PTSD research activities at the San Francisco VA medical center

1991 ◽  
Author(s):  
Charles R. Marmar ◽  
Daniel S. Weiss
Keyword(s):  
San Francisco ◽  
Medical Center ◽  
Research Activities

scholarly journals Physical Therapist–Established Intensive Care Unit Early Mobilization Program: Quality Improvement Project for Critical Care at the University of California San Francisco Medical Center

2013 ◽  
Vol 93 (7) ◽  
pp. 975-985 ◽  
Author(s):  
Heidi J. Engel ◽  
Shintaro Tatebe ◽  
Philip B. Alonzo ◽  
Rebecca L. Mustille ◽  
Monica J. Rivera
Keyword(s):  
Quality Improvement ◽  
Physical Therapy ◽  
San Francisco ◽  
Physical Therapist ◽  
Medical Center ◽  
Early Mobilization ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Icu Admission ◽  
Number Of Patients

Background Long-term weakness and disability are common after an intensive care unit (ICU) stay. Usual care in the ICU prevents most patients from receiving preventative early mobilization. Objective The study objective was to describe a quality improvement project established by a physical therapist at the University of California San Francisco Medical Center from 2009 to 2011. The goal of the program was to reduce patients' ICU length of stay by increasing the number of patients in the ICU receiving physical therapy and decreasing the time from ICU admission to physical therapy initiation. Design This study was a 9-month retrospective analysis of a quality improvement project. Methods An interprofessional ICU Early Mobilization Group established and promoted guidelines for mobilizing patients in the ICU. A physical therapist was dedicated to a 16-bed medical-surgical ICU to provide physical therapy to selected patients within 48 hours of ICU admission. Patients receiving early physical therapy intervention in the ICU in 2010 were compared with patients receiving physical therapy under usual care practice in the same ICU in 2009. Results From 2009 to 2010, the number of patients receiving physical therapy in the ICU increased from 179 to 294. The median times (interquartile ranges) from ICU admission to physical therapy evaluation were 3 days (9 days) in 2009 and 1 day (2 days) in 2010. The ICU length of stay decreased by 2 days, on average, and the percentage of ambulatory patients discharged to home increased from 55% to 77%. Limitations This study relied upon the retrospective analysis of data from 6 collectors, and the intervention lacked physical therapy coverage for 7 days per week. Conclusions The improvements in outcomes demonstrated the value and feasibility of a physical therapist–led early mobilization program.

scholarly journals SUMMIT (Serially Unified Multicenter Multiple Sclerosis Investigation): creating a repository of deeply phenotyped contemporary multiple sclerosis cohorts

2017 ◽  
Vol 24 (11) ◽  
pp. 1485-1498 ◽  
Author(s):  
Riley Bove ◽  
Tanuja Chitnis ◽  
Bruce AC Cree ◽  
Mar Tintoré ◽  
Yvonne Naegelin ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
San Francisco ◽  
Medical Center ◽  
Clinically Isolated Syndrome ◽  
American University ◽  
American University Of Beirut ◽  
Longitudinal Investigation ◽  
American Academic

Background: There is a pressing need for robust longitudinal cohort studies in the modern treatment era of multiple sclerosis. Objective: Build a multiple sclerosis (MS) cohort repository to capture the variability of disability accumulation, as well as provide the depth of characterization (clinical, radiologic, genetic, biospecimens) required to adequately model and ultimately predict a patient’s course. Methods: Serially Unified Multicenter Multiple Sclerosis Investigation (SUMMIT) is an international multi-center, prospectively enrolled cohort with over a decade of comprehensive follow-up on more than 1000 patients from two large North American academic MS Centers (Brigham and Women’s Hospital (Comprehensive Longitudinal Investigation of Multiple Sclerosis at the Brigham and Women’s Hospital (CLIMB; BWH)) and University of California, San Francisco (Expression/genomics, Proteomics, Imaging, and Clinical (EPIC))). It is bringing online more than 2500 patients from additional international MS Centers (Basel (Universitätsspital Basel (UHB)), VU University Medical Center MS Center Amsterdam (MSCA), Multiple Sclerosis Center of Catalonia-Vall d’Hebron Hospital (Barcelona clinically isolated syndrome (CIS) cohort), and American University of Beirut Medical Center (AUBMC-Multiple Sclerosis Interdisciplinary Research (AMIR)). Results and conclusion: We provide evidence for harmonization of two of the initial cohorts in terms of the characterization of demographics, disease, and treatment-related variables; demonstrate several proof-of-principle analyses examining genetic and radiologic predictors of disease progression; and discuss the steps involved in expanding SUMMIT into a repository accessible to the broader scientific community.

scholarly journals Managing the Patient With Pulmonary Arterial Hypertension and Methamphetamine Use: A Practical Perspective for the Clinician

