55 results match your criteria: "Stanford University Hospitals[Affiliation]"

Alcoholic Liver Disease: High Risk or Low Risk for Developing Hepatocellular Carcinoma?

Clin Liver Dis

August 2016

Division of Hepatology, St. Joseph's Hospital and Medical Center, Creighton University School of Medicine, 500 West Thomas Road, Suite 900, Phoenix, AZ 85013, USA; Division of Hepatology and Gastroenterology, Stanford University Hospitals and Clinics, 300 Pasteur Drive, Palo Alto, CA 94304, USA. Electronic address:

In this review we critically assess the literature to evaluate the level of risk posed by alcohol as both a primary etiology of hepatocellular carcinoma (HCC) and as a cofactor in its development. Although there have been conflicting findings, based on the body of evidence to date, it appears that the linkage between compensated alcoholic liver disease-associated cirrhosis and HCC is best characterized as medium-high risk, with the risk increasing with age and with quantity and duration of alcohol consumption and is more pronounced in females. While abstinence is the most effective way to reduce HCC risk, its effect seems largely dependent on the severity of liver damage at the point of cessation.

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Background: Endovascular treatment for aortic arch aneurysms often requires adjunctive use of hybrid debranching procedures to maintain branch vessel perfusion. This study describes early results with a novel branched arch endograft for total endovascular repair of distal arch aneurysms.

Methods: This US feasibility multicenter clinical trial evaluated 22 patients (mean age, 74.

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Smoking Trends Among Adults With Behavioral Health Conditions in Integrated Health Care: A Retrospective Cohort Study.

Psychiatr Serv

September 2016

Dr. Young-Wolff, Ms. Kline-Simon, Mr. Miller-Rosales, and Dr. Weisner are with the Division of Research, Kaiser Permanente, Oakland, California (e-mail: ). Dr. Weisner is also with the Department of Psychiatry, University of California, San Francisco. Dr. Das is with Stanford University Hospitals and Clinics, Palo Alto, California. Dr. Mordecai is with the Permanente Medical Group, Kaiser Permanente Northern California, Santa Clara.

Objective: Individuals with behavioral health conditions (BHCs) smoke at high rates and have limited success with quitting, despite impressive gains in recent decades in reducing the overall prevalence of smoking in the United States. This study examined smoking disparities among individuals with BHCs within an integrated health care delivery system with convenient access to tobacco treatments.

Methods: The sample consisted of patients in an integrated health care delivery system in 2010-a group (N=155,733) with one or more of the five most prevalent BHCs (depressive disorders, anxiety disorders, substance use disorders, bipolar and related disorders, and attention-deficit hyperactivity disorder) and a group (N=155,733) without BHCs who were matched on age, sex, and medical home facility.

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The use of Doppler sonography for evaluation of the liver is well established, and evaluation of the portal and hepatic veins in native livers, as well as the hepatic artery in transplant livers, is a standard part of the examination. Less well known, however, is that assessment hepatic of artery blood flow velocities and waveforms can permit inferences to be made about liver and system pathophysiology even in native livers. This review will illustrate that hepatic parenchymal abnormalities, as well as primary vascular abnormalities both upstream and downstream of the proper hepatic artery, can be inferred from careful interrogation of its Doppler signature during routine abdominal sonography.

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Objectives: To analyse predictors for short- and long-term renal function changes after fenestrated and branched endovascular aortic repair (EVAR).

Methods: A total of 157 patients underwent fenestrated and branched EVAR. Procedural intra-arterial iodinated contrast volume was documented.

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Objective: Demonstrating the value of spine care requires adequate outcomes assessment. Long-term outcomes are best measured as overall improvement in quality of life (QOL) after surgical intervention. Present registries often require parallel data entry, introducing inefficiencies and limiting compliance.

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Cost-effectiveness modelling in diagnostic imaging: a stepwise approach.

Eur Radiol

December 2015

Department for Health Evidence, Radboud University Medical Center, P.O. Box 9101, Geert Grooteplein-Zuid 10, Nijmegen, 6500 HB, The Netherlands.

Unlabelled: Diagnostic imaging (DI) is the fastest growing sector in medical expenditures and takes a central role in medical decision-making. The increasing number of various and new imaging technologies induces a growing demand for cost-effectiveness analysis (CEA) in imaging technology assessment. In this article we provide a comprehensive framework of direct and indirect effects that should be considered for CEA in DI, suitable for all imaging modalities.

