Potential Side Effects and Adverse Events of Antipsychotic Use for Residents With Dementia in Assisted Living: Implications for Prescribers, Staff, and Families.
dementia; Alzheimer's disease; family; SYMPTOMS; medication; Alzheimer’s disease; assisted living; ALZHEIMERS-DISEASE; BENEFITS; CARE; INVOLVEMENT; MEDICATIONS; MORTALITY; NURSING-HOME RESIDENTS; PREVALENCE; RISK
Antipsychotic medications are frequently prescribed to assisted living (AL) residents who have dementia, although there is a lack of information about the potential side effects and adverse events of these medications among this population. Oversight and monitoring by family members is an important component of AL care, and it is important to understand family awareness of antipsychotic use and reports of potential side effects and adverse events. This cross-sectional, descriptive study of family members of 283 residents with dementia receiving antipsychotic medications in 91 AL communities found high rates (93%) of symptoms that could be potential side effects and a 6% rate of potential adverse events. The majority of families were aware their relative was taking an antipsychotic. Findings suggest that obtaining family perspectives of potential side effects and adverse events related to medication use may contribute to overall improvement in the safety of AL residents living with dementia.
Beeber AS; Zimmerman S; Wretman CJ; Palmertree S; Patel K; Sloane PD
Journal Of Applied Gerontology : The Official Journal Of The Southern Gerontological Society
2021
2021-06-23
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1177/07334648211023678" target="_blank" rel="noreferrer noopener">10.1177/07334648211023678</a>
Association of pulse pressure, pulse pressure index, and ambulatory arterial stiffness index with kidney function in a cross-sectional pediatric chronic kidney disease cohort from the CKiD study.
inflammation; risk; children; blood-pressure; progression; ckd; AASI; chronic kidney disease; pulse pressure; pulse pressure index; aasi; albuminuria; dialysis patients; left-ventricular hypertrophy
The morbidity and mortality of adult and pediatric chronic kidney disease (CKD) and end-stage renal disease (ESRD) populations are mainly driven by cardiovascular disease (CVD). Improving CVD outcomes focuses on risk assessment of factors including diastolic blood pressure (DBP), systolic blood pressure (SBP), left ventricular mass index (LVMI), pulse pressure (PP), and pulse pressure index (PPi), which is calculated as PP/SBP. These markers are also proven predictors of CKD progression; however, their role in children has not been established. This study aims to evaluate the relationship between PP, PPi, ambulatory arterial stiffness index (AASI), and proteinuria with kidney function in pediatric CKD patients; it is a retrospective analysis of 620 patients (1-16 years) from the NIDDK Chronic Kidney Disease in Children (CKiD) registry. The authors analyzed data for three separate cohorts: an overall CKD as well as immunological versus non-immunological cause for CKD groups. An inverse relationship was found between SBP, DBP, and PP with iGFR and LVMI in the overall CKD group. Our immunological CKD subgroup showed significantly higher serum creatinine, SBP, DBP, and PP values with significantly lower serum albumin levels compared to the non-immunological group. There were no significant differences with iohexol-based glomerular filtration rate (iGFR), LVMI, PPi, or high-sensitivity C-reactive protein (hs-CRP) between the two groups. A subgroup analysis demonstrated that SBP, DBP, and PP all correlated significantly with LVMI in the immunological CKD patients but not the non-immunological subgroup. Additionally, AASI data in the overall CKD population were significantly correlated with PP, PPi, and DBP. This study is one of the first to correlate noninvasive measurements of vascular compliance including PP, PPi, and AASI with iGFR and LVMI in a pediatric CKD cohort. Improving our understanding of surrogate markers for early CVD is integral to improving the care of pediatric CKD population as these patients have yet to develop the hard end points of ESRD, heart failure, myocardial infarction, or stroke.
