General Practitioner, Internists, Geriatric Specialist (elderly care)
28 years of experience
Video profile
Accepting new patients
Oak Lawn
5303 Harry Hines Blvd
Dallas, TX 75390
214-645-8610
Locations and availability (3)

Education ?

Medical School Score Rankings
UMDNJ (1982)
  • Currently 3 of 4 apples
Top 50%

Awards & Distinctions ?

Awards  
Fellow American College of Physicians
Fellow American College of Physicians (1990)
Fellow American Geriatrics Society
Fellow American Geriatrics Society (1992)
Castle Connolly's Top Doctors™ (2012 - 2013)
Appointments
University of Texas Southwestern Medical School at Dallas
Professor
Associations
American Board of Internal Medicine

Affiliations ?

Dr. Rubin is affiliated with 9 hospitals.

Hospital Affilations

Score

Rankings

  • UT Southwestern University Hospital - Zale Lipshy
    5151 Harry Hines Blvd, Dallas, TX 75235
    • Currently 4 of 4 crosses
    Top 25%
  • UT Southwestern University Hospital - St. Paul
    5909 Harry Hines Blvd, Dallas, TX 75235
    • Currently 4 of 4 crosses
    Top 25%
  • Parkland Health & Hospital System *
    5201 Harry Hines Blvd, Dallas, TX 75235
    • Currently 1 of 4 crosses
  • University Hospital - St Paul
  • UT Southwestern Medical Center at Dallas *
  • Parkland Hospital
  • UT Southwestern Zale Lipshy Hospital
  • UT Southwestern St Paul Hospital
  • Dallas County Hospital District
  • * This information was reported to Vitals by the doctor or doctor's office.

    Publications & Research

    Dr. Rubin has contributed to 20 publications.
    Title Reduced Hippocampal Functional Connectivity in Alzheimer Disease.
    Date November 2007
    Journal Archives of Neurology
    Excerpt

    OBJECTIVE: To determine if functional connectivity of the hippocampus is reduced in patients with Alzheimer disease. DESIGN: Functional connectivity magnetic resonance imaging was used to investigate coherence in the magnetic resonance signal between the hippocampus and all other regions of the brain. PARTICIPANTS: Eight patients with probable Alzheimer disease and 8 healthy volunteers. RESULTS: Control subjects showed hippocampal functional connectivity with diffuse cortical, subcortical, and cerebellar sites, while patients demonstrated markedly reduced functional connectivity, including an absence of connectivity with the frontal lobes. CONCLUSION: These findings suggest a functional disconnection between the hippocampus and other brain regions in patients with Alzheimer disease.

    Title The Primary Care of Alzheimer Disease.
    Date February 2007
    Journal The American Journal of the Medical Sciences
    Excerpt

    Alzheimer disease is the most common cause of progressive irreversible intellectual loss in aging humans. The number of individuals and families affected by this disorder will continue to grow as society ages worldwide. Our understanding of the biology, underlying pathophysiology, and diagnosis of Alzheimer disease has greatly expanded over the past few years and much has been published in these areas. This review focuses on the primary care of this disorder and addresses the "now what" question. Topics examined include limiting excess disability, responding to commonly raised questions of family members, pharmacologic and nonpharmacologic therapeutic options, long-term planning, and caregiver issues.

    Title The Spectrum of Wrn Mutations in Werner Syndrome Patients.
    Date June 2006
    Journal Human Mutation
    Excerpt

    The International Registry of Werner syndrome (www.wernersyndrome.org) has been providing molecular diagnosis of the Werner syndrome (WS) for the past decade. The present communication summarizes, from among 99 WS subjects, the spectrum of 50 distinct mutations discovered by our group and by others since the WRN gene (also called RECQL2 or REQ3) was first cloned in 1996; 25 of these have not previously been published. All WRN mutations reported thus far have resulted in the elimination of the nuclear localization signal at the C-terminus of the protein, precluding functional interactions in the nucleus; thus, all could be classified as null mutations. We now report two new mutations in the N-terminus that result in instability of the WRN protein. Clinical data confirm that the most penetrant phenotype is bilateral ocular cataracts. Other cardinal signs were seen in more than 95% of the cases. The median age of death, previously reported to be in the range of 46-48 years, is 54 years. Lymphoblastoid cell lines (LCLs) have been cryopreserved from the majority of our index cases, including material from nuclear pedigrees. These, as well as inducible and complemented hTERT (catalytic subunit of human telomerase) immortalized skin fibroblast cell lines are available to qualified investigators.

