Hoi Ho | Texas Tech University El Paso (original) (raw)

Papers by Hoi Ho

Medical Clinics of North America, 1994

It appears that many commonly recognized syndromes such as the ARDS may well be caused by agents ... more It appears that many commonly recognized syndromes such as the ARDS may well be caused by agents that have only recently emerged as respiratory pathogens. HPS represents one such entity. It appears likely that the increasing pressure of antibiotic use as well as the reemergence of certain pathogens will continue to challenge the clinician. Paramount to the identification and treatment of unusual pneumonias will be the degree with which an effort is made to make an etiologic diagnosis through sputum examination, transtracheal aspirate, bronchoscopy, or lung biopsy. Although pneumococcal pneumonia is the most common community-acquired pneumonia seen by practicing physicians, in all likelihood from time to time a physician will encounter pneumonia caused by one of the unusual pathogens described in this article or else by an altogether new pathogen.

Therapeutic Drug Monitoring, 1993

The American Surgeon

Staphylococcal postoperative toxic shock syndrome (PTSS) has been associated with a variety of su... more Staphylococcal postoperative toxic shock syndrome (PTSS) has been associated with a variety of surgical procedures. It is generally believed that the source of infection is acquired at or near the time of surgery. PTSS has been specifically associated with nasal packing, insertion of hardware, surgical drains, retained foreign materials, and breaks in sterile technique. Although PTSS has been associated with postoperative abscesses, development of PTSS after surgery of a pre-existing source of infection has not been described. We report a case of PTSS that developed after vertebral abscess drainage, and we review the literature to determine the incidence of PTSS due to preexisting staphylococcal infection.

INTED2021 Proceedings, 2021

Canadian Medical Education Journal, 2010

Background - Despite continued curriculum reform, the clinical skills competencies of medical gra... more Background - Despite continued curriculum reform, the clinical skills competencies of medical graduates at all levels are steadily declining within a training system, where bedside opportunities become a luxury and the laboratory tests prevail over the clinical skills. While high-fidelity expensive simulators are being embraced by high-procedure volume specialties, low-fidelity and relatively inexpensive simulators, such as the heart sounds simulators remain under-utilized in medical training. Methods - We used a commercially available heart sound synthesizer in 2-hour training sessions with students and residents. Pre-post testing was completed at the beginning of the training session and three weeks after the session; participant responses were recorded by audience interactive response system. Results - Data analysis was accomplished with statistical software SPSS 17.0 utilizing paired t-test, and showed a statistically significant difference in learners’ knowledge and skills at...

Frontiers in medicine, 2016

Esophageal variceal banding may be less likely to cause bacteremia than sclerotherapy. The existi... more Esophageal variceal banding may be less likely to cause bacteremia than sclerotherapy. The existing data about the frequency of bacteremia after esophageal variceal banding are conflicting, and few studies include both banding and sclerotherapy. We conducted a prospective randomized controlled trial to compare the frequency of bacteremia after esophageal variceal banding and sclerotherapy. Over a 2-year period, patients with liver disease admitted for upper gastrointestinal bleeding or for outpatient elective variceal therapy were enrolled. New patients were randomized preprocedure to either banding or sclerotherapy, and subsequent sessions utilized the initial procedure. The groups consisted of banding, sclerotherapy, and endoscopy without variceal therapy. Subjects underwent endoscopy by one out of three gastroenterologists. Blood cultures were obtained 5 min before and 30 min after endoscopy to check for bacteremia. Postendoscopic blood cultures were positive following 4 out of 1...