Raina R; Polaconda S; Nair N; Chakraborty R; Sethi S; Krishnappa V; Kapur G; Mhanna M; Kusumi K
Journal of Clinical Hypertension
2020
2020-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1111/jch.13905" target="_blank" rel="noreferrer noopener">10.1111/jch.13905</a>
Caring for patients with pain during the COVID-19 pandemic: consensus recommendations from an international expert panel.
chronic pain; COVID-19; COVID-19; epidural steroid injections; immune; management; opioid therapy; opioids; population; prevalence; prevention; quality-of-life; recommendations; risk; steroids; united-states
Chronic pain causes significant suffering, limitation of daily activities and reduced quality of life. Infection from COVID-19 is responsible for an ongoing pandemic that causes severe acute respiratory syndrome, leading to systemic complications and death. Led by the World Health Organization, healthcare systems across the world are engaged in limiting the spread of infection. As a result, all elective surgical procedures, outpatient procedures and patient visits, including pain management services, have been postponed or cancelled. This has affected the care of chronic pain patients. Most are elderly with multiple comorbidities, which puts them at risk of COVID-19 infection. Important considerations that need to be recognised during this pandemic for chronic pain patients include: ensuring continuity of care and pain medications, especially opioids; use of telemedicine; maintaining biopsychosocial management; use of anti-inflammatory drugs; use of steroids; and prioritising necessary procedural visits. There are no guidelines to inform physicians and healthcare providers engaged in caring for patients with pain during this period of crisis. We assembled an expert panel of pain physicians, psychologists and researchers from North America and Europe to formulate recommendations to guide practice. As the
Shanthanna H; Strand N H; Provenzano D A; Lobo C A; Eldabe S; Bhatia A; Wegener J; Curtis K; Cohen S P; Narouze S
Anaesthesia
2020
2020-04-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1111/anae.15076" target="_blank" rel="noreferrer noopener">10.1111/anae.15076</a>
An Update on the Pathophysiology and Treatment of Cardiorenal Syndrome.
cardiac resynchronization therapy; Cardiorenal syndrome; cardiovascular events; Chronic kidney disease; Chronic kidney disease; decompensated heart-failure; Heart failure; impact; left-ventricular dysfunction; preserved ejection fraction; risk; vasopressin; worsening renal-function
Cardiorenal syndrome (CRS) encompasses various disorders of the heart and kidneys; dysfunction of one organ leads to acute or chronic dysfunction of the other. It incorporates the intersection of heart-kidney interactions across several mediums, hemodynamically, through the alterations in neurohormonal markers, and increased venous and renal pressure, all of which are hallmarks of its clinical phenotypes. This article explores the epidemiology, pathology, classification and treatment of each type of CRS.
Raina Rupesh; Nair Nikhil; Chakraborty Ronith; Nemer Lena; Dasgupta Rahul; Varian Kenneth
Cardiology research
2020
2020-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.14740/cr955" target="_blank" rel="noreferrer noopener">10.14740/cr955</a>
Bone mineral density in adolescent urinary stone formers: is sex important?
