Author: admin | 28.10.2015

The UCLA Pain Management Fellowship Program consists of a comprehensive outpatient pain practice, along with an inpatient consult service.
The UCLA Pain Management Center offers clinical services to our patients Monday through Friday, divided between 4 attending physicians.
Doubly Board-Certified by The American Board of Anesthesiology, and The American Academy of Pain Management.
Chandler Pain Management Doctor Tristan Pico is fellowship trained in both Interventional Pain Management and Anesthesiology.
Cervical epidural steroid injections (CESI) have been utilized for decades in the treatment of radicular pain. This injection relieves pain in the neck, shoulders, and arms caused by a pinched nerve (or nerves) in the cervical spine.
An epidural steroid injection significantly reduces pain for approximately 50% of patients.
If you manage this site and have a question about why the site is not available, please contact us directly. The Department faculty and staff sincerely wish the Fellowship and Residency graduates of 2011 all the best of success in their careers, and look forward to hearing from them in the future.
Rima Matevosian, MD, CMO and Chief, Anesthesiology, Olive View-UCLA Los Angeles County Medical Center; and Patricia Kapur, MD, Chair, UCLA Department of Anesthesiology, at reception. Anahat Dillon, MD, Assistant Clinical Professor, receiving Dhillon Award, from Harvey Rosenbaum, MD, Clinical Professor, and Patricia Kapur, MD, Department Chair. Pain Medicine FellowshipThe Department of Anesthesiology at Vanderbilt University is proud to direct the institution's first and only multidisciplinary pain medicine fellowship. Trainees in the fellowship program will be extensively exposed to strategies of pain management by both anesthesiologists and faculty from other disciplines.
Vanderbilt University Medical Center is committed to principles of equal opportunity and affirmative action.
Assess your knowledge, prep for the boards, and earn CME credits and MOC points with the best self-assessment program. It is cost-effective to screen asymptomatic patients for type 2 diabetes beginning between the ages of 30 and 45 and repeating the test every three to five years, according to a computer model.
Compared to not screening, all of the strategies reduced the incidence of myocardial infarction and microvascular complications and increased the number of quality-adjusted life-years (QALYs).
Screening patients who were already being treated for hypertension had the lowest cost per QALY, but less effect on microvascular outcomes because fewer cases of diabetes were diagnosed. The cost of these screenings could be minimized further by conducting the screening in conjunction with other recommended care, such as lipid screening, the authors noted. The study did not address the American Diabetes Association’s current recommendations, which suggest screening 30- to 45-year-olds only if they have risk factors, an accompanying comment noted. The Federation of State Medical Boards reported a 6% increase in disciplinary actions in 2009 overall among state medical boards. Because of the wide variations between state medical boards in terms of composition, funding, size and levels of proof required, the report is most useful in comparing variations within each state over time, instead of comparisons among the states. However, each year the federation issues a Composite Action Index, an average of disciplinary actions that weights the severity of actions taken, such as license revocations and suspensions. While most states were fairly consistent, some states saw wider variations in the numbers of disciplinary actions taken between 2009 and 2008. A 28-year-old woman develops a 2-month history of aching in the joints in her hands and knees. In addition to a calcium-channel blocker trial, which of the following is the most appropriate management for this patient?
Dutasteride (Avodart) reduced the risk of prostate cancers and precursor lesions and improved outcomes related to benign prostatic hyperplasia (BPH) among men, a study concluded. The Reduction by Dutasteride of Prostate Cancer Events (REDUCE) study was done in collaboration with the drug's maker, GlaxoSmithKline. Researchers wrote that while dutasteride therapy may have played a role in reducing the number of cancers with Gleason scores of 8 to 10, more men in the placebo group may have had their tumors upgraded had the study protocols not required they be withdrawn.
However, an accompanying editorial cautioned that dutasteride (and finasteride, another drug in the 5a-reductase inhibitors class) do not prevent prostate cancer, but only shrink tumors that have a low potential for mortality.
Women treated with chest radiation for cancer as children or young adults may benefit from early surveillance for breast cancer, according to a new study.
Researchers performed a meta-analysis of 11 trials to examine the incidence of and excess risk for breast cancer in women after chest radiation for pediatric or young adult cancer, as well as the clinical characteristics of their cancers and the possible benefits and harms of surveillance in this group.
The authors acknowledged that their results were limited by study heterogeneity, varied study design, and small sample size. In related news, a study published online March 29 by the Journal of Clinical Oncology found that in women with early-stage breast cancer, those who had mastectomies were less likely to receive subsequent radiation than those who had breast-conserving surgery, even when radiation was strongly indicated. About 30% of older adults near the end of life needed decisions made about medical treatment but lacked such decision-making capacity, a new study found, and most of those with advance directives got the care they had specified. Using data from the Health and Retirement Study, researchers studied 3,746 adults age 60 years or older who had died between 2000 and 2006 and for whom a proxy answered study questions after the patient died. Forty-two-and-a-half percent of study patients needed decision making, and of these, 70.3% lacked the capacity to make decisions for themselves.
