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Koo S, Osterwald A, Spaventa S, Tsai W, Gurin L, Im B. Unexplained Hemiplegia in Traumatic Brain Injury: An Atypical Presentation of Diffuse Axonal Injury. Am J Phys Med Rehabil 2023; 102:e97-e99. [PMID: 36730422 DOI: 10.1097/phm.0000000000002154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Siulam Koo
- From the New York University Grossman School of Medicine, New York, New York
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Lamm R, Cannaday S, Ponzini F, Moskal D, Lundgren M, Williamson JE, Wummer B, Huang R, Sun G, Song SG, Im B, Kowal LL, Wu I, Bowne WB, Nevler A, Cowan SW, Yeo T, Yeo CJ, Lavu H. Implementation of an opioid reduction toolkit in pancreatectomy patients significantly increases patient awareness of safe practice and decreases amount prescribed and consumed. HPB (Oxford) 2023:S1365-182X(23)00098-9. [PMID: 37019725 DOI: 10.1016/j.hpb.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/07/2023] [Accepted: 03/19/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Postoperative opioid abuse following surgery is a major concern. This study sought to create an opioid reduction toolkit to reduce the number of narcotics prescribed and consumed while increasing awareness of safe disposal in pancreatectomy patients. METHODS Prescription, consumption, and refill request data for postoperative opioids were collected from patients receiving an open pancreatectomy before and after the implementation of an opioid reduction toolkit. Outcomes included safe disposal practice awareness for unused medication. RESULTS 159 patients were included in the study: 24 in the pre-intervention and 135 in the post-intervention group. No significant demographic or clinical differences existed between groups. Median morphine milliequivalents (MMEs) prescribed were significantly reduced from 225 (225-310) to 75 (75-113) in the post-intervention group (p < 0.0001). Median MMEs consumed were significantly reduced from 109 (111-207) to 15 (0-75), p < 0.0001), as well. Refill request rates remained equivalent during the study (Pre: 17% v Post: 13%, p = 0.9) while patient awareness of safe disposal increased (Pre: 25% v Post: 62%, p < 0.0001). DISCUSSION An opioid reduction toolkit significantly reduced the number of postoperative opioids prescribed and consumed after open pancreatectomy, while refill request rates remained the same and patients' awareness of safe disposal increased.
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Affiliation(s)
- Ryan Lamm
- Thomas Jefferson University Hospital, Department of General Surgery, Philadelphia, PA, 19107, USA.
| | - Shawnna Cannaday
- Thomas Jefferson University Hospital, Department of General Surgery, Philadelphia, PA, 19107, USA
| | - Francesca Ponzini
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - David Moskal
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Megan Lundgren
- Penn Highlands Hospital, Department of Surgery, Dubois, PA, 15801, USA
| | - John E Williamson
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Brandon Wummer
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Rachel Huang
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - George Sun
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Steven G Song
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Brian Im
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Luke L Kowal
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Inga Wu
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Wilbur B Bowne
- Thomas Jefferson University Hospital, Department of General Surgery, Philadelphia, PA, 19107, USA
| | - Avinoam Nevler
- Thomas Jefferson University Hospital, Department of General Surgery, Philadelphia, PA, 19107, USA
| | - Scott W Cowan
- Thomas Jefferson University Hospital, Department of General Surgery, Philadelphia, PA, 19107, USA
| | - Theresa Yeo
- Thomas Jefferson University Hospital, Department of General Surgery, Philadelphia, PA, 19107, USA
| | - Charles J Yeo
- Thomas Jefferson University Hospital, Department of General Surgery, Philadelphia, PA, 19107, USA
| | - Harish Lavu
- Thomas Jefferson University Hospital, Department of General Surgery, Philadelphia, PA, 19107, USA
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Rath JF, McGiffin JN, Glubo H, McDermott HW, Beattie A, Arutiunov C, Schaefer LA, Im B, Bushnik T. Cognitive Dependence in Physically Independent Patients at Discharge From Acute Traumatic Brain Injury Rehabilitation. Arch Phys Med Rehabil 2022; 103:1866-1869. [PMID: 35196504 PMCID: PMC9391527 DOI: 10.1016/j.apmr.2022.01.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the incidence of cognitive dependence in adults who are physically independent at discharge from acute traumatic brain injury (TBI) rehabilitation. DESIGN Analysis of historical clinical and demographic data obtained from inpatient stay. SETTING Inpatient rehabilitation unit in a large, metropolitan university hospital. PARTICIPANTS Adult inpatients with moderate to severe TBI (N=226) who were physically independent at discharge from acute rehabilitation. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES FIM Motor and Cognitive subscales, discharge destination, and care plan. RESULTS Approximately 69% (n=155) of the physically independent inpatients were cognitively dependent at discharge from acute rehabilitation, with the highest proportions of dependence found in the domains of problem solving and memory. Most (82.6%; n=128) of these physically independent, yet cognitively dependent, patients were discharged home. Of those discharged home, 82% (n=105) were discharged to the care of family members, and 11% (n=15) were discharged home alone. Patients from racial and ethnic minority backgrounds were significantly more likely than White patients to be discharged while cognitively dependent. CONCLUSIONS The majority of physically independent patients with TBI were cognitively dependent at the time of discharge from acute inpatient rehabilitation. Further research is needed to understand the effect of cognitive dependence on caregiver stress and strain and the disproportionate burden on racial and ethnic minority patients and families. Given the potential functional and safety limitations imposed by cognitive deficits, health care policy and practice should facilitate delivery of cognitive rehabilitation services in acute TBI rehabilitation.