    Title Emerging Concepts in Osteoporosis and Bone Strength.
    Date September 2005
    Journal Current Medical Research and Opinion
    Excerpt

    OBJECTIVE: Osteoporosis is a systemic skeletal disorder characterized by compromised bone strength and increased fracture risk. The factors that contribute to bone strength include bone mineral density (BMD) and bone quality, which encompasses factors such as bone turnover, microarchitecture, mineralization, and geometry. The objective of this paper was to review the factors that contribute to bone strength and osteoporosis. RESEARCH DESIGN: A MEDLINE search of English language journals between 1 January 1995 and 1 March 2005 was conducted using the term 'osteoporosis' combined with 'bone strength' or 'bone quality'. Reference lists of pivotal studies and reviews were also examined. Studies were otherwise not excluded on the basis of quality or size, the aim being to present an overview of research conducted to date on osteoporosis and bone strength. RESULTS: While there is a relationship between BMD and fracture risk, evidence suggests that BMD measurements reflect only 1 component of bone strength. For example, small changes in BMD produced by osteoporosis treatments do not fully explain the reductions in fracture risk observed after initiation of therapy, and substantial fracture risk reduction is observed before peak increases in BMD are achieved. In addition to their effects on BMD, anti-resorptive therapies for osteoporosis (i.e., bisphosphonates, selective estrogen receptor modulators, calcitonin, and estrogen) produce positive effects on bone turnover, microarchitecture, and/or mineralization, all of which can contribute to the reductions in fracture risk observed with these agents. Anabolic agents such as teriparatide also appear to have beneficial effects on bone strength independent of bone mass. New, non-invasive, high-resolution imaging methods, such as magnetic resonance imaging and computed tomography, may offer a comprehensive assessment of bone quality in the future. CONCLUSIONS: The development of clinical tools that assess bone quality independent of BMD will be essential to advance our assessment of fracture risk and response to osteoporosis treatment.

    Title Differential Activation on Fmri of Monozygotic Twins Discordant for Ad.
    Date January 2004
    Journal Neurology
    Excerpt

    This is the first report of fMRI in monozygotic twins discordant for AD. FMRI brain activation patterns were examined during visuospatial and verbal working memory tasks. The affected twin had greater parietal involvement bilaterally during both working memory tasks and reduced left dorsolateral prefrontal cortex activity on the visuospatial memory task. Thus, fMRI may identify additional brain regions recruited in patients with AD to perform a given cognitive task.

    Title Development of Geriatrics-oriented Faculty in General Internal Medicine.
    Date October 2003
    Journal Annals of Internal Medicine
    Excerpt

    The need for adequate geriatrics training for the physician workforce has been recognized for decades. However, there are not enough academic geriatricians to provide for the educational needs of trainees, and this situation is not expected to change in the future. General internists are often responsible for teaching medical students and internal medicine residents to care for elderly patients in inpatient and ambulatory settings. These academic general internists could play a pivotal role in providing geriatrics instruction. To characterize what is being done to develop geriatrics-oriented general internal medicine faculty, we identified current practices, "best practices," goals and targets, and barriers to achieving those goals and targets. We reviewed the literature on faculty-development programs for general internal medicine faculty, and we held focus groups and structured interviews with general internal medicine unit chiefs and directors of Geriatric Centers of Excellence at 46 medical schools throughout the United States. We found a need for programs to develop geriatrics-oriented academic general internists. Although general internal medicine faculties seem receptive to further geriatrics training, important obstacles exist. These include inadequate time and resources as well as motivational and attitudinal challenges. We discuss potential solutions for overcoming these barriers and the implications of these solutions for stakeholders.