The Internet Journal of Infectious Diseases, 2011

Background: The U.S./Mexico border is more than 2,000 miles long and stretches 62.5 miles wide on... more Background: The U.S./Mexico border is more than 2,000 miles long and stretches 62.5 miles wide on each side. With more than 2 million residents, El Paso, Texas and Ciudad Juarez, Mexico comprise the largest U.S-Mexico border population. Every month, more than 4 million Americans and Mexicans cross the border to work, shop, visit, and seek medical care. It is hypothesized that factors stemming from uncontrolled and easy access to antibiotics in Ciudad Juarez, together with the enormous flow of traffic across the border, make this a prime area for the development of bacterial resistance.Objective: To compare the bacterial sensitivity patterns of Escherichia coli and Pseudomonas aeruginosa isolates from two U.S.-Mexico border cities.Methods: Isolates were collected from patients seen and treated at two hospitals in El Paso and two in Ciudad Juarez. The organisms were tested at a reference laboratory in El Paso according to NCCLS standards. Statistical analyses were performed using SAS to compare proportions of susceptible organisms between El Paso and Juarez.Results: A total of 364 Escherichia coli and 285 Pseudomonas aeruginosa isolates were identified and tested. Escherichia coli isolates in Juarez were more frequently resistant to aztreonam, cefazolin, cefepime, cefotaxime, ceftriaxone, ciprofloxacin, and gentamicin (p<.05) as compared to those in El Paso. Extended spectrum betalactamases (ESBL)-producing Escherichia coli were more prevalent in Juarez as compared to El Paso. Pseudomonas aeruginosa isolates in Juarez were more frequently resistant to amikacin, aztreonam, ceftazidime, ciprofloxacin, gentamicin, piperacillin/tazobactam, and tobramycin as compared to those in El Paso (p<.05).Conclusion: We documented significant differences in bacterial resistance between the two cities for Escherichia coli and Pseudomonas aeruginosa isolates. Although we encountered some variations, these differences supported that antimicrobial resistance is more prevalent in Juarez, Mexico than in El Paso, Texas for these two organisms.

Donald School Journal of Ultrasound in Obstetrics and Gynecology, 2014

Evidence-based medicine (EBM) is the conscientious, explicit and judicious use of current best ev... more Evidence-based medicine (EBM) is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. Despite improvement in knowledge, technology, effective medical therapies and ample practice guidelines, the practice of medicine in all specialties including obstetrics and gynecology (OB/GYN) continues to lag behind along with alarming rate of medical errors. Similarly, ultrasonography is rapidly expanding in the practice of medicine across many specialties but standardized requirements and ultrasound curricula for residency training in obstetrics and gynecology are still lacking. EBM is a required component of the curriculum of medical education at all levels but still does not have a firm foothold in the practice of medicine in the United States and other countries because of barriers. There are many proposed changes to improve the efficacy of current teaching of EBM and ultrasound including an early introduction in pr...

Donald School Journal of Ultrasound in Obstetrics and Gynecology, 2009

Advances in computer technology, hardware and software have made ultrasound a diagnostic imaging ... more Advances in computer technology, hardware and software have made ultrasound a diagnostic imaging technique of choice in certain areas of medicine or specialties such as obstetrics and gynecology. In teaching and training of obs/gyne ultrasonography, medical educators can utilize different forms of clinical simulators: traditional standardized patients and standard ultrasound diagnostic equipment, computer-based simulators, ultrasound simulators or ultrasound simulators with manikins. The popularity of a simulator is determined not only by its features, ease of use and cost, but also by its available learning modules and applications. Technology in ultrasound and computers are rapidly advancing in enhancing the quality and miniaturizing ultrasound machines. Portable and handheld ultrasound equipments are quickly becoming indispensable diagnostic instruments in different health care settings especially the emergency rooms and physician offices. Concerns, however, remain related to the...

Southern Medical Journal, 1994

Venous thrombosis is a frequent complication in patients with paroxysmal nocturnal hemoglobinuria... more Venous thrombosis is a frequent complication in patients with paroxysmal nocturnal hemoglobinuria (PNH). However, arterial thrombosis is rare, and cerebral arterial thrombosis has been reported only in postmortem studies. We discuss the case of a PNH patient in whom both clinical and neuroimaging findings were compatible with cerebral arterial and venous thrombosis.