2018 ◽  
Vol 17 (2) ◽  
pp. 55-62 ◽  
Author(s):  
Nimaljeet Tarango ◽  
Andrea Gergay Baird
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
San Francisco ◽  
Medical Center ◽  
The United States ◽  
Methamphetamine Abuse ◽  
Methamphetamine Use ◽  
Personal Experiences ◽  
History Of ◽  
Pulmonary Arterial

Pulmonary arterial hypertension (PAH) is a serious, chronic, progressive cardiopulmonary disease. PAH is associated with several concomitant conditions, as well as drugs and toxins.12 Methamphetamine abuse is likely associated with the development of PAH.3 Methamphetamine abuse is epidemic in the United States and abroad, with rates of new users escalating since 2012. There are over 100,000 new users annually as young as 12 years old. Treating a patient with a history of methamphetamine abuse poses many challenges for a clinician, including nonadherence, therapeutic treatment selection, complex psychosocial issues, and relapse or continued drug abuse. Patients with methamphetamine-associated PAH (Meth-APAH) have higher mortality rates when compared to idiopathic PAH.3 Having a better understanding of the complexities of addiction and working with a multidisciplinary team that includes a social worker to provide care and counseling to these patients can improve their trajectory. In this article, we will offer insight and background into methamphetamine abuse and addiction, as well as discuss a practical approach for clinicians in treating a patient with Meth-APAH, based on the literature, as well as our personal experiences at University of California, San Francisco Medical Center.

NEWS AND ANNOUNCEMENTS

PEDIATRICS ◽  
1972 ◽  
Vol 49 (1) ◽  
pp. 155-159
Keyword(s):  
San Francisco ◽  
Reading Disabilities ◽  
Medical Center ◽  
Perinatal Care ◽  
Guest Speaker ◽  
Obstetrics And Gynecology ◽  
Information Contact ◽  
Good Samaritan ◽  
Good Samaritan Hospital ◽  
Hilton Hotel

Symposium on Reading Disabilities in Children: The Eye Section of the California Medical Association will sponsor an interdisciplinary symposium on "Reading Disabilities in Children," at the San Francisco Hilton Hotel, on Sunday, February 13, 1972. Dr. Arthur Keeney of Philadelphia is the invited guest speaker. The panel will comprise representatives of ophthalmology, pediatrics, child psychiatry, and education. For information contact Rush M. Blodget, Jr., M.D., Redding Ophthalmology Group, 1950 Court Street, Redding, California 96001. Obstetrics-Pediatrics Symposium : The Department of Obstetrics and Gynecology of Good Samaritan Hospital, in cooperation with the same Department of Saint Joseph's Hospital and Medical Center, both of Phoenix, will present a symposium, "Newer Concepts in Delivery of Obstetrical and Perinatal Care," February 25-26, 1972.

scholarly journals Many Neurology Readmissions Are Nonpreventable

2016 ◽  
Vol 7 (2) ◽  
pp. 61-69 ◽  
Author(s):  
Sidney T. Le ◽  
S. Andrew Josephson ◽  
Hans A. Puttgen ◽  
Lorrie Gibson ◽  
Elan L. Guterman ◽  
...  
Keyword(s):  
Length Of Stay ◽  
San Francisco ◽  
Chart Review ◽  
Medical Center ◽  
Hospital Readmissions ◽  
Johns Hopkins Hospital ◽  
Unplanned Readmission ◽  
Neurosurgical Procedures ◽  
Patient Age ◽  
Patient Âgé

Introduction: Reducing unplanned hospital readmissions has become a national focus due to the Centers for Medicare and Medicaid Services’ (CMS) penalties for hospitals with high rates. A first step in reducing unplanned readmission is to understand which patients are at high risk for readmission, which readmissions are planned, and how well planned readmissions are currently captured in comparison to patient-level chart review. Methods: We examined all 5455 inpatient neurology admissions over a 2-year period to University of California San Francisco Medical Center and Johns Hopkins Hospital via chart review. We collected information such as patient age, procedure codes, diagnosis codes, all-payer diagnosis-related group, observed length of stay (oLOS), and expected length of stay. We performed multivariate logistic modeling to determine predictors of readmission. Discharge summaries were reviewed for evidence that a subsequent readmission was planned. Results: A total of 353 (6.5%) discharges were readmitted within 30 days. Fifty-five (15.6%) of the 353 readmissions were planned, most often for a neurosurgical procedure (41.8%) or immunotherapy (23.6%). Only 8 of these readmissions would have been classified as planned using current CMS methodology. Patient age (odds ratio [OR] = 1.01 for each 10-year increase, P < .001) and estimated length of stay (OR = 1.04, P = .002) were associated with a greater likelihood of readmission, whereas index admission oLOS was not. Conclusions: Many neurologic readmissions are planned; however, these are often classified by current CMS methodology as unplanned and penalized accordingly. Modifications of the CMS lists for potentially planned neurological and neurosurgical procedures and for acute discharge neurologic diagnoses should be considered.