    Title Evaluation and Treatment of Postmenopausal Osteoporosis.
    Date December 2001
    Journal The American Journal of Managed Care
    Excerpt

    Osteoporosis is a prevalent condition among elderly women and is associated with an increased risk for fractures. With the burgeoning size of the elderly population, a practitioner is likely to face many questions regarding the evaluation and management of postmenopausal osteoporosis. This review discusses and compares available therapies. All women should have adequate calcium and vitamin D intake. Women diagnosed as having osteoporosis should be evaluated for secondary causes of osteoporosis and risk factors for falls. For women with postmenopausal osteoporosis, therapy with hormone replacement, bisphosphonates (alendronate sodium or risedronate sodium), raloxifene hydrochloride, or calcitonin should be considered. The results of ongoing studies will help refine the strategies used for management of postmenopausal osteoporosis.

    Title Sustained-release Sodium Fluoride in the Treatment of the Elderly with Established Osteoporosis.
    Date December 2001
    Journal Archives of Internal Medicine
    Excerpt

    BACKGROUND: We ascertained the safety and efficacy of fluoride in augmenting spinal bone mass and reducing spinal fractures in older women with established osteoporosis. We compared a combination of sustained-release sodium fluoride, calcium citrate, and cholecalciferol (SR-NaF group) with calcium and cholecalciferol alone (control group). METHODS: Eighty-five ambulatory women aged 65 years or older with 1 or more nontraumatic vertebral compression fractures were enrolled in a 42-month randomized, double-blind, placebo-controlled trial. Primary outcome measures were vertebral fracture rate, bone mass, and safety. RESULTS: The vertebral fracture rate determined by means of computer assistance in the SR-NaF group was significantly lower than that in the control group (relative risk [RR], 0.32; 95% confidence interval [CI], 0.14-0.73; P =.007). Results of visual adjudicated inspection also confirmed a significant reduction in fracture rate (RR, 0.40; 95% CI, 0.17-0.95; P =.04). Bone mineral density in L2 through L4 increased significantly from baseline in the SR-NaF group by 5.4% (95% CI, 2.7%-8.2%; P<.001), and by 3.2% in the control group (95% CI, 0.8%-5.6%; P =.01). The between-group differences in bone mineral density were not significant. The femoral neck and total hip bone mineral density remained stable in the SR-NaF group and was not significantly different from that of the control group. There were no significant differences in adverse effects between groups. CONCLUSION: The SR-NaF group significantly decreased the risk for vertebral fractures and increased spinal bone mass without reducing bone mass at the femoral neck and total hip.

    Title Treatment Considerations in the Management of Age-related Osteoporosis.
    Date September 1999
    Journal The American Journal of the Medical Sciences
    Title Twenty-four Hour Growth Hormone Secretion in a Patient with Werner's Syndrome.
    Date January 1998
    Journal Experimental Gerontology
    Excerpt

    OBJECTIVE: To assess the 24-h endogenous secretory growth hormone (GH) profile and serum insulin-like growth factor-I (IGF-I) response to exogenous recombinant human growth hormone (rhGH) in a patient with Werner's syndrome. DESIGN: Blood sampling every 20 min for 24 h followed by three daily injections of growth hormone. SETTING: General Clinical Research Center. PATIENTS: Single patient with Werner's syndrome. MEASUREMENTS: Serum GH and IGF-I. RESULTS: Growth hormone pulses were absent during the 24-h monitoring period. Likewise, integrated GH concentrations were very low at 0.25 mu min/mL, and no peaks occurred after sleep onset. Following single daily administration of rhGH, serum GH and IGF-I rose. CONCLUSIONS: Our findings support previous but less extensive studies suggesting patients with Werner's syndrome have reduced growth hormone levels. Preliminary investigations using rhGH in patients with Werner's syndrome should be considered.