Bone; children; disease; fracture; health; inflammation; kidney-stones; nephrolithiasis; osteoporosis; Pediatrics; risk; Sex; Urolithiasis; Urolithiasis
Urinary stone disease (USD) is affecting a greater number of children and low bone mineral density (BMD) and increased skeletal fractures have been demonstrated in stone patients; however, the mechanism(s) driving bone disease remain unclear. This pilot study was undertaken to assess an adolescent kidney stone cohort's BMD and evaluate for an inverse correlation between BMD and urine concentration of lithogenic minerals and/or inflammatory levels. Prospective case-control study was carried out at a large pediatric center. 15 participants with USD (12-18 years of age, 8 female) were matched by age, sex, and body mass index to 15 controls. Lumbar and total body BMD z-score did not differ between groups. When stone formers were separated by sex, there was a significant difference between male stone formers vs. controls total body BMD z-score (Fig. 1). BMD z-score did not significantly correlate with urine calcium, oxalate, citrate or magnesium. Higher urine IL-13 did significantly correlate with higher total body BMD z-score (r = 0.677, p = 0.018). Total body BMD z-score did significantly correlate with body mass index (BMI) as expected for the control group (r = 0.6321, p = 0.0133). However, this relationship was not present in the USD group (r = - 0.1629, p = 0.5619). This is a small but hypothesis-generating study which demonstrates novel evidence of male-specific low BMD in adolescent stone formers. Furthermore, we demonstrated a positive association between urine
Kusumi Kirsten; Schwaderer Andrew L; Clark Curtis; Budge Kevin; Hussein Nazar; Raina Rupesh; Denburg Michelle; Safadi Fayez F
Urolithiasis
2020
2020-03-31
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1007/s00240-020-01183-w" target="_blank" rel="noreferrer noopener">10.1007/s00240-020-01183-w</a>
Risk Stratification: A Two-Step Process for Identifying Your Sickest Patients
Risk, stratification, patients, team, primary care, healthcare, high risk, care management
Risk stratification uses a mix of objective and subjective data to assign risk levels to patients. Practices can systematically use patient risk levels to make care management decisions, such as providing greater access and resources to patients in higher risk levels. Risk stratification helps practices to better focus on their sickest patients, reduce costs, and improve care.
James DomDera
Family Practice Management
2019
James DomDera
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="https://www.aafp.org/fpm/2019/0500/p21.html" target="_blank" rel="noreferrer noopener">https://www.aafp.org/fpm/2019/0500/p21.html</a><br /><br />Author's ORCID: <a href="https://orcid.org/0000-0002-8730-5610" target="_blank" rel="noreferrer noopener">https://orcid.org/0000-0002-8730-5610 </a><br /><br />PMID:<span> </span>31083868
Predictive Factors For Early Mortality After Percutaneous Endoscopic Gastrostomy
aspiration pneumonia; complications; Gastroenterology & Hepatology; jejunostomy; risk; surgical gastrostomy; tube
Background: Percutaneous endoscopic gastrostomy (PEG) is a safe access procedure for enteral nutrition. The purpose of this investigation is to identify predictive factors for early mortality after PEG. Methods: A retrospective review of the hospital records of 416 patients undergoing PEG from June 1, 1989, through December 31, 1991, was conducted. Patient demographics, admitting diagnosis, indication for PEG, risk factors for early mortality, and cause and date of death were reviewed. Logistic regression analysis was used to develop a model to predict early mortality after PEG. The follow-up period ranged from 1 to 30 months. Results: The overall mortality rate in this review was 227 of 416 patients (54.6%). The 7- and 30-day case fatality rates were 39 of 416 (9.4%) and 97 of 416 (23.3%), respectively. Logistic regression analysis showed that urinary tract infection (odds ratio (OR) = 3.05; 95% confidence interval (CI) = 1.45 - 6.43) and previous aspiration (OR = 6.86; 95% CI = 3.27 - 14.4) were predictive factors for death at 1 week after PEG. Patients who had both risk factors had a 48.4% probability of dying within 7 days after PEG insertion, whereas those who had no risk factors had a 4.3% probability of death. Urinary tract infection (OR = 2.00; 95% CI = 1.17 - 3.41), previous aspiration (OR = 3.62; 95% CI = 2.00 - 6.55), and age greater than 75 years (OR = 2.49; 95% CI = 1.47 - 4.21) were predictive factors for death at 1 month after PEG. Patients who had all three risk factors had a 67.1% probability of death at 1 month while those who had no risk factors had a 10% probability of death. Conclusions: A subgroup of patients exists that has a very high mortality rate after PEG. Less invasive ways of nutritionally supporting these high-risk patients should be evaluated.
