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Diagnostic and treatment utility of echocardiography in the management of the cardiac patient

World Journal of Cardiology 2020年第6期12卷 262-268页

作者： Ariella Khalili Jennifer Drummond n.iman.ramjattan.roman.zeltser Amgad n Makaryus north Shore Hebrew Academy Great NeckNY 11020United States Department of Internal Medicine Tufts Medical CenterBostonMA 10211United States Department of Cardiology Nassau University Medical CenterEast MeadowNY 11554United States Department of Cardiology Donald and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNY 11549United States

BACKGROUnD Echocardiograms are an incredibly useful diagnostic tool due to their lack of harmful radiation,the relative ease and speed with which they can be performed,and their almost ubiquitous ***,the advantages that support the use of echocardiography can also lead to the overuse of this *** sought to evaluate the physician perceived impact echocardiography has on patient *** To evaluate the physician perceived impact echocardiography has on patient *** Surveys were distributed to the ordering physician for echocardiograms performed at our institution over a 10-wk *** transthoracic echocardiograms performed on the inpatient service were *** were distributed to either the attending physician or the resident physician listed on the echocardiogram *** information requested in the survey focused on the indication for the study and the perceived importance and effect of the *** statistical analysis was performed on all of the answers from the collected *** A total of 103 surveys were obtained and *** internal medicine(57%)and cardiology(37%)specialties ordered the most *** most common reason for ordering an echocardiogram was to rule out a diagnosis(38.2%).Only 27.5%of physicians reported that the echocardiogram significantly affected patient care,with 18.6%reporting a moderate effect,and 30.4%reporting a mild effect.A total of 19.6%of physicians stated that there was no effect on patient ***,43.1%of physicians reported that they made changes in patient management due to no change having occurred in the disease,11.8%reported that changes in management were based on the recommendation of a specialist,and only 9.8%reported that further imaging was ordered due to the results of the *** majority of physicians(67.6%)considered an echocardiogram to be“somewhat essential”in the management of adult inpat

关键词： Echocardiogram Utilization Cardiology Inpatient Survey Management

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Utility of short-term telemetry heart rhythm monitoring and CHA2DS2-VASc stratification in patients presenting with suspected cerebrovascular accident

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World Journal of Cardiology 2023年第2期15卷 56-63页

作者： Tanzim Bhuiya Sherif roman Taner Aydin Bhakti Patel roman zeltser Amgad n Makaryus Department of Cardiology Donald and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNY 11553United States Department of Cardiology St.Joseph’s University Medical CenterPatersonNJ 07503United States Department of Cardiology Nassau University Medical CenterEast MeadowNY 11554United States

BACKGROUnD Inpatient telemetry heart rhythm monitoring overuse has been linked to higher healthcare *** To evaluate if CHA2DS2-VASc score could be used to indicate if a patient admitted with possible cerebrovascular accident(CVA)or transient ischemic attack(TIA)requires inpatient telemetry *** A total of 257 patients presenting with CVA or TIA and placed on telemetry monitoring were analyzed *** investigated the utility of telemetry monitoring to diagnose atrial fibrillation/flutter and the CHA2DS2-VASc scoring tool to stratify the risk of having CVA/TIA in these *** In our study population,63(24.5%)of the patients with CVA/TIA and telemetry monitoring were determined to have no ischemic neurologic *** the 194(75.5)patients that had a confirmed CVA/TIA,only 6(2.3%)had an arrhythmia detected during their inpatient telemetry monitoring *** with a confirmed CVA/TIA had a statistically significant higher CHA2DS2-VASc score compared to individuals without an ischemic event(3.59 vs 2.61,PnCLUSIOn Given the low percentage of inpatient arrhythmias identified,further research should focus on discretionary use of inpatient telemetry on higher risk patients to diagnose the arrhythmias commonly leading to CVA/TIA.A prospective study assessing event rate of CVA/TIA in patients with higher CHA2DS2-VASc score should be performed to validate the CHA2DS2-VASc score as a possible risk stratifying tool for patients at risk for CVA/TIA.

关键词： Telemetry monitoring CHA2DS2-VASc score Arrhythmia Atrial fibrillation

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Impact of cardiologist intervention on guideline-directed use of statin therapy

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World Journal of Cardiology 2020年第8期12卷 419-426页

作者： Manouchkathe Cassagnol Ofek Hai Shaqeel A Sherali Kyla D’Angelo David Bass roman zeltser Amgad n Makaryus Department of Cardiology NuHealth/Nassau University Medical CenterEast MeadowNY 11554United States Department of Clinical Health Professions College of Pharmacy and Health SciencesSt.John’s UniversityQueensNY 11430United States Donald and Barbara Zucker School of Medicine at Hofstra/northwell HempsteadNY 11549United States St.Lawrence Health System PotsdamNY 13676United States