The American Journal of Gastroenterology, 2000

... [1991]. Geography of intestinal permeability and absorption. (PMID:10075954) Menzies IS, Zuck... more ... [1991]. Geography of intestinal permeability and absorption. (PMID:10075954) Menzies IS, Zuckerman MJ, Nukajam WS, Somasundaram SG, Murphy B, Jenkins AP, Crane RS, et al. ... (PMID:6973927) Wig JD, Malik AK, Khanna SK, Singh K, Talwar BL, Shukla NK, Sekar N. Am. ...

American Journal of Gastroenterology, 2003

The majority of responders were hospital-based and 59% of the units performed over 3000 procedure... more The majority of responders were hospital-based and 59% of the units performed over 3000 procedures per year. After use the endoscope was hand-carried or transported in a dry container (97%) to a separate cleaning room (85%) for HLD by technicians (40%). Wide variations existed in manual step procedures including use of disposable (50%) brushes and number of times channel brushed: once (21%), twice (35%), 3-5 times (37%). Soaking duration in disinfectant (gluteraldehyde 70%) was Ͻ10min (8%), 10-20 min (35%), 20-30 min (38%), 30-40 min (7%) and Ͼ40 min (3%). 67% had an active unit infection control (IC) service and 98% had a QA program. Monitoring of cleaning effectiveness was by visual inspection (50%) and culturing endoscopes (17%). Culturing was done weekly (1%) and biannually (6.5%) and performed by swab of the endoscope end (5%) or rinsing the biopsy channel (8%). If culture positive, most would remove the instrument from clinical use and reevaluate protocol and personnel for technique lapses. Two respondents were aware of a procedure related infection (bronchoscope in one). Conclusions: Wide practice variations were noted in manual cleaning and in soaking time during automated HLD in this community. Less variations were noted in cleaning personnel and training, location and methods of cleaning, presence of IC services and QA programs. Endoscope culturing was infrequently done and positive cultures were rare. While most units claim to have ongoing quality assurance programs, few use objective criteria to monitor effective disinfection or lapses in technique. Iatrogenic infection is uncommonly recognized following GI endoscope procedures.

Infectious Diseases Newsletter, 1987

Donald School Journal of Ultrasound in Obstetrics and Gynecology, 2014

Stethoscope, the symbol of modern medicine has been in place for more than 150 years. However, th... more Stethoscope, the symbol of modern medicine has been in place for more than 150 years. However, this reliable diagnostic instrument has started showing its age with the arrival of a newer diagnostic instrument: the hand-held ultrasound. Hand-held ultrasound is rapidly expanding in many specialties but not yet in obstetrics and gynecology. There is a paucity of literature on the application of hand-held ultrasound in obstetrics and gynecology, in contrast to a large volume of literature published by other specialties. Several studies demonstrated that medical students and residents can improve the accuracy of their physical examinations with the use of hand-held ultrasound. Similarly, physical examinations performed by hospitalists with hand-carried ultrasound are more accurate than those performed without the instrument. Advances in technology have contributed to the improvement of image quality and portability. As a result, these devices become increasingly available in many clinica...

Travel Medicine and Infectious Disease, 2009

El Paso, Texas and Ciudad Juarez, Mexico comprise the largest U.S./Mexico border population. Bact... more El Paso, Texas and Ciudad Juarez, Mexico comprise the largest U.S./Mexico border population. Bacterial samples were collected from two hospitals in El Paso and two in Ciudad Juarez and transported to a reference microbiology laboratory in El Paso for microbial identification and antimicrobial susceptibility testing according to NCCLS standards. The presence of the MecA gene, and the prevalence of both the SSCmec IV element and the Panton-Valentine leukocidin were investigated by PCR in all MRSA isolates. A total of 201 isolates in El Paso and 128 in Ciudad Juarez of Staphylococcus aureus were identified, of those, MRSA were significantly more prevalent in El Paso than in Ciudad Juarez [89 (44.3%) versus 10 (7.8%) respectively (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001)]. Thirty one (35%) of MRSA strains isolated in El Paso were community associated. Significantly higher prevalence of MRSA infections was documented in El Paso compared to Ciudad Juarez.