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A piece of my mind. Extraordinary.

JAMA

August 2014

Department of General Medical Disciplines, Division of Palliative Medicine, Stanford University Hospitals & Clinics, Palo Alto, California.

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Mortality among high-risk patients with acute myocardial infarction admitted to U.S. teaching-intensive hospitals in July: a retrospective observational study.

Circulation

December 2013

Department of Health Care Policy, Harvard Medical School, Department of Medicine, Massachusetts General Hospital, and the National Bureau of Economic Research, Cambridge, MA (A.B.J.); Department of Anesthesia, Stanford University Hospitals, Stanford, CA (E.C.S.); and the Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA and RAND Corporation, Santa Monica, CA (J.A.R.).

Background: Studies of whether inpatient mortality in US teaching hospitals rises in July as a result of organizational disruption and relative inexperience of new physicians (July effect) find small and mixed results, perhaps because study populations primarily include low-risk inpatients whose mortality outcomes are unlikely to exhibit a July effect.

Methods And Results: Using the US Nationwide Inpatient sample, we estimated difference-in-difference models of mortality, percutaneous coronary intervention rates, and bleeding complication rates, for high- and low-risk patients with acute myocardial infarction admitted to 98 teaching-intensive and 1353 non-teaching-intensive hospitals during May and July 2002 to 2008. Among patients in the top quartile of predicted acute myocardial infarction mortality (high risk), adjusted mortality was lower in May than July in teaching-intensive hospitals (18.

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Article Synopsis
  • - In a study examining the effectiveness of vagus nerve stimulation (VNS) for epilepsy, researchers analyzed data from California's healthcare databases to assess patient outcomes post-surgery from 2005 to 2009.
  • - The results showed low complication rates (under 2% in the first 30 days) and a 3.9% rate of reoperations in adults within the first year, with significant reductions in seizure-related hospitalizations and ED visits in both the first (17% lower) and second year (42% lower) post-surgery.
  • - The findings suggest that VNS surgery provides a safe option with favorable outcomes, leading to fewer emergency department visits and hospital admissions due to seizures.
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A Reexamination of the Costs of Medical R&D Regulation.

Forum Health Econ Policy

October 2012

Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA.

Recent evidence suggests that the economic value of increased health has been enormous, with most of these gains being driven by medical R&D. The R&D process for pharmaceuticals is particularly expensive and time consuming, with well-known studies from the Tufts Center for the Study of Drug Development suggesting that developing a single successful drug costs around $1 billion and takes roughly 12 years. We argue that these estimates are incomplete because they do not incorporate the social costs imposed by the regulatory process, namely the costs to producers in terms of forgone profits and the costs to consumers in terms of delayed access to drugs.

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Purpose: To demonstrate the role of endovascular approaches to the ascending aorta in the post-transplant context.

Case Reports: Three patients (2 women and 1 man aged 52, 68, and 43 years, respectively) developed pseudoaneurysm of the ascending aorta following thoracic organ transplantation. Due to the prohibitive risk of open surgery in each case, an endovascular repair of the ascending aorta was performed, with implantation of 1 to 3 stent-grafts to span the lesions.

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Study Design: A retrospective cross-sectional study of all spinal fusions in California from 2003 to 2007.

Objective: This study analyzes whether morbid obesity alters rates of complications and charges in patients undergoing spinal fusion.

Summary Of Background Data: Prior studies of obesity have focused on lumbar fusion; some identified increases in wound complications.

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Functional reconstruction of the hand: the stiff joint.

Clin Plast Surg

October 2011

Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University Hospitals & Clinics, 770 Welch Road, Suite 400, Palo Alto, CA 94304 USA.

Proper hand function relies on a combination of strength and mobility. The intricate architecture that allows for hand mobility includes the articular surfaces of joints, periarticular ligamentous structures, tendon mechanisms, and the soft-tissue envelope. These structures are subject to injury and scarring.

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Hospital costs, incidence, and inhospital mortality rates of traumatic subdural hematoma in the United States.

J Neurosurg

November 2011

Department of Neurosurgery, Stanford University Hospitals and Clinics, and Outcomes Research Center, VA Palo Alto Health Care System, Palo Alto, CA, USA.