    Title Sustained-release Sodium Fluoride in the Management of Established Postmenopausal Osteoporosis.
    Date February 1997
    Journal The American Journal of the Medical Sciences
    Title Southwestern Internal Medicine Conference: Prevention of Hip Fractures in the Elderly.
    Date September 1995
    Journal The American Journal of the Medical Sciences
    Excerpt

    Hip fracture is a common, morbid, and costly health problem. Because our population is aging, hip fractures will remain a major health concern as we enter the next century. It has been estimated that by the year 2040, 512,000 hip fractures will occur annually in people 50 years or older. A number of factors common in the elderly increase the risk of falling. Falls and age-related changes that influence bone quality increase susceptibility to fracture. In this article, the author focuses on studies that identified risk factors and strategies to reduce falls as well as pharmacologic agents that may reduce fracture risk. Because of the multifactorial etiology of hip fractures, their prevention will ultimately require a combination of pharmacologic approaches to improve bone strength and strategies to prevent falls and limit injury.

    Title Treating a Patient with the Werner Syndrome and Osteoporosis Using Recombinant Human Insulin-like Growth Factor.
    Date October 1994
    Journal Annals of Internal Medicine
    Excerpt

    OBJECTIVE: To assess the safety and effect of recombinant human insulin-like growth factor 1 (rhlGF-1) on measures of bone metabolism in a human model of age-related osteoporosis. DESIGN: 6-month prospective case study. SETTING: General clinical research center. PATIENTS: 1 patient with the Werner syndrome, a low serum IGF-1 level, and osteoporosis. INTERVENTION: Daily subcutaneous administration of rhIGF-1 for 6 months. MEASUREMENTS: Serum alkaline phosphatase, osteocalcin, type I procollagen C-peptide and urinary hydroxyproline, calcium, and pyridinoline cross-links as measures of bone metabolism and radial shaft, femoral neck, and lumbar bone masses. RESULTS: Serum osteocalcin and type I procollagen C-peptide increased during rhIGF-1 therapy (P < 0.05). Twenty-four hour urinary calcium, hydroxyproline, and pyridinoline cross-links were also higher after treatment than they were before treatment (P < 0.05). During 6 months of treatment, the bone mineral density of the L2 to L4 vertebrae increased 3%; this value exceeded the coefficient of variation of this measurement. Bone density at the femoral neck and radial shaft changed by less than the coefficient of variation of these measurements. No significant changes in serum glucose values or other adverse effects of treatment were noted. CONCLUSIONS: Treatment with rhIGF-1 increased both bone formation and resorption in a patient with the Werner syndrome, a low baseline serum IGF-1 level, and established osteoporosis. Because lumbar bone mass increased without evidence of bone loss in the appendicular skeleton, a net increase in bone formation (formation greater than resorption) may have been responsible.

    Title Osteoporosis: Considerations in Evaluating and Managing the Older Patient.
    Date January 1994
    Journal Texas Medicine
    Excerpt

    Osteoporosis is a common disorder that results in 1.3 million fractures each year in the United States. The resultant morbidity and mortality are substantial. While there has been considerable progress in our understanding of this disease, research studies frequently include only early postmenopausal individuals. At the same time, a number of important pathophysiologic and clinical differences exist between early postmenopausal and elderly individuals. These considerations raise the issue of the appropriateness of generalizing evaluation and treatment recommendations from younger to older patients. This review emphasizes factors important in the assessment and treatment of established osteoporosis in older patients.

    Title A Randomized, Controlled Trial of Outpatient Geriatric Evaluation and Management in a Large Public Hospital.
    Date November 1993
    Journal Journal of the American Geriatrics Society
    Excerpt

    OBJECTIVE: To study the effect of outpatient geriatric evaluation and management on physical function, mental status, and subjective well-being. DESIGN: Prospective randomized controlled trial with a 1-year study period. SETTING: Large medical school-affiliated public hospital in an urban community. SUBJECTS: Patients at least 70 years old admitted to the medicine service were screened, randomized, and completed a 1-year follow-up interview. INTERVENTIONS: Comprehensive geriatric evaluation and an outpatient care management program. MAIN OUTCOME MEASURES: Mental status (SPMSQ), ADL (Katz Index), IADL (Five-Item OARS Scale), Life satisfaction (LSI-Z), and self-perception of health status (physical health section of OARS). RESULTS: No significant differences were found for cognitive status, ADL functioning, life satisfaction, nursing home placement, or mortality. The experimental patients reported significantly higher function in IADL and more favorable self-perception of health status compared with controls. CONCLUSION: Outpatient comprehensive geriatric evaluation and management appears to be a useful model for providing care to medically frail elderly patients.

