In an effort to decrease the risk of harm from medical interventions, the Institute for Healthcare Improvement promoted six critical interventions in its 100,000 Lives campaign, one of which required hospitals to implement a procedure to reconcile all patient medications. [1][1] In 2005, the Joint

This article addresses a hospital's initiative to offer responsive pain management through the development of a Pain Management Task Force. It provides a sequential model and guide for nursing managers to use in their own health care environments.

STUDY DESIGN: This is a retrospective radiographic and medical record analysis of 77 patients. OBJECTIVES: To determine whether there is an increased prevalence of segmental sublaminar wire breakage associated with the knurled (diamond) pattern machined onto the Cotrel-Dubousset rod as opposed to a smooth rod. SUMMARY OF BACKGROUND DATA: Segmental fixation of vertebral segments with sublaminar wires is a common surgical technique, and the use of sublaminar wires with a knurled Cotrel-Dubousset rod theoretically could cause premature wire breakage. METHODS: Sixty-six patients with idiopathic scoliosis had the Cotrel-Dubousset (knurled rod) system and comprised the study group, and the Texas Scottish Rite Hospital system (smooth rod) was placed in 14 patients, who served as a control group. Serial radiographs after 3, 6, 12, and 24 months were reviewed. All patients had augmentation of their scoliosis constructs with 16-gauge sublaminar wires in the lumbar spine. Minimum follow-up period was 24 months. RESULTS: No wire breakage was noted in any patient. CONCLUSIONS: There is no increased likelihood that the knurled rod pattern will cause wire breakage, provided a solid fusion is obtained.