David Drachman

Maricopa Integrated Health System , Arizona City, Arizona, United States

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Publications (8)15.5 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: To describe a new approach to transgluteal pudendal neurolysis and transposition and to review the outcome in 10 patients who underwent repeat operation because of persistent pudendal neuralgia after failing to improve after initial surgical decompression. Retrospective analysis (Canadian Task Force classification II-3). Academic chronic pelvic pain practice at St. Joseph's Hospital and Medical Center in Phoenix, Arizona. Women and men with persistent pudendal neuralgia after undergoing transgluteal pudendal neurolysis and transposition. Transgluteal decompression of the pudendal nerve was performed in all 10 patients. In brief, a transgluteal incision was made, and the pudendal nerve was identified via a nerve integrity monitoring system. Adhesiolysis was performed from the piriformis muscle to the distal Alcock canal using a Zeiss NC-4 surgical microscope. The nerve was then enclosed in NeuraWrap Nerve Protector and coated with activated platelet-rich plasma. An ON-Q PainBuster catheter was place along the nerve into the Alcock canal, and 0.5% bupivacaine was infused at 2 mL/hr. The sacrotuberous ligament was repaired using an Achilles or gracillis cadaver ligament. The overlying subcutaneous tissue and skin were then closed. From June 2008 to March 2010, 10 consecutive patients (7 women and 3 men; age range, 29-81 years) underwent repeat operation with transgluteal decompression of the pudendal nerve. Neuropathic pain was unilateral (n = 8) or bilateral (n = 2), in the clitoris or penis (30%), vulva or scrotum (70%), perineum (40%), and rectum (50%). Of the 10 patients, 1 patient was lost to follow-up. Mean follow-up was 23 months. Eight of 9 patients reported global improvement, with 2 patients reporting complete resolution of symptoms. One patient reported no change. Pain, as measured using an 11-point numerical scale, improved from a mean of 7.2 to 4.0 (p = .02), with 5 patients reporting clinically significant improvement (change, ≥2). Comfortable sitting or maximum time that the patient was able to sit without exacerbation of pain improved in 8 patients, with a change in median time of 5 to 45 minutes (p = .008). Change in the ability to sit correlated well with patient-reported global improvement (correlation coefficient, 0.86). No patient experienced worsening of symptoms. Patients with persistent pudendal neuralgia after surgical decompression may benefit from repeat operation via our novel approach. Ability to sit correlates well with reported improvement due to surgery.
    Journal of Minimally Invasive Gynecology 02/2012; 19(3):325-30. · 1.61 Impact Factor
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    ABSTRACT: The purpose of this study was to compare influenza vaccination rates of pregnant women in a public safety-net health system to national coverage rates during the 2009-2010 pandemic influenza season. A chart review of a random sample of deliveries was undertaken to determine rates of coverage and predictors of vaccine coverage of women who obtained prenatal care and delivered in our health system. Rates were calculated from deliveries from when the vaccine was first available through April 30, 2010. Coverage rates were 54% for the seasonal influenza vaccine and 51% for the H1N1 vaccine. Race/ethnicity, insurance status and language spoken did not predict the receipt of either vaccine. When we included only births which occurred through March 12, 2010, as was done in a large population-based study, the rates were 61% and 59%, respectively. Our rates are about 10% higher than the rates reported in that study. Our comprehensive strategy for promoting vaccine coverage achieved higher vaccination rates in a safety-net health system, which serves groups historically less likely to be vaccinated, than those reported for the pregnant population at large.
    Influenza research and treatment. 01/2012; 2012:329506.
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    ABSTRACT: There is no clear gold standard treatment for childhood posttraumatic stress disorder (PTSD). An annotated bibliography and meta-analysis were used to examine the efficacy of cognitive behavioral therapy (CBT) in the treatment of pediatric PTSD as measured by outcome data from the Child Behavior Checklist (CBCL). A literature search produced 21 studies; of these, 10 utilized the CBCL but only eight were both 1) randomized; and 2) reported pre- and post-intervention scores. The annotated bibliography revealed efficacy in general of CBT for pediatric PTSD. Using four indices of the CBCL, the meta-analysis identified statistically significant effect sizes for three of the four scales: Total Problems (TP; -.327; p = .003), Internalizing (INT; -.314; p = .001), and Externalizing (EXT; -.192; p = .040). The results for TP and INT were reliable as indicated by the fail-safe N and rank correlation tests. The effect size for the Total Competence (TCOMP; -.054; p = .620) index did not reach statistical significance. Limitations included methodological inconsistencies across studies and lack of a randomized control group design, yielding few studies for meta-analysis. The efficacy of CBT in the treatment of pediatric PTSD was supported by the annotated bibliography and meta-analysis, contributing to best practices data. CBT addressed internalizing signs and symptoms (as measured by the CBCL) such as anxiety and depression more robustly than it did externalizing symptoms such as aggression and rule-breaking behavior, consistent with its purpose as a therapeutic intervention.
