Read about Upstate expertise in Physicians Practice magazine

physpractThe February edition of Physicians Practice magazine showcases Upstate experts from gerontology, urology, otolaryngology, nursing and pharmacy, as well as a story about Danielle Laraque-Arena, Upstate’s new president.

Physicians Practice is a publication that is distributed to physicians throughout the Central New York region.

 

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Baby King needs a bone marrow donor. Can you help?

King Nazir Leon, 2, needs a bone marrow transplant, the only cure for a rare disease that affects his immune system. Photo by Mike Greenlar/Syracuse Media Group.

King Nazir Leon, 2, needs a bone marrow transplant. Potential donors can register today at Upstate’s Setnor Hall and Cancer Center. Photo by Mike Greenlar/Syracuse Media Group

King Nazir Leon, age 2, has CD40 Ligand deficiency, a rare disease that affects his immune system and is life-threatening. He has monthly, day-long treatments at the Upstate Golisano Children’s Hospital in Syracuse. His mother, Denisha DeLee, is vigilant about his health, watching for any sniffle or sign of fever, which means a race to the emergency room and probable hospitalization. At this stage, King’s best hope is a bone marrow match.

Would you take 20 minutes to try to save Baby King from this disease?

Tesha English collects tissue samples by swabbing her mouth with a Q-tip, a key component to registering as a marrow donor, 2008.

Tesha English collects tissue samples by swabbing her mouth with a Q-tip, a key component to registering as a marrow donor. Photo by Susan Keeter.

If you are between the ages of 18 and 44, and willing to donate to any patient in need, come to Upstate Medical University and sign up for the marrow registry today (Friday, Jan. 29). African-Americans are especially encouraged to register because King is most likely to match with someone of his own race. (Tissue types are inherited, so marrow transplant patients are most likely to match with someone of their own ethnicity.) However, everyone is welcome to join.

King loves Mickey Mouse, Teenaged Mutant Ninja Turtles and his Grandma Honey. He likes listening to music, especially the hip-hop song, “Long Live the King,” created for him by Makhai “Truth Speaker” Bailey, a 16-year-old student at Syracuse’s Henninger High School. Bailey, who is too young to donate himself,  performs the song to raise awareness of King and his need for a marrow transplant.

King’s mother plans to be at the marrow drive to thank the students and staff at Upstate for trying to find a donor. The marrow donor drive is open to the public from 10 a.m. to noon at Upstate’s Setnor Hall atrium and 2 to 4 p.m. at the Upstate Cancer Center lobby.

If you  are unable to attend today’s drive, and would like to register as a marrow donor or host your own marrow drive, contact the the William G. Pomeroy Foundation at info@wgpfoundation.org.

To learn more about the bone marrow registry, go to the national donor program, Be the Match.

To learn more about Baby King, read this Post Standard story.

What is a bone marrow transplant?

A bone marrow transplant is a life-saving treatment for people with leukemia, lymphoma and many other diseases. First, patients undergo chemotherapy and sometimes radiation to destroy their diseased marrow. Then a donor’s healthy blood-forming cells are put into the patient’s bloodstream, where they can begin to function and multiply. In order for a patient’s body to accept these healthy cells, the donor’s tissue type needs to match the patient’s type as closely as possible. Patients who do not have a suitably matched donor in their family may search the National Marrow Donor Program Registry for an unrelated bone marrow donor or cord blood unit. –National Marrow Donor Program

Posted in community, education, Golisano, health care, hospital, medical student, patient stories, public health, transplant, volunteers | Leave a comment

Jimmy Carter’s cancer: Melanomas can appear throughout the body

Former President Jimmy Carter greets a Nepalese boy in Kathmandu, Nepal, in November 2013, when the Carter Center monitored Nepal's constituent assembly election, sending observers from 31 countries. (PHOTO BY THE CARTER CENTER)

Former President Jimmy Carter greets a Nepalese boy in Kathmandu, Nepal, in November 2013, when the Carter Center monitored Nepal’s constituent assembly election, sending observers from 31 countries. (PHOTO BY THE CARTER CENTER)

Former President Jimmy Carter’s skin cancer diagnosis began the way it does for so many others facing the disease. A spot discovered on his liver turned out to be melanoma. Then when doctors ordered an imaging scan, they found four more melanomas on his brain.