Donald School Journal of Ultrasound in Obstetrics and Gynecology, 2014

In the current era of decreased funding for teaching and research, academic centers are increasin... more In the current era of decreased funding for teaching and research, academic centers are increasingly focused on clinical productivity. The lack of structured mentoring programs along with increasing clinical demands has led to unrealistic academic expectations for physician faculty. Faculty mentoring is a dynamic reciprocal relationship for both the mentor and mentee to work closely in developing a professional and productive academic partnership. Both mentor and mentee are equally important in achieving a rewarding mentoring partnership. There are fundamental guidelines for the mentor and the mentee to follow to ensure the desired outcomes. Traditional mentoring relationship is strictly voluntary without a defined commitment from either party. However, outcome-driven mentoring relationship is a structured process in which specific goals and objectives are well-defined, and in which the mentoring progresses and feedback are closely monitored. Much information about faculty mentoring...

Donald School Journal of Ultrasound in Obstetrics and Gynecology, 2014

Advances in technology have made ultrasonography a rapidly evolving concept in the practice of me... more Advances in technology have made ultrasonography a rapidly evolving concept in the practice of medicine and a valuable component of the competency-based education. American Medical Association (AMA) recently affirms that ‘ultrasound imaging is a safe, effective and efficient tool when utilized by, or under the direction of appropriately trained physicians.’ AMA also supports the educational efforts and widespread integration of ultrasound throughout the continuum of medical education. Training in ultrasonography is rapidly expanding to numerous residency programs of graduate medical education but discrepancies in ultrasound curriculum and criteria for proficiency exist among programs within the same discipline, despite clearly defined objectives recommended by the governing bodies. There is a trend to integrate ultrasonography into the curriculum of undergraduate medical education. However, funding, availability of ultrasound-trained faculty and student time are barriers to the impl...

Southern Medical Journal, 1995

Journal of Clinical Ultrasound, 2011

We report the case of a 39-year-old woman who presented with a pelvic mass extending into the upp... more We report the case of a 39-year-old woman who presented with a pelvic mass extending into the upper abdomen. Transabdominal sonography revealed a complex left adnexal mass. Color Doppler imaging and spectral Doppler analysis showed increased vascularity with low impedance blood flow signals, suggestive of neovascularization. The patient underwent a laparotomy and a 56-kg predominantly cystic tumor was removed from the left adnexal region. The patient died 3 months later with pulmonary metastases and massive pulmonary hemorrhage. Postmortem resampling of the ovarian tumor initially diagnosed as mucinous cystadenoma showed nodular areas of malignant pleomorphic cells consistent with angiosarcoma.

Journal of Clinical Gastroenterology, 1990

H2-antagonists are frequently used in the management of upper gastrointestinal (UGI) hemorrhage d... more H2-antagonists are frequently used in the management of upper gastrointestinal (UGI) hemorrhage despite their lack of proven efficacy. In order to determine the pattern of H2-antagonist usage for this indication, we retrospectively reviewed the charts of 137 patients admitted with acute UGI bleeding over a 1-year period at two teaching hospitals in West Texas. An H2-antagonist was ordered in 89% of patients (77%) intravenous, 12% oral). It was administered within 2 h of admission in 25% of these patients, within 4 h in 54%, and within 8 h in 78%. An H2-antagonist was ordered among the initial six orders in 49% and among the initial 10 orders in 77% of patients. Considering orders for specific therapies, an H2-antagonist was in the initial three orders in 60% of patients and among the initial six orders in 97%. Of the patients who were prescribed an H2-antagonist and who also had upper endoscopy, the drug was ordered prior to endoscopy in 86%. This review of H2-antagonist usage in the management of acute UGI bleeding has identified a prescribing pattern of writing for these drugs early in the sequence of order writing, with the drugs being given early in the course of hospitalization.