Light V L; Slezak F A; Porter J A; Gerson L W; McCord G
Gastrointestinal Endoscopy
1995
1995-10
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/s0016-5107(95)70132-x" target="_blank" rel="noreferrer noopener">10.1016/s0016-5107(95)70132-x</a>
Variable Penetrance And Expressivity Of The Splice Altering 5t Sequence In The Cystic Fibrosis Gene
cftr gene; congenital bilateral absence; disease; Genetics & Heredity; males; messenger-rna; mutations; polymorphism; repeat; Research & Experimental Medicine; risk; vas-deferens
This manuscript reviews the frequencies, symptoms, testing, and reporting of genotypes with the 5T poly-thymidine tract which reduces splicing efficiency in the cystic fibrosis transmembrane conductance regulator ( CFTR) gene in congenital bilateral absence of the vas deferens (CBAVD) patients and in patients and fetuses with cystic fibrosis-like symptoms. The 5T sequence has not been included in the American College of Medical Genetics (ACMG) CFTR mutation panel recommended for screening pregnant women for an increased fetal risk of cystic fibrosis (CF; MIM 219700) because finding this allele would raise concern for possible CFTR gene-related symptoms in many fetuses, even though only a fraction inheriting 5T and another major CFTR mutation would develop CF-like symptoms. In contrast, 40-80% of the symptomatic patients with CBAVD (MIM 277180) are compound heterozygotes for the 5T sequence. This submission provides template report summaries for CBAVD patient results for the 5T allele when tested along with the 23 most common ACMG mutation panel. If CBAVD patients were also tested with the remaining 16 most common reported mutations in CBAVD, the derived proportion of patients with at least one CFTR mutant allele is predicted to increase from 63% to 97%. Testing for the 5T sequence in symptomatic patients and reflex 5T testing in fetuses found to carry a major CF allele are discussed because finding the 5T sequence in these patients lowers the risk of typical severe symptoms. Additional reflex testing for the number of TG repeats adjacent to a 5T allele further modifies the predicted long-term severity of disease symptoms in patients and fetuses that are compound heterozygotes for a major CF mutation and the 5T sequence. Even though patient advice can be modified currently based upon the adjacent TG-repeat number, the final most accurate risk frequencies with different 5T + TG-repeat alleles are likely to become available only after a larger patient population is completed with multiple well-defined clinical and mutation categories.
Lebo R V; Grody W W
Genetic Testing
2007
2007-03
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1089/gte.2006.9997" target="_blank" rel="noreferrer noopener">10.1089/gte.2006.9997</a>
Patient Computer Use To Prompt Doctor Adherence To Diabetes Management Guidelines
complications; computer; delivery; diabetes; General & Internal; Health Care Sciences & Services; intervention; involvement; knowledge; management guidelines; Medical Informatics; Medicine; mellitus; patient; performance; preventive services; primary care; quality; risk; standards
Rationale, Aims and Objectives Doctor compliance with diabetic care guidelines is low and may be improved with system-wide changes that include patient involvement. The objective of this study was to determine if patients in an internal medicine teaching clinic would use a touch-screen computer to receive personalized information regarding their need for diabetes care. Outcomes included determining if this intervention would improve resident doctor compliance with diabetic guidelines. Methods In this prospective study a computer was available for patients to use independently in one clinic, while another computer was placed in a second clinic with nursing support. Patients responding they were diabetic to the first screen received screens covering HbA1c, blood pressure, cholesterol, foot, eye examinations and compliance with having labs drawn. Non-diabetic patients received three general health screens. A response-based report was printed for patients to share with their doctor. Chart reviews were conducted to assess diabetic health care delivery. Results The computer was used voluntarily by 20.6% of patients in the primary clinic and by 100% of patients in the nurse-assisted clinic. A total of 104 patients from both clinics responded they were diabetic; over 50% did not know what HbA1c meant and a minority responded their HbA1c, blood pressure and cholesterol were at good levels. Significantly more HbA1c tests conducted within 6 months were documented in patients' charts. Discussion Patients used the computer effectively without direction in the primary clinic. In this initial study, implementation of the computer program increased the number of HbA1c tests ordered. Future studies incorporating refinements may increase both usage and efficacy of this intervention.