Carter, 91, disclosed his diagnosis in August. Four months later, he announced that his latest brain scan found no evidence of melanoma – but no one is using the word “cure.” Tim Turnham, the executive director of the Melanoma Research Foundation, told the New York Times that melanoma has a “frightening ability” to return years into remission.

Most likely in Carter’s case, the melanoma started somewhere in his skin and traveled via his bloodstream or lymph system to his liver and brain, says Ramsay Farah, MD, division chief for dermatology at Upstate Medical University. The majority of cases of melanoma begin in melanocytes in our skin, although these cells that provide our pigment can be located in other parts of the body.

“As the fetus is developing, these melanocytes can migrate to other parts of the body,” he explains. “So even though most of them are in the skin, you find them in the eye, in the gastrointestinal tract, in the lining of the brain. Anywhere you have melanocytes, you can get a melanoma.”

News reports say the 91-year-old Carter underwent radiation therapy and has been taking a new immune therapy drug called Keytruda. He receives his care at Emory University’s Kinship Cancer Institute in Atlanta.

Farah says Keytruda is an antibody that targets a receptor on a cell of the immune system called a T cell. “Normally T cells have some natural breaks on them so that they don’t attack every cell in your body. When the T cells are sleeping, they’re not going to attack the melanoma,” he explains. “This medicine basically awakens the T cell, so it can awaken its brothers and sisters, and they all attack the melanoma.”

While some melanomas run in families, most are caused by exposure to ultraviolet radiation from sunshine or tanning beds.

Who is more likely to develop melanoma?

  • Someone with light skin. The pigment in our skin is protective. Melanocytes produce melanin, the chemical that absorbs ultraviolet radiation and protects the cells. People with dark pigment have an incidence of melanoma about 1/20th that of people with light pigment.
  • Someone who was exposed to high levels ultraviolet radiation, especially in childhood. Farah says “a lot of the sun damage we see in adults, they acquired it before the age of 12. There is a long latency period for melanoma.”
  • Someone who lives in an ozone-depleted region. Earth’s ozone layer filters some of the ultraviolet radiation coming from the sun. The highest rates of melanoma are from areas, such as Queensland, Australia, with a hole in the ozone.
  • Someone with lots of moles. Having 50 or more moles increases one’s risk of melanoma, and having suspicious moles also increases the risk.

Farah advocates prevention and vigilant screening so that any melanomas are caught early, before they can spread.

Mole check

See your health care provider if you have moles with any of these characteristics:

A asymmetry. Use your mind’s eye to cut the mole in half: Are both sides symmetrical?

B – border. Healthy moles have borders that are smooth, as opposed to jagged.

C – color. Shades of tan or brown are normal. Troublesome colors are red, white or blue.

D – diameter. Moles greater than ¼ inch diameter are suspicious.

E – evolution. Sudden growth of a mole, pain or bleeding warrants examination by a health professional.

Some melanomas are hidden, existing in the gastrointestinal tract, an eye or a nail bed. Others, called amelanotic melanomas, have no color but may be felt as bumps on the skin.

Source: Ramsay Farah, MD

hloa-art2Layout 1Hear Farah’s radio interview at healthlinkonair.org by searching “melanoma.” This article appears in the winter 2016 issue of Cancer Care magazine. 

 

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New Upstate displays honor students, faculty, patients and providers

First-year medical student Tyler Pluchino recognizes his classmate, John Frandino, in one of the new student display panels in Weiskotten Hall.

First-year medical student Tyler Pluchino recognizes his classmate, John Frandino, in one of the new student display panels in Weiskotten Hall.

Three areas at Upstate Medical University have new displays, all created to celebrate its students and faculty, patients and providers.

Students at Weiskotten

 A new series of wall panels can be found in Weiskotten Hall, a historic Greek-style academic building that houses numerous portraits of medical school leaders dating from the 19th century through today.

“Medicine is changing,” reflects Bilal Butt, a third-year medical student of Puerto Rican and Pakistani descent, when asked to comment on the traditional imagery in Weiskotten Hall. “For a long time, doctors didn’t reflect the population of America.“

Butt was one of a number of students who wanted a change in the visual environment of  the academic building. There was a desire for imagery that was contemporary and reflective of the diversity of the student population.