Medical Clinics of North America, 1994

It appears that many commonly recognized syndromes such as the ARDS may well be caused by agents ... more It appears that many commonly recognized syndromes such as the ARDS may well be caused by agents that have only recently emerged as respiratory pathogens. HPS represents one such entity. It appears likely that the increasing pressure of antibiotic use as well as the reemergence of certain pathogens will continue to challenge the clinician. Paramount to the identification and treatment of unusual pneumonias will be the degree with which an effort is made to make an etiologic diagnosis through sputum examination, transtracheal aspirate, bronchoscopy, or lung biopsy. Although pneumococcal pneumonia is the most common community-acquired pneumonia seen by practicing physicians, in all likelihood from time to time a physician will encounter pneumonia caused by one of the unusual pathogens described in this article or else by an altogether new pathogen.

Therapeutic Drug Monitoring, 1993

The American Surgeon

Staphylococcal postoperative toxic shock syndrome (PTSS) has been associated with a variety of su... more Staphylococcal postoperative toxic shock syndrome (PTSS) has been associated with a variety of surgical procedures. It is generally believed that the source of infection is acquired at or near the time of surgery. PTSS has been specifically associated with nasal packing, insertion of hardware, surgical drains, retained foreign materials, and breaks in sterile technique. Although PTSS has been associated with postoperative abscesses, development of PTSS after surgery of a pre-existing source of infection has not been described. We report a case of PTSS that developed after vertebral abscess drainage, and we review the literature to determine the incidence of PTSS due to preexisting staphylococcal infection.

INTED2021 Proceedings, 2021

Canadian Medical Education Journal, 2010

Background - Despite continued curriculum reform, the clinical skills competencies of medical gra... more Background - Despite continued curriculum reform, the clinical skills competencies of medical graduates at all levels are steadily declining within a training system, where bedside opportunities become a luxury and the laboratory tests prevail over the clinical skills. While high-fidelity expensive simulators are being embraced by high-procedure volume specialties, low-fidelity and relatively inexpensive simulators, such as the heart sounds simulators remain under-utilized in medical training. Methods - We used a commercially available heart sound synthesizer in 2-hour training sessions with students and residents. Pre-post testing was completed at the beginning of the training session and three weeks after the session; participant responses were recorded by audience interactive response system. Results - Data analysis was accomplished with statistical software SPSS 17.0 utilizing paired t-test, and showed a statistically significant difference in learners’ knowledge and skills at...

Frontiers in medicine, 2016

Esophageal variceal banding may be less likely to cause bacteremia than sclerotherapy. The existi... more Esophageal variceal banding may be less likely to cause bacteremia than sclerotherapy. The existing data about the frequency of bacteremia after esophageal variceal banding are conflicting, and few studies include both banding and sclerotherapy. We conducted a prospective randomized controlled trial to compare the frequency of bacteremia after esophageal variceal banding and sclerotherapy. Over a 2-year period, patients with liver disease admitted for upper gastrointestinal bleeding or for outpatient elective variceal therapy were enrolled. New patients were randomized preprocedure to either banding or sclerotherapy, and subsequent sessions utilized the initial procedure. The groups consisted of banding, sclerotherapy, and endoscopy without variceal therapy. Subjects underwent endoscopy by one out of three gastroenterologists. Blood cultures were obtained 5 min before and 30 min after endoscopy to check for bacteremia. Postendoscopic blood cultures were positive following 4 out of 1...