    Title Southwestern Internal Medicine Conference: Growth Hormone--aging and Osteoporosis.
    Date March 1993
    Journal The American Journal of the Medical Sciences
    Excerpt

    Until recently, the use of growth hormone (GH) has been confined to the treatment of GH-deficient children. The advent of GH produced by recombinant DNA technology has increased the availability of GH. The increased availability of GH has made possible studies of the physiology and the possible therapeutic role of this hormone and its mediator insulin-like growth factor. One area where GH may play a therapeutic role is in the treatment of osteoporosis. This review will briefly summarize normal GH physiology and discuss age-related changes in GH and insulin-like growth factor 1 (IGF-1) axis and how they may relate to age-related physiologic changes. Evidence for and against a possible therapeutic role for GH/IGF-1 in the treatment of age-related (senile) osteoporosis will be discussed.

    Title Characterization of Osteoporosis in a Patient with Werner's Syndrome.
    Date November 1992
    Journal Journal of the American Geriatrics Society
    Title The Effect of Geriatric Evaluation and Management on Medicare Reimbursement in a Large Public Hospital: a Randomized Clinical Trial.
    Date November 1992
    Journal Journal of the American Geriatrics Society
    Excerpt

    OBJECTIVE: To study the effect of a geriatric evaluation and management program on health care charges and Medicare reimbursement. DESIGN: Prospective randomized controlled trial during a 1-year study period. SETTING: Large medical school-affiliated public hospital in an urban community. SUBJECTS: Patients at least 70 years old admitted to the medicine service were screened and randomized into two groups of 100 patients each. INTERVENTION: Patients randomized to the experimental group underwent initial comprehensive geriatric evaluation and once discharged from the hospital were enrolled in a geriatric care management and treatment program. The control group received usual care only. The major intervention of this study was in outpatient long-term care. MAIN OUTCOME MEASURE: Total charges for services billed to Medicare Part A and Part B and total Medicare reimbursement. The Medicare charge and reimbursement data were obtained by use of the Medicare Automated Data Retrieval System, a linked Medicare Part A and Part B utilization file. RESULTS: Total charges and reimbursement were greater for the control group but not significantly so. Subset analysis revealed significantly greater inpatient charges (P < 0.03) and Medicare reimbursement (P < 0.005) for the control patients and a greater likelihood of utilization of home health care services in the experimental group (P < 0.01). CONCLUSION: A geriatric evaluation and management program appeared to shift utilization and Medicare expenditures from inpatient services to home health care services. There was no evidence that the experimental program resulted in increased expenditures for Medicare. In selected populations, geriatric evaluation and management programs may contribute to cost containment.

    Title Age-related Osteoporosis.
    Date May 1991
    Journal The American Journal of the Medical Sciences
    Excerpt

    Osteoporosis is a common disease that results in 1.2 million fractures each year in the United States. The morbidity and mortality as well as the financial impact from this disease is substantial. There has been considerable progress in our understanding of this disorder, but studies commonly include only early postmenopausal individuals. At the same time, it is clear that there are major epidemiologic, physiologic, and clinical differences between early postmenopausal and older individuals. These considerations raise the issue of the appropriateness of generalizing evaluation and treatment recommendations from younger to older patients. This review will focus on the age-related changes in bone physiology as it relates to osteoporosis and consider the available evidence for using commonly used (calcium) or approved (estrogen and calcitonin) agents in the elderly patient.

    Title Urinary Incontinence in the Elderly.
    Date March 1990
    Journal The American Journal of the Medical Sciences
    Excerpt

    Urinary incontinence is a prevalent problem among the elderly and has a significant clinical, social, psychological, and economical impact. In spite of these consequences, often very little is done to evaluate the problem. Furthermore, patients may be reluctant to bring their complaint to the attention of their health care provider. This broad review will discuss the anatomy, physiology, and pathophysiology of urinary incontinence. The initial evaluation and treatment options will also be outlined. As the aged population continues to grow, physicians can expect to see this problem with greater frequency. It is hoped that this discussion will facilitate the evaluation and management of this common but frequently neglected problem.


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