Haller N A; Gil K M; Gardner W G; Whittier F C
Journal of Evaluation in Clinical Practice
2009
2009-12
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1111/j.1365-2753.2009.01264.x" target="_blank" rel="noreferrer noopener">10.1111/j.1365-2753.2009.01264.x</a>
Endometrial Cancer Survivors' Assessment Of The Benefits Of Exercise
adherence; breast; Cancer survivors; exercise; Health beliefs; intervention; maintenance; Obesity; Obstetrics & Gynecology; Oncology; outcome expectations; physical-activity; quality-of-life; risk; self-efficacy; women
Lukowski J; Gil K M; Jenison E; Hopkins M; Basen-Engquist K
Gynecologic Oncology
2012
2012-03
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.ygyno.2011.11.002" target="_blank" rel="noreferrer noopener">10.1016/j.ygyno.2011.11.002</a>
Update On Prostate Cancer Chemoprevention
5-alpha-reductase inhibitors; antigen; beta-carotene; chemoprevention; clinical trial; dutasteride; finasteride; men; nonsteroidal antiinflammatory drugs; over-expression; PCPT; Pharmacology & Pharmacy; prevention; prostate cancer; REDUCE trial; REDUCE trial; risk; SELECT; selenium level
Lowe J F; Frazee L A
Pharmacotherapy
2006
2006-03
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1592/phco.26.3.353" target="_blank" rel="noreferrer noopener">10.1592/phco.26.3.353</a>
Cataract Surgery And The Primary Care Practitioner
adults; age-related cataract; astigmatism; cortical; Geriatrics & Gerontology; impact; Intraocular lens implantation; men; nuclear sclerosis; posterior subcapsular; presbyopla; responses; risk; smoking; trial
Goldman H B; Kiffel S; Weinstock F J
Geriatrics
2009
2009-05
Journal Article or Conference Abstract Publication
n/a
Duration Of Anticoagulant Therapy After Initial Idiopathic Venous Thromboembolism
anticoagulation; antiphospholipid syndrome; deep-vein thrombosis; duration of therapy; factor-v-leiden; first episode; heterozygous carriers; idiopathic venous thromboembolism; intensity warfarin therapy; long-term; medical progress; Pharmacology & Pharmacy; pulmonary-embolism; risk; warfarin
Frazee L A; Chomo D L
Annals of Pharmacotherapy
2003
2003-10
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1345/aph.1C486" target="_blank" rel="noreferrer noopener">10.1345/aph.1C486</a>
Soft-tissue Images. Melanosis Coli
gastrointestinal-tract; risk; Surgery
Erzurum V; Obermeyer R; Smaroff G; Mehta J
Canadian Journal of Surgery
2000
2000-12
Journal Article or Conference Abstract Publication
n/a
Emergency Department Visits For Suicidality In Three Hospitals
cohort; Nursing; Psychiatry; risk; united-states
Drew B L; Jones S L; Meldon S W; Varley J D
Archives of Psychiatric Nursing
2006
2006-06
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.apnu.2005.11.001" target="_blank" rel="noreferrer noopener">10.1016/j.apnu.2005.11.001</a>
Obesity And Breast Cancer Prognosis: An Expanding Body Of Evidence
mass; Oncology; receiving adjuvant chemotherapy; risk; size; stage; weight; women
Dignam J J; Mamounas E P
Annals of Oncology
2004
2004-06
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1093/annonc/mdh241" target="_blank" rel="noreferrer noopener">10.1093/annonc/mdh241</a>
Awareness Of Genital Health In Young Male Athletes
athletic; athletic cup; injuries; male genital injury; men; Orthopedics; Physiology; risk; Sport Sciences; supporter; testicular cancer; testicular torsion; testis; torsion; united-states
Congeni J; Miller S F; Bennett C L
Clinical Journal of Sport Medicine
2005
2005-01
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1097/00042752-200501000-00005" target="_blank" rel="noreferrer noopener">10.1097/00042752-200501000-00005</a>
Increasing lipid adherence to goal
atherosclerosis; cholesterol; Goals; therapy; guidelines; disease; Pharmacology & Pharmacy; Lipids; program; risk; population; care; impact; trials; guidelines; Assistant; Calculator; Personal Digital