The Internet Journal of Infectious Diseases, 2011

Background: The U.S./Mexico border is more than 2,000 miles long and stretches 62.5 miles wide on... more Background: The U.S./Mexico border is more than 2,000 miles long and stretches 62.5 miles wide on each side. With more than 2 million residents, El Paso, Texas and Ciudad Juarez, Mexico comprise the largest U.S-Mexico border population. Every month, more than 4 million Americans and Mexicans cross the border to work, shop, visit, and seek medical care. It is hypothesized that factors stemming from uncontrolled and easy access to antibiotics in Ciudad Juarez, together with the enormous flow of traffic across the border, make this a prime area for the development of bacterial resistance.Objective: To compare the bacterial sensitivity patterns of Escherichia coli and Pseudomonas aeruginosa isolates from two U.S.-Mexico border cities.Methods: Isolates were collected from patients seen and treated at two hospitals in El Paso and two in Ciudad Juarez. The organisms were tested at a reference laboratory in El Paso according to NCCLS standards. Statistical analyses were performed using SAS to compare proportions of susceptible organisms between El Paso and Juarez.Results: A total of 364 Escherichia coli and 285 Pseudomonas aeruginosa isolates were identified and tested. Escherichia coli isolates in Juarez were more frequently resistant to aztreonam, cefazolin, cefepime, cefotaxime, ceftriaxone, ciprofloxacin, and gentamicin (p<.05) as compared to those in El Paso. Extended spectrum betalactamases (ESBL)-producing Escherichia coli were more prevalent in Juarez as compared to El Paso. Pseudomonas aeruginosa isolates in Juarez were more frequently resistant to amikacin, aztreonam, ceftazidime, ciprofloxacin, gentamicin, piperacillin/tazobactam, and tobramycin as compared to those in El Paso (p<.05).Conclusion: We documented significant differences in bacterial resistance between the two cities for Escherichia coli and Pseudomonas aeruginosa isolates. Although we encountered some variations, these differences supported that antimicrobial resistance is more prevalent in Juarez, Mexico than in El Paso, Texas for these two organisms.

Donald School Journal of Ultrasound in Obstetrics and Gynecology, 2014

Evidence-based medicine (EBM) is the conscientious, explicit and judicious use of current best ev... more Evidence-based medicine (EBM) is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. Despite improvement in knowledge, technology, effective medical therapies and ample practice guidelines, the practice of medicine in all specialties including obstetrics and gynecology (OB/GYN) continues to lag behind along with alarming rate of medical errors. Similarly, ultrasonography is rapidly expanding in the practice of medicine across many specialties but standardized requirements and ultrasound curricula for residency training in obstetrics and gynecology are still lacking. EBM is a required component of the curriculum of medical education at all levels but still does not have a firm foothold in the practice of medicine in the United States and other countries because of barriers. There are many proposed changes to improve the efficacy of current teaching of EBM and ultrasound including an early introduction in pr...

Donald School Journal of Ultrasound in Obstetrics and Gynecology, 2009

Advances in computer technology, hardware and software have made ultrasound a diagnostic imaging ... more Advances in computer technology, hardware and software have made ultrasound a diagnostic imaging technique of choice in certain areas of medicine or specialties such as obstetrics and gynecology. In teaching and training of obs/gyne ultrasonography, medical educators can utilize different forms of clinical simulators: traditional standardized patients and standard ultrasound diagnostic equipment, computer-based simulators, ultrasound simulators or ultrasound simulators with manikins. The popularity of a simulator is determined not only by its features, ease of use and cost, but also by its available learning modules and applications. Technology in ultrasound and computers are rapidly advancing in enhancing the quality and miniaturizing ultrasound machines. Portable and handheld ultrasound equipments are quickly becoming indispensable diagnostic instruments in different health care settings especially the emergency rooms and physician offices. Concerns, however, remain related to the...

Southern Medical Journal, 1994

Venous thrombosis is a frequent complication in patients with paroxysmal nocturnal hemoglobinuria... more Venous thrombosis is a frequent complication in patients with paroxysmal nocturnal hemoglobinuria (PNH). However, arterial thrombosis is rare, and cerebral arterial thrombosis has been reported only in postmortem studies. We discuss the case of a PNH patient in whom both clinical and neuroimaging findings were compatible with cerebral arterial and venous thrombosis.