“A lot of students walk these hallways,” notes Ryan Schiedo, medical student and president of student government. “We needed something that expressed our pride and a sense of community.”

The challenge was to design something that appealed to current students, most of whom were born in the 1990s, while ensuring that the pieces were in keeping with the style of the historic building, which was built in 1936.

The answer?

Utilize the existing color scheme of the building’s interior — the dark brown of walnut doors, the yellow ochre of the wainscoating, and the cream color of the walls. Add brick-red accents to match the building’s exterior. To integrate new images into the historic environment, turn color photos into sepia prints to give them uniformity and a sense of timelessness.

A new plaque of Anesthesiology Chairman Sebastian Thomas, MD, was hung in Weiskotten Hall by Jason Tyre of Image Press.

A new sepia and yellow ochre plaque of chairman Sebastian Thomas, MD, hangs in Weiskotten Hall alongside colleagues and students.

Temporarily remove the color portraits of the current chairpersons of the academic departments — 25 in all — and reinstall in sepia tones to match the existing décor and the new student-focused displays.

To show campus life, sort through hundreds of current photographs of students, at work and play. Select 56 photos representing students from all four colleges. Create sepia-toned collages and include statements of Upstate’s values such as “we drive innovation and discovery,” “we serve our community” and “we respect people.”

Make sure the student panels are the same height as the faculty portraits, thereby communicating mutual respect and equality.

Medical student Jordana Gilman is pleased with the new display in Weiskotten Hall. “It shows all sorts of activities that represent the life of a SUNY Upstate student,” she explains. “It’s visually appealing, reflective of my classmates and me, and sends a positive message about who can be a chairman and who can be a doctor.”

Dear Upstate…

A hallway on the second floor of the downtown hospital has posters of employees who have been praised, in writing, by patients and family members.

A hospital hallway showcases employees who have been praised by patients and family members.

In Upstate’s downtown hospital, a second-floor hallway celebrates caregivers. On the walls are eleven posters featuring 21 nurses and physicians, all of whom have been praised, in writing, by patients and family members. Each poster reads “Dear Upstate” and has an excerpt from a letter. One of the most poignant reads, “Autumn McCann was the angel Mom needed at the end of her life.”

This display, located in the hallway that leads to the east tower and children’s hospital, is a component of the Human Resources Department’s ongoing employee recognition project.

“We love our patients”

A third location — Upstate’s Pediatric and Adolescent Center, the 4,735 sq. ft. clinic at Upstate Health Care Center in downtown Syracuse — has had a makeover. Walls have been painted, new signs installed, and a series of “Busytown-style” murals hung to entertain young patients. The final feature, a series of posters of young patients with their doctors and nurses, resulted from listening to medical director Steven Blatt, MD, say, “We love our patients.” Photographer Susan Kahn spent a day shooting portraits of patients with staff to give visual expression to Blatt’s sentiment.

Inspirational quotes such as “you’re braver than you believe, stronger than you seem, and smarter than you think” and “the most precious jewels you will ever wear around your neck are the arms of your children” were added to give an extra dimension of warmth to the portraits.

The results? Lots of little patients looking at the posters, smiling and saying, “There’s my doctor!”

Kelly Dawn admires a new poster of patients Awi and Ali with Steven Blatt MD, medical director of Upstate’s Pediatric and Adolescent Center.

Dawn Kelly admires a new poster of patients Awi and Ali with Steven Blatt MD, medical director of Upstate’s Pediatric and Adolescent Center.

Posted in community, education, Golisano, health care, history, hospital, human resources, medical student, patient stories | 1 Comment

Good sports: Medical student arranges hat donations for young cancer patients

Medical student Shunqing Zhang lets cancer patient Connor Stanton, 10, choose from a collection of New Era hats. The youngster (son of Rebecca Quilty of Whitney Point) was especially pleased to find one for his favorite NFL team, the Seattle Seahawks. (PHOTO BY JIM McKEEVER)

Medical student Shunqing Zhang lets cancer patient Connor Stanton, 10, choose from a collection of New Era hats. The youngster (son of Rebecca Quilty of Whitney Point) was especially pleased to find one for his favorite NFL team, the Seattle Seahawks. (PHOTO BY JIM McKEEVER)

BY JIM McKEEVER

It started with a simple, two-word compliment.