While the results suggest more than a quarter of older adults may need surrogate decision making before death, the data also indicate it's difficult to predict who will need this decision making, the authors noted. Physicians looking for a new job may submit a Job Seeker's Profile to the ACP Job Placement Center, a service available at Internal Medicine 2010 in Toronto, Canada. Profiles are distributed to numerous employers participating in Internal Medicine 2010, which will be held April 22-24. The American Health Information Management Association’s second annual ICD-10 summit will be held April 12-13, 2010, in Washington, D.C. The Annual ICD-10 Summit is the primary source for information, education and resources for preparedness and strategic implementation guidance.


The Joint Commission will hold its annual Conference on Quality and Patient Safety June 23-25 in Chicago.
Information, including registration instructions, is available on The Joint Commission Web site.
ACP InternistWeekly wants readers to create captions for this cartoon and help choose the winner. Combination therapy with a proton-pump inhibitor, such as omeprazole, and a calcium-channel blocker is the most appropriate treatment in this clinical scenario.
Because scleroderma is not characterized by an inflammatory disorder, neither high-dose corticosteroids nor immunosuppressive agents are used in this setting.
In patients with scleroderma, high-dose corticosteroid therapy may be associated with normotensive renal crisis.
To add your e-mail address to your member record and to begin receiving ACP InternistWeekly, please click here. A 52-year-old man is evaluated for low back pain of 3 months' duration that is nonradiating, progressive, and worse with ambulation. ACP offers different categories of membership depending on your career stage and professional status.
Ensure you're board-exam ready with ACP's Board Prep Ace - a multifaceted, self-study program that prepares you to pass the ABIM Certification Exam in internal medicine.
Pico is an advocate of providing patients with a wide array of treatments to ensure that pain treatment is tailored to each patient’s unique pain profile. Medicus Pain and Spine, PLC, with offices in Bloomfield Hills and Plymouth Michigan is  the practice of Richard K. It works by delivering steroids directly to the painful area to help decrease the inflammation that may be causing the pain. Randolph Steadman, Victor Duval, Judi Turner, and Samuel Wald applauding graduating residents. Accredited by the ACGME in 2008, our fellowship combines extensive experience with advanced interventional techniques in addition to rotations in regional anesthesia, addiction psychiatry, neurology, radiology, neuroradiology, neurosurgery, physical medicine and rehabilitation, cancer pain and palliative care. The fellows, regardless of their primary specialty, should be competent in pain assessment, formulation and coordination of a multiple modality treatment plan, integration of pain treatment with primary disease management and palliative care and interaction with members of a disciplinary team. The most cost-effective strategies appeared to be those that started screening patients between 30 and 45 and repeated screening every three to five years, the researchers concluded. Although the model is limited by being a simulation, the study’s results are applicable to real life, the study authors said, concluding that screening every three to five years starting between 30 and 45 would be cost-effective for the U.S.
The annual report summarizing disciplinary actions against physicians by 70 medical and osteopathic boards in U.S. New Hampshire's actions more than doubled from 7 (against 7 doctors) to 16 (against 16 doctors).
Idaho handed out 19 actions (against 16 doctors) in 2009, compared to 29 actions (against 28 doctors) in 2008. Among the 6,706 men who underwent a needle biopsy, there were 220 tumors with a Gleason score of 7 to 10 among 3,299 men in the dutasteride group and 233 among 3,407 men in the placebo group (P=0.81).
Researchers also said the data support the idea that the difference in the number of cancers with a Gleason score of 8 to 10 was due in part to dutasteride therapy. However, they concluded that women who receive chest radiation for childhood or young adult cancer are at substantially elevated risk for early breast cancer and that the risk does not seem to plateau with age.
The researchers found that patients' willingness to receive radiation and surgeon involvement in the decision heavily influenced treatment.
Outcomes included whether the patient had completed a living will or durable power of attorney, maintained decision-making capacity, and needed decision making at the end of his or her life. The fact that so many older adults have advance directives suggests they find them acceptable, familiar, available and valuable, they said. Celiac disease incidence has risen since the 1950s, so alert internists listen to the symptoms, get to the basis, and make accurate attributions to make the right diagnosis. Offices feeling confident about HIPAA compliance now face HITECH, which involves increased demands meant to secure confidential information in a digital age.
For a year, one patient saw specialist after specialist and received a different diagnosis each time. The Center, located in the Metro Toronto Convention Centre’s Exhibit Hall, Booth 222, provides physicians with tools to assist in job searches as well as the opportunity to meet with potential employers.
After reviewing a profile, a recruiter may contact the physician to schedule a private on-site interview at the Convention Centre. The conference will focus on ways for organizations to improve quality and reduce errors, contain costs, increase productivity and execution, and build leaders throughout their organization. Pen the winning caption and win a $50 gift certificate good toward any ACP product, program or service. This item is available online to MKSAP 14 subscribers in the Rheumatology section, Item 28. This patient has aggressive new-onset diffuse cutaneous systemic sclerosis with extensive skin involvement.