The American Journal of Gastroenterology, 2000

... [1991]. Geography of intestinal permeability and absorption. (PMID:10075954) Menzies IS, Zuck... more ... [1991]. Geography of intestinal permeability and absorption. (PMID:10075954) Menzies IS, Zuckerman MJ, Nukajam WS, Somasundaram SG, Murphy B, Jenkins AP, Crane RS, et al. ... (PMID:6973927) Wig JD, Malik AK, Khanna SK, Singh K, Talwar BL, Shukla NK, Sekar N. Am. ...

American Journal of Gastroenterology, 2003

The majority of responders were hospital-based and 59% of the units performed over 3000 procedure... more The majority of responders were hospital-based and 59% of the units performed over 3000 procedures per year. After use the endoscope was hand-carried or transported in a dry container (97%) to a separate cleaning room (85%) for HLD by technicians (40%). Wide variations existed in manual step procedures including use of disposable (50%) brushes and number of times channel brushed: once (21%), twice (35%), 3-5 times (37%). Soaking duration in disinfectant (gluteraldehyde 70%) was Ͻ10min (8%), 10-20 min (35%), 20-30 min (38%), 30-40 min (7%) and Ͼ40 min (3%). 67% had an active unit infection control (IC) service and 98% had a QA program. Monitoring of cleaning effectiveness was by visual inspection (50%) and culturing endoscopes (17%). Culturing was done weekly (1%) and biannually (6.5%) and performed by swab of the endoscope end (5%) or rinsing the biopsy channel (8%). If culture positive, most would remove the instrument from clinical use and reevaluate protocol and personnel for technique lapses. Two respondents were aware of a procedure related infection (bronchoscope in one). Conclusions: Wide practice variations were noted in manual cleaning and in soaking time during automated HLD in this community. Less variations were noted in cleaning personnel and training, location and methods of cleaning, presence of IC services and QA programs. Endoscope culturing was infrequently done and positive cultures were rare. While most units claim to have ongoing quality assurance programs, few use objective criteria to monitor effective disinfection or lapses in technique. Iatrogenic infection is uncommonly recognized following GI endoscope procedures.

Infectious Diseases Newsletter, 1987

Donald School Journal of Ultrasound in Obstetrics and Gynecology, 2014

Stethoscope, the symbol of modern medicine has been in place for more than 150 years. However, th... more Stethoscope, the symbol of modern medicine has been in place for more than 150 years. However, this reliable diagnostic instrument has started showing its age with the arrival of a newer diagnostic instrument: the hand-held ultrasound. Hand-held ultrasound is rapidly expanding in many specialties but not yet in obstetrics and gynecology. There is a paucity of literature on the application of hand-held ultrasound in obstetrics and gynecology, in contrast to a large volume of literature published by other specialties. Several studies demonstrated that medical students and residents can improve the accuracy of their physical examinations with the use of hand-held ultrasound. Similarly, physical examinations performed by hospitalists with hand-carried ultrasound are more accurate than those performed without the instrument. Advances in technology have contributed to the improvement of image quality and portability. As a result, these devices become increasingly available in many clinica...

Travel Medicine and Infectious Disease, 2009

El Paso, Texas and Ciudad Juarez, Mexico comprise the largest U.S./Mexico border population. Bact... more El Paso, Texas and Ciudad Juarez, Mexico comprise the largest U.S./Mexico border population. Bacterial samples were collected from two hospitals in El Paso and two in Ciudad Juarez and transported to a reference microbiology laboratory in El Paso for microbial identification and antimicrobial susceptibility testing according to NCCLS standards. The presence of the MecA gene, and the prevalence of both the SSCmec IV element and the Panton-Valentine leukocidin were investigated by PCR in all MRSA isolates. A total of 201 isolates in El Paso and 128 in Ciudad Juarez of Staphylococcus aureus were identified, of those, MRSA were significantly more prevalent in El Paso than in Ciudad Juarez [89 (44.3%) versus 10 (7.8%) respectively (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001)]. Thirty one (35%) of MRSA strains isolated in El Paso were community associated. Significantly higher prevalence of MRSA infections was documented in El Paso compared to Ciudad Juarez.