Upstate second-year medical student Shunqing Zhang was volunteering at the Ronald McDonald House last summer when he saw an adolescent boy wearing a cap with the logo of the Cleveland Cavaliers professional basketball team.

“Nice cap!” Zhang told him.

Zhang learned that the boy was being treated at the Upstate Cancer Center. The cap had been a gift from the staff, who would regularly purchase caps for sports-minded patients who lose their hair from chemotherapy. The center receives many donations of toys and gifts appropriate for cheering up little kids – but few things that appeal to older kids.

With guidance from a child life specialist at the center, Zhang reached out to a woman he met while working on his master’s degree at the Roswell Park Cancer Institute in Buffalo. The woman, a Syracuse University graduate, works for New Era Cap Co.

As Zhang describes, his request was well received. Now, a box of three or four dozen caps representing a variety of professional and college teams arrives every month. The company sends warm hats, instead of caps, as the weather turns cold. Cancer Center staff enjoy being able to present a patient with head coverings that promote his or her favorite team.

Zhang, who is from China, plans to specialize in oncology, partly because his grandfather died from the disease. He got his bachelor’s degree in biology from Cornell University and a master’s degree in interdisciplinary science at Roswell Park before starting medical school at Upstate.

He keeps his perspective by spending time with children and their parents at the Ronald McDonald House, which provides lodging to families during children’s medical treatment. While the patients are grateful for the caps to cover their heads, it’s Zhang who is grateful for New Era’s generosity.

Layout 1This article appears in the winter 2016 issue of Cancer Care magazine. 

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Patients with broken jaws may also have concussions

medical illustration of a broken jaw boneConcussions caused by sports injuries and active-duty military combat have garnered lots of publicity lately. Specialists at Upstate are now calling attention to a concussion that can result from a forceful punch to the jaw.

Patients with isolated mandible fractures should be screened for concussion and referred to a concussion clinic, say the authors of a paper published in October in Facial Plastic Surgery, a publication of the Journal of the American Medical Association.

Seventy-five percent of patients with mandibular fractures were found to have concussions during a year-long study at Upstate University Hospital, according to research by otolaryngologists Robert Kellman, MD and Robert Kopp, MD, nurse practitioner Ronald Walsh and Lindsay Sobin, MD, an Upstate otolaryngology resident who is doing a fellowship at Boston Children’s Hospital.

Their research included 16 patients between June 2013 and June 2014 with a median age of 27 ½ years old. Fourteen were male. Twelve were injured in assaults. Twelve broke their jaws in two places. Eleven reported losing consciousness.

Although half of the patients admitted drinking alcohol, the authors found no relationship between the rates of concussion and the use of alcohol.

Significant force is required to break a human jaw, which is designed to protect the brain.

“The horseshoe shape of the mandible and its relationship with the skull base allows it to absorb rather than transmit forces to the middle cranial vault, which often leads to fractures in two locations, providing a degree of protection to the brain,” the authors write, pointing out that high velocity impact can overcome such evolutionary advantage.

Also, they note, with increasing force, the likelihood of intracranial and cervical spine injury increases.

The otolaryngologists urge medical colleagues to be alert for concussions in patients with jaw fractures. “Given the high rates of potential concussion seen in our study, and the low rates previously reported, we recommend an awareness of concussive symptoms and a high index of suspicion for mild traumatic brain injury,” they conclude.

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Sudden weakness, numbness, trouble speaking or seeing? Quickly get to hospital for stroke evaluation

A comprehensive stroke center is typically the largest and best-equipped hospital in a given geographical area that can treat patients with any kind of stroke or stroke complication.

A comprehensive stroke center is typically the largest and best-equipped hospital in a given geographical area that can treat patients with any kind of stroke or stroke complication. In Syracuse, Upstate University Hospital is the first and only comprehensive stroke center. In the photo above, neurosurgeon Satish Krishnamurthy, MD, left, operates with residents Meg Riordan, MD, and Ali Hazama, MD.

What would you be likely to do within the first three hours of experiencing weakness, numbness, difficulty speaking or difficulty seeing?

Researchers from Ronald Reagan UCLA Medical Center asked this question of more than a thousand people nationwide – and were astonished that almost three quarters of respondents under the age of 45 gave an answer that could endanger their health.