Object: This study provides the first US national data regarding frequency, cost, and mortality rate of traumatic subdural hematoma (SDH), and identifies demographic factors affecting morbidity and death in patients with traumatic SDH undergoing surgical drainage.

Methods: A retrospective analysis was conducted by querying the Nationwide Inpatient Sample, the largest all-payer database of nonfederal community hospitals. All cases of traumatic SDH were identified using ICD-9 codes.

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Joint arthritis and soft-tissue problems of the hand.

Plast Reconstr Surg

December 2010

Palo Alto, Calif.; Rochester, Minn.; and Seattle, Wash. From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Hospitals and Clinics; the Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic; and the Department of Surgery, Division of Plastic Surgery, University of Washington Medical Center.

The hand, by virtue of its position in space, complex anatomical composition, and characteristic biomechanical properties, is subject to a host of disease processes and traumatic injuries. This article reviews the presentation, evaluation, treatment, and outcomes of treatment in hand infections, high-pressure injection injuries, Dupuytren disease, and arthritis.

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Storing and retrieving radiology cases is an important activity for education and clinical research, but this process can be time-consuming. In the process of structuring reports and images into organized teaching files, incidental pathologic conditions not pertinent to the primary teaching point can be omitted, as when a user saves images of an aortic dissection case but disregards the incidental osteoid osteoma. An alternate strategy for identifying teaching cases is text search of reports in radiology information systems (RIS), but retrieved reports are unstructured, teaching-related content is not highlighted, and patient identifying information is not removed.

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Collagenase clostridium histolyticum for Dupuytren's contracture.

Expert Opin Biol Ther

September 2010

Stanford University Hospitals and Clinics, Robert A. Chase Hand & Upper Limb Center, 770 Welch Road, Suite #400, Palo Alto, CA 94304, USA.

Importance Of The Field: Dupuytren's disease is a non-malignant, progressive disorder of the hands that can severely limit hand function and diminish overall quality of life. With global life expectancy increasing, the prevalence of this disease appears to be increasing amongst all ethnic groups. Treatment has traditionally remained surgical with few effective, nonsurgical options.

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Adult xanthogranuloma causing nasal obstruction.

Arch Otolaryngol Head Neck Surg

May 2010

Department of Otolaryngology-Head and Neck Surgery, Stanford University Hospitals and Clinics, Stanford, California 94305, USA.

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Purpose: Collagenase has been investigated in phase II and phase III clinical trials for the treatment of Dupuytren's disease. The purpose of this study is to report 8-year follow-up results in a subset of patients who had collagenase injection for the treatment of Dupuytren's contracture.

Methods: Twenty-three patients who participated in the phase II clinical trial of injectable collagenase were contacted by letter and phone.

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Generalized skeletal abnormalities.

Hand Clin

May 2009

Department of Surgery, Stanford University Hospitals & Clinics, Palo Alto, CA 94304, USA.

Given the complexity and diversity of congenital differences, a separate and broad category of generalized skeletal abnormalities was proposed to include all conditions that are unable to be neatly packaged into the other categories. Some of the conditions included in this category are obscure, whereas others are more common. Some conditions listed in this section may fit into other categories but may be considered as part of the overall classification scheme.

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Duplication.

Hand Clin

May 2009

Department of Surgery, Stanford University Hospitals and Clinics, Palo Alto, CA 94304, USA.

Congenital limb duplications include pre- and post-axial polydactyly, central polydactyly, and the mirror-hand spectrum. Treatment of these duplications constitutes a significant functional and aesthetic challenge for the reconstructive hand surgeon. This article provides an inclusive review of the embryologic and molecular mechanisms underlying these deformities and focuses on their clinical treatment.

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Lumbar tumor resections and management.

Orthop Clin North Am

January 2009

Stanford University Department of Orthopaedic Surgery, Spinal Surgery Section, Stanford University School of Medicine, 300 Pasteur Drive, Stanford University Hospitals and Clinics, Room R171, Stanford, CA 94305, USA.

More than one-third of patients with cancer have vertebral metastases found at autopsy. Primary and metastatic tumors to the spinal column can lead to pain, instability, and neurologic deficit. Symptomatic lesions are most prevalent in the thoracic spine (70%), followed by the lumbar spine (20%) and cervical spine (10%).

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