BACKGROUND: In April 2004, the National Cholesterol Education Program Adult Treatment Panel III Guidelines for management of high cholesterol encouraged even lower levels of low-density lipoprotein (LDL) than previous guidelines for high and very high risk groups. Assessing patients' risk factors to determine LDL goals is the first step to help guide therapy. OBJECTIVE: To determine whether the use of the Mobile Lipid Clinic Personal Digital Assistant (PDA) Calculator during office visits will increase the number of patients achieving their LDL goal compared to using electronic medical records or conventional methods. METHODS: Four family medicine residency programs affiliated with the Northeastern Ohio Network participated with each site using a different method. The PDA site used the Mobile Lipid Clinic Calculator, the second site used electronic health records (EHRs), the control site used usual care methods, and the transition site moved from paper charts to EHRs during the study. In 2006, baseline chart reviews were conducted to randomly enroll 100 patients per site (aged 40-75 years) with LDL levels at least 10% above goal. In 2007, follow-up chart reviews were conducted on the same patients to determine reductions in LDL and the percent of patients that reached their LDL goals. RESULTS: The percentage reaching their LDL goal and option goal were as follows: PDA site 27% and 12%, EHR site 19% and 3%, control site 4% and 1%, transition site 32% and 12%. Cholesterol-lowering medication usage increased significantly from 38% at baseline to 47% at follow-up (chi(2) = 149.5, P < 0.0001). CONCLUSIONS Using a PDA tool can be just as effective as EHRs in getting patients to their LDL goal and is better than some conventional methods, suggesting the benefit of utilizing technology to improve patient care and health outcomes. (C) 2008 National Lipid Association. All rights reserved.
Davidson E; Uhlenhake E; McCord G
Journal of Clinical Lipidology
2008
2008-10
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.jacl.2008.06.010" target="_blank" rel="noreferrer noopener">10.1016/j.jacl.2008.06.010</a>
Prostate Cancer: Diagnostic Performance of Real-time Shear-Wave Elastography
ultrasound; guidelines; ultrasonography; Radiology; elasticity; Nuclear Medicine & Medical Imaging; localization; risk; predictors; radical prostatectomy; biopsy; contrast-enhanced mri
Purpose: To prospectively evaluate the performance of real-time ultrasonographic (US) shear-wave elastography (SWE) in the diagnosis of peripheral zone prostate cancer in patients with high and/or increasing prostate-specific antigen levels and/or abnormal digital rectal examination results. Materials and Methods: After signing an informed consent form, men referred for transrectal prostate biopsy were enrolled in this prospective HIPAA-compliant two-center study, which was conducted with institutional review board approval. Transrectal US SWE of the prostate was performed after a conventional transrectal US examination and immediately before US-guided 12-core sextant biopsy. For each sextant, the maximum SWE value was measured and matched to the pathologic results of that sextant biopsy. The diagnostic performance of SWE was assessed at both patient and sextant levels. The elasticity value maximizing the Youden index was used to derive sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: The elasticity values were matched to pathologic results for a total of 1040 peripheral zone sextants in 184 men. One hundred twenty-nine positive biopsy findings (size,. 3 mm; Gleason score,. 6) were identified in 68 patients. The sextant-level sensitivity, specificity, PPV, NPV, and area under the receiver operating characteristic curve for SWE with a cutoff of 35 kPa for differentiating benign from malignant lesions were 96% (95% confidence interval [CI]: 95%, 97%), 85% (95% CI: 83%, 87%), 48% (95% CI: 46%, 50%), 99% (95% CI: 98%, 100%), and 95% (95% CI: 93%, 97%), respectively. Conclusion: Use of a 35-kPa threshold at SWE may provide additional information for the detection and biopsy guidance of prostate cancer, enabling a substantial reduction in the number of biopsies while ensuring that few peripheral zone adenocarcinomas are missed. (C) RSNA, 2014