Sudden weakness, numbness, difficulty speaking or seeing are symptoms of stroke. Your brain is sending signals that its blood flow is impeded – either from a burst or blocked blood vessel — and you must act quickly in order to minimize or reverse damage. That means an urgent trip to the hospital.

Which one?

Syracuse has the region’s first and only comprehensive stroke center, at Upstate University Hospital. On duty around the clock at Upstate is a medical team of experts in stroke care including neurologists, neurosurgeons, neurointerventional radiologists, neurocritical care specialists, board certified emergency physicians and specialized neuroscience nurses.

But the team’s abilities are useless if patients don’t recognize stroke symptoms and promptly get to the hospital. The first three hours of a stroke are critical. Waiting to see whether symptoms improve, as many survey respondents said they would do, is wrong.

“There simply is no time to wait. There is a very limited window in which to start treatment because the brain is very sensitive to a lack of blood flow or to bleeding, and the longer patients wait, the more devastating the consequences,” says David Liebeskind, MD, a neurologist at UCLA, which released results of the study this morning.

Gene Latorre, MD, is medical director of Upstate's stroke program.

Neurologist Gene Latorre, MD, is medical director of Upstate’s stroke service.

Neurologist Gene Latorre, MD, medical director of the stroke service at Upstate, emphasizes that every minute counts. “The sooner we identify and treat acute stroke, the better the outcome.”

Medications and medical interventions can be used to treat different kinds of strokes.

Ischemic strokes, those caused by clots, may be treated with an intravenous clot-busting medication. Sometimes the blood clot is too big, or the patient cannot be given the medication because of other medical concerns. Upstate has specialists who can remove the clot using special catheters inserted through the patient’s groin. Hemorrhagic strokes, caused by a bleed, are sometimes managed with medications that carefully control blood pressure. Sometimes surgery is indicated.

Results of the UCLA survey are especially troubling because they reveal so many young adults are unaware of the signs and symptoms of stroke at a time when the number of strokes in people under the age of 45 have increased by as much as 53 percent since the mid 90s.

Latorre says Upstate University Hospital has seen an increase in patients diagnosed with stroke who are younger than 45. The increase is likely caused in part by a rise in the number of young adults with diabetes, uncontrolled high blood pressure and/or obesity, conditions that increase a person’s risk for stroke. Smoking rates also remain high among people from age 18 to 45, and smoking significantly increases a person’s risk of stroke.

Stroke experts suggest memorizing the mnemonic FAST to help remember the sudden signs of stroke:

F is for face drooping. Does one side of the face droop or is it numb? Ask the person to smile. Is the person’s smile uneven?

A is for arm weakness. Is one are weak or numb? As the person to raise both arms. Does one arm drift downward?

S is for speech difficulty. Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence, such as “The sky is blue.” Is the sentence repeated correctly?

T is time to call 9-1-1. If someone shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get the person to the hospital immediately. Check the time so you’ll know when the first symptoms appeared.

So, what if you are a 30-something who experiences sudden weakness, numbness, fuzzy vision and slurred speech?

Remember that stroke happens to both the young and the old.

Memorize this pneumonic to help remember the symptoms of stroke.

Memorize this mnemonic to help remember the symptoms of stroke.

“If you experience sudden dysfunction in your face, arm or speech, it’s time to call 911,” says Latorre. “Stroke is treatable, and every minute counts. The sooner you get to the nearest Stroke Center, the better your chance of having a good recovery.”

Posted in community, emergency, neurology, neurosurgery, nursing, stroke, surgery | Leave a comment

Visiting professors discuss aging, independence at home

Bruce Kinosian, MD, and nurse practitioner Jean Yudin, both of University of Pennsylvania School of Medicine Division of Geriatrics, will present The Willie Sutton Effect in Health Care: Independence at Home Targeting and Incentives from 5 to 6 p.m. Thursday, Jan. 21 in the Medical Alumni Auditorium of Upstate’s Weiskotten Hall.

Kinosian and Yudin will review the Centers for Medicare and Medicaid’s “Independence at Home Demonstration,” the project’s research design and preliminary findings, as well as an evaluation of Penn’s house call program and integrated medical and social services delivery model.