BACKGROUnD Statins have an important and well-established role in the prevention of atherosclerotic cardiovascular disease(ASCVD).However,several studies have reported widespread underuse of statins in various practice settings and *** of relevant literature reveals opportunities for improvement in the implementation of guideline-directed statin therapy(GDST).AIM To examine the impact of cardiologist intervention on the use of GDST in the ambulatory *** Patients with at least one encounter at the adult Internal Medicine Clinic(IMC)and/or Cardiology Clinic(CC),who had an available serum cholesterol test performed,were *** 2 comparison groups were defined as:(1)Patients only seen by IMC;and(2)Patients seen by both IMC and *** were excluded if variables needed for calculation of ASCVD risk scores were lacking,and if demographic information lacked guideline-directed treatment *** were analyzed using student t-tests or χ^2,as *** of Variance was used to compare rates of adherence to *** A total of 268 patients met the inclusion criteria for this study;211 in the IMC group and 57 in the IMC-CC ***,56%of patients were female,mean age 56 years(±10.65,SD),22%Black or African American,56%Hispanic/Latino,14%had clinical ASCVD,13%current smokers,66%diabetic and 63%*** use was observed in 55%(n=147/268)of the entire patient *** the IMC-CC group,73.6%(n=42/57)of patients were prescribed statin therapy compared to 50.7%(n=107/211)of patients in the IMC group(P=0.002).In terms of appropriate statin use based on guidelines,there was no statistical difference between groups[IMC-CC group 61.4%(n=35/57)vs IMC group,55.5%(n=117/211),P=0.421].Patients in the IMC-CC group were older,had more cardiac risk factors and had higher proportions of non-white patients compared to the IMC group(PnCLUSIOn Although overall use of GDST was suboptimal,there was no statis

关键词： Statin use Guideline directed statin therapy Cardiologist Ambulatory care Adherence

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Utility of routine blood tests after elective laparoscopic cholecystectomy for symptomatic gallstones

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World Journal of Gastrointestinal Surgery 2017年第6期9卷 149-152页

作者： Offir Ben-Ishay Marina zeltser Yoram Kluger Surgical Oncology Pancreatic and Hepatobiliary Surgery ServiceDepartment of General SurgeryDivision of SurgeryRambam Health Care CampusHaifa 35254Israel

AIM To evaluate the value of blood testing after elective laparoscopic cholecystectomy and its association with procedure related *** Charts of all patients undergoing elective laparoscopic cholecystectomy from January 2013 through December2014 were reviewed retrospectively for demographics,indication for surgery,operative course and *** our institution the decision to perform postoperative blood analysis is left for the discretion of the surgeon,therefore we had the possibility to compare the results of those who had blood analyses results to those who did *** was performed to identify variables associated with the decision to perform postoperative blood *** a univariate and multivariate analyses was performed comparing the two *** subgroup analysis was performed to identify factors associated with procedure related *** Five hundred and thirty-two elective laparoscopic cholecystectomies for symptomatic gallstones were performed during the study ***-four percent of the patients(n=340)had blood tests taken post *** that had laboratory tests taken were older(P=0.006,OR=1.01),had longer surgery(Pns placed(Pnd stayed longer in the hospital(Pnalysis of the patients who experienced complications revealed longer stay in the hospital(Pndex(BMI)(P=0.04,OR=1.08),increased rates of drain placement(P=0.006,OR=3.1)and higher conversion rates(P=0.01,OR=14.6).Postoperative blood tests withdrawals were not associated with complications(P=0.44).On Multivariate analysis BMI and drain placement were independently associated with *** The current study indicate that routine postoperative blood tests after elective laparoscopic cholecystectomy for symptomatic gallstones does not predict complications and may have an added benefit in diagnosis and management of cases w

关键词： Cholecystectomy Blood tests Laparoscopy Complications Post-operative Gallstones symptomatic

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B细胞淋巴瘤的罕见表现:表皮脓肿

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世界核心医学期刊文摘（皮肤病学分册） 2006年第11期2卷 5-6页

作者： zeltser R. Kalra A. Stadecker M.J. Krejci-Papa n. 周欣

Cutaneous abscesses can result from many conditions and are primarily managed with incision,drainage and antibiotics, without the need for extensive diagnostic workup. We herein report a case of a B-cell lymphoma manifesting as an abscess on the back of a 67-year-old female. Standard therapies failed to improve her condition, and, by the time of tissue diagnosis, a greater than palm-sized necrotic ulcer eroding through skin and fat, and into the psoas muscle had developed. Primary or secondary cutaneous B-cell lymphomas almost never lead to tissue necrosis but should be entertained in cases of abscesses or ulcers with unusual presentation.

关键词：淋巴瘤坏死性腰肌

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