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Affiliation(s)
- Joseph F Rath
- Rusk Rehabilitation, NYU Langone Health, New York, NY.
| | | | - Heather Glubo
- Rusk Rehabilitation, NYU Langone Health, New York, NY
| | | | - Aaron Beattie
- Rusk Rehabilitation, NYU Langone Health, New York, NY
| | | | | | - Brian Im
- NYU Grossman School of Medicine, New York, NY
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Amorapanth PX, Aluru V, Stone J, Yousefi A, Tang A, Cox S, Bilaloglu S, Lu Y, Rath J, Long C, Im B, Raghavan P. Traumatic brain injury results in altered physiologic, but not subjective responses to emotional stimuli. Brain Inj 2018; 32:1712-1719. [DOI: 10.1080/02699052.2018.1519598] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Prin X. Amorapanth
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Viswanath Aluru
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Jennifer Stone
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Arash Yousefi
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Alvin Tang
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Sarah Cox
- Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, USA
| | - Seda Bilaloglu
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Ying Lu
- Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, USA
| | - Joseph Rath
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Coralynn Long
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Brian Im
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Preeti Raghavan
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
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Affiliation(s)
- Heidi Schambra
- Department of Rehabilitation & Regenerative Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Brian Im
- Rusk Rehabilitation, NYU Langone Medical Center, New York, NY
| | - Michael W O'Dell
- Department of Rehabilitation Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, 525 E. 68th St. F-1602, New York, NY 10021
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Trovato E, Danko J, Im B. Poster 15 Acute Vision Loss after Treatment with Amantadine in the Setting of Traumatic Brain Injury in a Patient with History of Fuchs' Dystrophy: A Case Report. PM R 2015. [DOI: 10.1016/j.pmrj.2015.06.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abdou A, Liu J, Carroll M, Vivaldi G, Rizzo JR, Im B. Motor and neurocognitive recovery in the syndrome of the trephined: A case report. Ann Phys Rehabil Med 2015; 58:183-5. [PMID: 25864913 DOI: 10.1016/j.rehab.2014.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 11/23/2014] [Accepted: 11/26/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Andrew Abdou
- Ambulatory Care Center, New York University, Room 17-76, 17th Floor, 240 East 38th Street, New York, NY 10016, United States.
| | - Jackson Liu
- Ambulatory Care Center, New York University, Room 17-76, 17th Floor, 240 East 38th Street, New York, NY 10016, United States
| | - Michelle Carroll
- Ambulatory Care Center, New York University, Room 17-76, 17th Floor, 240 East 38th Street, New York, NY 10016, United States
| | - Giselle Vivaldi
- Ambulatory Care Center, New York University, Room 17-76, 17th Floor, 240 East 38th Street, New York, NY 10016, United States
| | - John-Ross Rizzo
- Ambulatory Care Center, New York University, Room 17-76, 17th Floor, 240 East 38th Street, New York, NY 10016, United States
| | - Brian Im
- Ambulatory Care Center, New York University, Room 17-76, 17th Floor, 240 East 38th Street, New York, NY 10016, United States
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Danko J, Boudakian C, Im B. Poster 340 Cognitive Recovery in Seronegative Limbic Encephalitis following Benzodiazepine Initiation: A Case Report. PM R 2014. [DOI: 10.1016/j.pmrj.2014.08.719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- John Danko
- Rusk Institute of Rehabilitation Medicine, New York, NY, United States
| | | | - Brian Im
- Rusk Institute of Rehabilitation Medicine, New York, NY, United States
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Bhatti RS, Im B. Poster 245: Atypical Schwannoma in a Woman With Multiple Falls: A Case Report. PM R 2010. [DOI: 10.1016/j.pmrj.2010.07.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Rabinder S. Bhatti
- Rusk Institute of Rehabilitation/NYU Langone Medical Center, New York, NY
| | - Brian Im
- Rusk Institute of Rehabilitation/NYU Langone Medical Center, New York, NY
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Portugal SE, Im B. Poster 116: Bilateral Lower Extremity Atherosclerotic Embolic Painful Ulcerations with Unilateral Above-Knee Amputation: A Case Report. PM R 2009. [DOI: 10.1016/j.pmrj.2009.08.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Im B, Kominami E, Grube D, Uchiyama Y. Immunocytochemical localization of cathepsins B and H in human pancreatic endocrine cells and insulinoma cells. Histochemistry 1989; 93:111-8. [PMID: 2559067 DOI: 10.1007/bf00315963] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cathepsins B and H are representative cysteine proteinases localized to lysosomes of a variety of mammalian cells. Previous studies indicated the presence of these enzymes also in secretory granules of endocrine cells. Therefore, the human endocrine pancreas and human insulinomas were investigated by light microscopical immunohistochemistry on serial semithin plastic sections immunostained sequentially for cathepsins B or H and pancreatic hormones. Out of the four established endocrine cell types, insulin (B-) and glucagon (A-) cells showed immunoreactivities for these cathepsins. Cathepsin B immunoreactivities showed a dot-like appearance in A- and B-cells and in insulinoma cells. Immunoreactivities for cathepsin H additionally were found in cell parts containing secretory granules of B-cells and insulinoma cells. By single and double immunoelectron microscopy the dot-like immunoreactivities for cathepsin B were identified as immunoreactive lysosomes of A- and B-cells and insulinoma cells. In addition, some of the secretory granules of A- and B-cells showed cathepsin B immunoreactivities. Cathepsin H immunoreactivities showed an other pattern: they were found regularly in the secretory granules of A- and B-cells and insulinoma cells, and in lysosomes of A-cells. These findings suggest that cathepsins B and H in lysosomes of A- and/or B-cells are involved in the degradation of lysosomal constituents. In secretory granules of these cells, these cysteine proteinases may participate in the processing of the corresponding hormones from their precursor proteins.
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Affiliation(s)
- B Im
- Pharma Clinical Research, Tokyo, Japan
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