The presentation is designed for researchers, clinicians, policy-makers, educators and students in the health professions.

The Penn scholars are pioneers in the design and study of in-home primary care programs. They were instrumental in creating the University of Pennsylvania’s successful house call program, which has been in operation for more than 20 years. This program has led to the creation of a model collaboration with Philadelphia’s largest provider of social services for older adults, which has demonstrated the effectiveness of integrated medical and supportive services to maintain frail elders efficiently in the community.

The event is sponsored by the Central New York Citizen’s Aging Research and Action Network (CNY-CAN), a partnership of F.O.C.U.S. Greater Syracuse, HealtheConnections, the Southwest Community Center and Upstate Medical University.

For more information, contact Anne Lutz at lutza@upstate.edu or 315-464-5167. The presentation is open to the public.

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College of Nursing hosts annual open house

15.388 CON Open house boost artUpstate’s College of Nursing hosts an open house from 5 to 7:30 p.m. Wednesday, Jan. 13 in the Medical Alumni Auditorium of Weiskotten Hall, 766 Irving Ave.

Learn about nursing degree programs and how obtaining a bachelor’s, master’s or doctoral degree can inspire your career. Admissions staff and nursing faculty will be available to answer questions about the Upstate nursing programs. Representatives of Crouse College of Nursing will also be present to discuss the Crouse associate’s degree program.

 

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Which medical apps are on your phone?

Nearly all family physicians carry powerful computers in their pockets, loaded with reference information and connected to vastly more on the Web, says Joshua Steinberg, MD, an assistant professor of family medicine at Upstate’s Binghamton Clinical Campus.

“If you collect good resources and know how to get what you’re looking for efficiently, you should be able to answer a great number of questions at the point of patient care with but a few clicks, in less than 20 seconds,” Steinberg writes in the fall issue of Family Doctor, a journal of the New York State Academy of Family Physicians.

He recalls the various manuals, pharmacopeias and guides on which he relied during medical training. Today, much of that information is replaced by apps that are downloaded onto smartphones. Eleven of his favorites include:

epocratesePocrates, a free drug reference that includes pill sizes, dosing, renal and hepatic insufficiency adjustments, out-of-pocket pricing and more.

“Anyone can remember that quinolones mess up Coumadin. But when a patient feels lousy, can you gaze at a list of 14 meds and pick out the four that might interact with each other? ePocrates will do this for you.”

CDCThe Centers for Disease Control and Prevention’s Vaccine Schedules app, and family medicine’s own Shots Immunizations app, which provide the typical schedules for kids, teens and adults. Both includes tables of vaccines by medical indication, catch-up schedules and additional details about particular vaccines.

infect.disThe Infectious Disease Compendium, a concise resource of nearly any entity or microbe, with parenteral and oral regimens and alternatives that will work around allergies – plus hot links to evidence in the literature to support numerous assertions. “You will actually enjoy using this app,” Steinberg writes. “The tracts are peppered with wisecracks, sarcasm and all manner of humor.”

QXmedBIGx Calculate, which organizes frequently used medical calculations such as BMI, Framingham cardiac risk, fractional excretions of sodium and others.

 

 

storkDueDateCalc, the modern version of an OB wheel.

 

 

 

EPSSThe Electronic Preventive Services Selector, or EPSS, which organizes the screening and preventive services that have been reported by the United States Preventive Services Task Force.

 

preopevalPreopEval, which combines the guidance on preoperative clearance and perioperative management from several authoritative guidelines.

 

 

contraceptionContraception Pocketcards, a reference that offers comparative contraception effectiveness, quick start algorithms, medical contraindications table, pill formulations, and more.

 

warfarinWarfarin Guide, which combines a Warfarin adjustment protocol from American Family Physician with indications, targets, and durations of therapy as recommended by the American College of Chest Physicians.

 

biliBiliCalc, for providers who do newborn care. This gives bilirubin levels, along with details about which infants are at risk for needing phototherapy. Providers input the newborn’s age in hours and the bilirubin level, and the app shows the data on a graph.

 

STDSTD 2010, provided by the Centers for Disease Control and Prevention. This app gives concise and comprehensive information about sexually transmitted diseases.

Posted in family medicine, Golisano, infectious disease, maternity, pharmacy, surgery | Leave a comment