Moreover, even moderate-dose corticosteroid therapy may be associated with normotensive renal crisis in patients with scleroderma. It is automatically sent to all College members who have an e-mail address on file with ACP. He completed his Anesthesia Residency Training at Johns Hopkins and his Pain Management Fellowship Training at the Cleveland Clinic Foundation. This, paired with his desire to treat pain led him to the field of pain management, which not only provides the opportunity to connect with his patients during their time of greatest difficulty, but also alleviate their suffering. His training at MD Anderson, the nation’s premier cancer treatment facility, helped him master the most advanced pain treatment techniques that can be offered to patients.


The medication injected helps decrease the swelling of nerves, which is often the source of the pain.
Diabetes incidence, health care costs associated with screening and treatment, and potential complications (including myocardial infarction, stroke and microvascular complications) were simulated for the following 50 years of the hypothetical patients’ lives. South Carolina handed out 20 actions (against 20 doctors) in 2009, compared to 56 actions (against 54 doctors) in 2008. In addition, she has experienced postprandial and occasional burning nocturnal chest discomfort for the past 3 months. Lungs are clear to auscultation, and cardiac examination reveals a normal S1 and S2 with no gallops or murmurs. In the placebo group, men with prostate cancer were withdrawn from the study, so during years 3 and 4, there were 12 tumors with a Gleason score of 8 to 10 in the dutasteride group, as compared with only 1 in the placebo group (P=0.003). Although evidence on the characteristics and outcomes of breast cancer in this group was limited, both seemed similar to the general population. Early detection appeared to have benefit in this group because those who received diagnoses of early-stage breast cancer were likely to have favorable outcomes. Data were also collected on care preferences of subjects who completed a living will, and researchers compared these preferences with the outcomes of surrogate decision making.
A causal relationship can't be inferred, but the findings do suggest advance directives influence end-of-life decisions, they added.
Like the story of the blind men and the elephant, specialists often see the patient through only one component of training, as anchoring and availability sneak into their thinking. In one study of 140 patients with “scleroderma renal crisis,” 11% of these patients had normal blood pressure but a rapid decline in renal function. Medical history is notable for smoldering multiple myeloma diagnosed 1 year ago; he has been stable since that time.
Our practice is exclusively limited to Pain Management, and we have multiple offices in Southern Nevada for the convenience of our patients. Tristan Pico witnessed the devastating consequences of pain during his grandfather’s battle with colon cancer. In addition to relieving pain, the process of natural healing can occur more quickly once the inflammation is reduced.
A number of different screening strategies were put into the model—screens starting at different ages, occurring at different frequencies, or triggered by a diagnosis of hypertension. Screening at frequent intervals (every six months starting at 30 or every year starting at 45) or late-onset screening (every three years starting at 60) was associated with a cost of more than $15,000 per QALY.
The authors pointed out that more research is needed to weigh the potential benefits and harms of the additional radiation exposure involved when mammograms are started early. Eighty-three percent of those who requested limited care, and 97.1% of those who requested comfort care, got care consistent with these preferences.
Of those patients who wanted aggressive care but didn't receive it, the decisions may have been overridden by their surrogates, or such care may not have been an option. Therefore, therapy with a proton-pump inhibitor or, alternately, a histamine-2 receptor antagonist is indicated to treat this patient's symptoms of gastroesophageal reflux. These patients also were more likely to have microangiopathic hemolytic anemia and thrombocytopenia and were more likely to receive higher doses of prednisone during the 2 months immediately preceding renal crisis.
The acute pain requirement is met by providing in-patient pain consultation services at Santa Monica-UCLA Orthopaedic Hospital. At MD Anderson, he learned that pain is a highly personal experience and does not affect any one person in the same way. Nadjarian specializes in the diagnosis and treatment of pain and spinal disorders throughout Southeast Michigan. Florida's Board of Osteopathic Medicine handed out 16 actions (against 16 doctors) in 2009, compared to 54 (against 46 doctors) in 2008. Medical history is unremarkable, and family history is remarkable only for an aunt with systemic lupus erythematosus. There is no evidence of synovitis, but flexion contractures are present at the proximal interphalangeal joints and elbows. Overall, the study suggests the health care system should ensure clinicians receive the time and reimbursement needed to help patients plan for the end of life, the authors concluded.
In addition, a calcium-channel blocker is indicated to manage this patient's Raynaud's phenomenon. Low-dose corticosteroids are indicated to treat inflammatory arthritis associated with scleroderma if first-line therapy is not effective. Our goal is to provide a well rounded experience which will prepare our fellows for the pain medicine board exam, and more importantly, future practice. All patients who endure pain on a day-to-day basis can have their lives immeasurably improved with advanced pain treatment. Bernstein and Fooladian to help everyone have a great training experience during the 2010-11 year. This patient has aggressive skin involvement, but no treatments for skin involvement in scleroderma are documented in clinical trials to be disease modifying.
Pico was raised in Glendora, California and will reside in Mesa, Arizona with his wife and three children. Wu will be taking up private practice positions in Pennsylvania and Los Angeles, respectively.



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