Donald School Journal of Ultrasound in Obstetrics and Gynecology, 2014

In the current era of decreased funding for teaching and research, academic centers are increasin... more In the current era of decreased funding for teaching and research, academic centers are increasingly focused on clinical productivity. The lack of structured mentoring programs along with increasing clinical demands has led to unrealistic academic expectations for physician faculty. Faculty mentoring is a dynamic reciprocal relationship for both the mentor and mentee to work closely in developing a professional and productive academic partnership. Both mentor and mentee are equally important in achieving a rewarding mentoring partnership. There are fundamental guidelines for the mentor and the mentee to follow to ensure the desired outcomes. Traditional mentoring relationship is strictly voluntary without a defined commitment from either party. However, outcome-driven mentoring relationship is a structured process in which specific goals and objectives are well-defined, and in which the mentoring progresses and feedback are closely monitored. Much information about faculty mentoring...

Donald School Journal of Ultrasound in Obstetrics and Gynecology, 2014

Advances in technology have made ultrasonography a rapidly evolving concept in the practice of me... more Advances in technology have made ultrasonography a rapidly evolving concept in the practice of medicine and a valuable component of the competency-based education. American Medical Association (AMA) recently affirms that ‘ultrasound imaging is a safe, effective and efficient tool when utilized by, or under the direction of appropriately trained physicians.’ AMA also supports the educational efforts and widespread integration of ultrasound throughout the continuum of medical education. Training in ultrasonography is rapidly expanding to numerous residency programs of graduate medical education but discrepancies in ultrasound curriculum and criteria for proficiency exist among programs within the same discipline, despite clearly defined objectives recommended by the governing bodies. There is a trend to integrate ultrasonography into the curriculum of undergraduate medical education. However, funding, availability of ultrasound-trained faculty and student time are barriers to the impl...

Southern Medical Journal, 1995

Journal of Clinical Ultrasound, 2011

We report the case of a 39-year-old woman who presented with a pelvic mass extending into the upp... more We report the case of a 39-year-old woman who presented with a pelvic mass extending into the upper abdomen. Transabdominal sonography revealed a complex left adnexal mass. Color Doppler imaging and spectral Doppler analysis showed increased vascularity with low impedance blood flow signals, suggestive of neovascularization. The patient underwent a laparotomy and a 56-kg predominantly cystic tumor was removed from the left adnexal region. The patient died 3 months later with pulmonary metastases and massive pulmonary hemorrhage. Postmortem resampling of the ovarian tumor initially diagnosed as mucinous cystadenoma showed nodular areas of malignant pleomorphic cells consistent with angiosarcoma.

Journal of Clinical Gastroenterology, 1990

H2-antagonists are frequently used in the management of upper gastrointestinal (UGI) hemorrhage d... more H2-antagonists are frequently used in the management of upper gastrointestinal (UGI) hemorrhage despite their lack of proven efficacy. In order to determine the pattern of H2-antagonist usage for this indication, we retrospectively reviewed the charts of 137 patients admitted with acute UGI bleeding over a 1-year period at two teaching hospitals in West Texas. An H2-antagonist was ordered in 89% of patients (77%) intravenous, 12% oral). It was administered within 2 h of admission in 25% of these patients, within 4 h in 54%, and within 8 h in 78%. An H2-antagonist was ordered among the initial six orders in 49% and among the initial 10 orders in 77% of patients. Considering orders for specific therapies, an H2-antagonist was in the initial three orders in 60% of patients and among the initial six orders in 97%. Of the patients who were prescribed an H2-antagonist and who also had upper endoscopy, the drug was ordered prior to endoscopy in 86%. This review of H2-antagonist usage in the management of acute UGI bleeding has identified a prescribing pattern of writing for these drugs early in the sequence of order writing, with the drugs being given early in the course of hospitalization.