Adefovir dipivoxil alone or in combination with lamivudine in patients with lamivudine-resistant chronic hepatitis B 1 1The Adefovir Dipivoxil International 461 Study Group includes the following: N. Afdhal (Beth Israel Deaconess Medical Center, Boston, MA); P. Angus (Austin and Repatriation Medical Centre, Melbourne, Australia); Y. Benhamou (Hopital La Pitie Salpetriere, Paris, France); M. Bourliere (Hopital Saint Joseph, Marseille, France); P. Buggisch (Universitaetsklinikum Eppendorf, Department of Medicine, Hamburg, Germany); P. Couzigou (Hopital Haut Leveque, Pessac, France); P. Ducrotte and G. Riachi (Hopital Charles Nicolle, Rouen, France); E. Jenny Heathcote (Toronto Western Hospital, Toronto, Ontario, Canada); H. W. Hann (Jefferson Medical College, Philadelphia, PA); I. Jacobson (New York Presbyterian Hospital, New York, NY); K. Kowdley (University of Washington Hepatology Center, Seattle, WA); P. Marcellin (Hopital Beaujon, Clichy, France); P. Martin (Cedars-Sinai Medical Center, Los Angeles, CA); J. M. Metreau (Centre Hospitalier Universitaire Henri Mondor, Creteil, France); M. G. Peters (University of California, San Francisco, San Francisco, CA); R. Rubin (Piedmont Hospital, Atlanta, GA); S. Sacks (Viridae Clinical Sciences, Inc., Vancouver, Canada); H. Thomas (St. Mary’s Hospital, London, England); C. Trepo (Hopital Hôtel Dieu, Lyon, France); D. Vetter (Hopital Civil, Strasbourg, France); C. L. Brosgart, R. Ebrahimi, J. Fry, C. Gibbs, K. Kleber, J. Rooney, M. Sullivan, P. Vig, C. Westland, M. Wulfsohn, and S. Xiong (Gilead Sciences, Inc., Foster City, CA); D. F. Gray (GlaxoSmithKline, Greenford, Middlesex, England); R. Schilling and V. Ferry (Parexel International, Waltham, MA); and D. Hunt (Covance Laboratories, Princeton, NJ).

2004 ◽  
Vol 126 (1) ◽  
pp. 91-101 ◽  
Author(s):  
Marion G. Peters ◽  
H.W. Hann ◽  
Paul Martin ◽  
E.Jenny Heathcote ◽  
P. Buggisch ◽  
...  
Keyword(s):  
New York ◽  
Los Angeles ◽  
San Francisco ◽  
Adefovir Dipivoxil ◽  
Medical Center ◽  
Jefferson Medical College ◽  
Toronto Western Hospital ◽  
Medical College ◽  
Centre Hospitalier ◽  
Centre Hospitalier Universitaire

scholarly journals Perioperative β-Blockade

2011 ◽  
Vol 114 (4) ◽  
pp. 824-836 ◽  
Author(s):  
Arthur W. Wallace ◽  
Selwyn Au ◽  
Brian A. Cason
Keyword(s):  
Risk Factors ◽  
San Francisco ◽  
Medical Center ◽  
Medication Use ◽  
Cardiac Risk ◽  
Veterans Affairs ◽  
Population Differences ◽  
Propensity Matching ◽  
Β Blocker ◽  
Β Blockers

Background The Atenolol study of 1996 provided evidence that perioperative β-blockade reduced postsurgical mortality. In 1998, the indications for perioperative β-blockade were codified as the Perioperative Cardiac Risk Reduction protocol and implemented at the San Francisco Veterans Affairs Medical Center. The current study tested the following hypothesis: Is there a difference in mortality rates between patients receiving perioperative atenolol and metoprolol? Methods Epidemiologic analysis of the operations performed at the San Francisco Veterans Affairs Medical Center since 1996 was performed. High-risk inpatients with perioperative β-blockade were divided into two groups: patients who received perioperative atenolol only and those who received metoprolol only. Patients who switched between the two chronic oral β-blocker medications were excluded. IV administration of β-blockers was ignored. Propensity matching analysis was used to correct for population differences in risk factors. Results There were 38,779 operations performed from 1996 to 2008, with 24,739 inpatient procedures. Based on analysis of inpatient medication use, 3,787 patients received atenolol only (1,011) or metoprolol only (2,776). Thirty-day mortality (atenolol 1% vs. metoprolol 3%, P &lt; 0.0008) and 1-yr mortality (atenolol 7% vs. metoprolol 13%, P &lt; 0.0001) differed between the two β-blockers. Analysis based on inpatient and outpatient β-blocker use showed a similar pattern. Propensity matching that corrected for multiple cardiac risk factors found an odds ratio (OR) of 2.1 [95% CI 1.5-2.9], P &lt; 0.0001 for increased 1-yr mortality with metoprolol for inpatient use. Conclusion Perioperative β-blockade using atenolol is associated with reduced mortality compared with metoprolol.

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