    Journal of behavior therapy and experimental psychiatry 03/2011; 42(3):405-13. · 2.48 Impact Factor
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    ABSTRACT: Transient tachypnea of the newborn (TTN) is a common respiratory problem in newborns. This study aims to determine if cesarean delivery (CD) is a risk factor for TTN, and if labor prior to CD decreases this risk. A linked data set consisting of Arizona birth certificates (1994 to 1998) and infants enrolled in a high-risk perinatal program provided 800 TTN cases and 800 controls, stratified by year. The relationships of CD and labor to TTN were examined using logistic regression. CD was associated with an increased risk of TTN, whether it was accompanied by labor (odds ratio [OR] 2.68; 95% confidence interval [CI] 1.62 to 4.45) or not accompanied by labor (OR 2.88; 95% CI 2.01 to 4.13), even after adjusting for confounding variables. Labor did not affect the development of TTN, nor did it modify the association of CD with increased risk for TTN. CD is a risk factor for TTN. Labor prior to CD is not protective for TTN.
    American Journal of Perinatology 11/2010; 27(10):797-802. · 1.57 Impact Factor
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    ABSTRACT: The objective of this study was to determine whether computed tomography (CT) is a reliable method of imaging to assess placental injury after acute trauma during pregnancy. This study was a retrospective review of digital CT images and electronically scanned charts of pregnant trauma patients identified from the hospital trauma registry list. Using delivery within 36 hours of trauma as the clinical marker for the occurrence of placental abruption, positive radiologic readings showed 86% sensitivity and 98% specificity. The overall accuracy was 96%. Given that defined patterns on CT can be identified and those can be correlated to actual abruption, CT may be a reliable method for evaluation of placental abruption after maternal trauma, especially in the face of abdominal trauma. Our results show that CT has both good sensitivity and specificity identifying abruption and should be considered for use in the management in the pregnant patient after trauma.
    American journal of obstetrics and gynecology 03/2010; 202(6):611.e1-5. · 3.28 Impact Factor
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    ABSTRACT: The objective of the study was to determine knowledge and attitudes regarding preconception care in a low-income Mexican American population. This was a cross-sectional survey of 305 reproductive-age women at an urban public hospital. The sample was mostly Hispanic (88%) and pregnant (68%); 35% had not completed high school. Eighty-nine percent agreed that improving preconception health benefits pregnancy. Seventy-seven percent expressed some interest in preconception health care with the obstetrics gynecology office at the preferred location. The average knowledge of preconception care score was 76% (higher score more favorable). Areas of higher knowledge included the effects on pregnancy of folic acid; alcohol use; substance use; and verbal, physical, and sexual abuse; lower knowledge was found for the effects of cat litter and fish products. There was interest in preconception education and agreement that preconception health has a positive effect on pregnancy. Fewer respondents agreed that it had a good effect than a suburban sample in the same region (89% vs 98%).
    American journal of obstetrics and gynecology 05/2009; 200(6):686.e1-7. · 3.28 Impact Factor
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    ABSTRACT: This study was undertaken to determine individual and institutional level variables predictive of variations in nulliparous term singleton vertex cesarean delivery rates. Retrospective cohort study of 28,863 nulliparous term singleton vertex births at 40 Arizona hospitals. The average nulliparous term singleton vertex cesarean delivery rate was 22.0%, the lowest hospital rate was 10.3%, high, 34.2%. The following individual level variables increased the nulliparous term singleton vertex cesarean delivery rate in a multivariable model: increased mother's age, African American race, increased birthweight, labor induction, and the presence of medical conditions such as diabetes and hypertension. Of the institutional variables, after adjustment, the highest level of nursery or a higher percentage of government-paid births was associated with lower risks, whereas delivery at a hospital with the lowest level of care or with an obstetric and gynecology residency was associated with an increased risk of cesarean delivery. Substantial variations in nulliparous term singleton vertex cesarean delivery rates were seen in this comparative analysis of 40 hospitals.
    American journal of obstetrics and gynecology 07/2008; 198(6):694.e1-11; discussion 694.e11. · 3.28 Impact Factor
  • American Journal of Obstetrics and Gynecology - AMER J OBSTET GYNECOL. 01/2007; 197(6).

Publication Stats

31 Citations
1 Download
516 Views
15.50 Total Impact Points

Institutions

  • 2010–2012
    • Maricopa Integrated Health System
      Arizona City, Arizona, United States
    • Rhode Island Hospital
      Providence, Rhode Island, United States
    • The University of Arizona
      • Obstetrics and Gynecology
      Phoenix, AZ, United States
  • 2011
    • District Medical Group
      Phoenix, Arizona, United States