Correas J M; Tissier A M; Khairoune A; Vassiliu V; Mejean A; Helenon O; Memo R; Barr R G
Radiology
2015
2015-04
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1148/radiol.14140567" target="_blank" rel="noreferrer noopener">10.1148/radiol.14140567</a>
Review of BMI-Based Pharmacologic Protocols for the Prevention of Venous Thromboembolism in Bariatric Surgery Patients
outcomes; Nursing; risk; morbidly obese-patients; y gastric bypass; heparin; enoxaparin; prophylaxis; deep-vein thrombosis; regimens; thromboprophylaxis
Background: Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is an important cause of morbidity and mortality in bariatric surgery patients. The objective of this study was to discuss the evolution of three bariatric surgery VTE prophylaxis protocols and compare safety and effectiveness of each. Methods: A retrospective review of 364 bariatric surgery patients utilizing three different dosing regimens of enoxaparin was completed. Enoxaparin was continued for the duration of the hospital stay in all groups unless hemorrhage was suspected. Sequential compression devices were used during and after surgery. All patients were required to ambulate within 6 h of their procedure. Patients were discharged off all prophylaxis. Results: Inclusive of all groups, two patients (0.5%) developed VTE (p = 0.50), eight patients (2%) required transfusion (p = 0.95), and five patients (1.4%) required reoperation for hemorrhage (p = 0.19). Overallmortality was 0%. Conclusions: A VTE prophylaxis regimen of 40 mg Lovenox subcutaneous (SC) 1-2 h preoperatively followed by 1 mg/body-mass index (rounded to the nearest 10 mg) SC every 12 h until discharge coupled with mechanical VTE prophylaxis is simple, safe, and effective in bariatric surgery patients.
Chlysta W J; Iffland P H; Haller N A
Bariatric Surgical Practice and Patient Care
2014
2014-09
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1089/bari.2014.0014" target="_blank" rel="noreferrer noopener">10.1089/bari.2014.0014</a>
Four-year outcomes of hypofractionated high-dose-rate prostate brachytherapy and external beam radiotherapy
cancer; Radiology; Prostate cancer; trial; Nuclear Medicine & Medical Imaging; Oncology; risk; failure; radiation-therapy; adenocarcinoma; boost; Brachytherapy; escalation; hdr brachytherapy; Outcome assessment; stereotactic body radiotherapy
PURPOSE: High-dose-rate (HDR) brachytherapy boost in prostate cancer allows dose escalation and delivery of higher biologically effective dose (BED). We evaluated the outcomes of intensitymodulated radiation therapy (IMRT) and HDR boost in a community setting. METHODS AND MATERIALS: Between July 2003 and April 2008, 148 patients with prostate cancer were treated at Cancer Center of Irvine using two transperineal implants performed 1 week apart (22 Gy delivered in four fractions divided between two insertions and delivered twice daily), followed by IMRT (50.4 Gy). Hormonal therapy was given for 1 year to all patients with Gleason score of 8 or higher. RESULTS: Patient characteristics are as follows: median age at treatment, 71 years; American Joint Committee on Cancer Group 103, 53%; Gleason score of 7, 41%; and Gleason score of 8 or higher, 14%. Median followup was 49 months, and median prostate-specific antigen (PSA) nadir was 0.15 ng/InL. The 4-year actuarial biochemical disease-free survival (bDFS) was 96.8/81% by Phoenix/PSA lower than 0.5 ng/mL criteria. According to National Comprehensive Cancer Center Clinical Practice Guidelines defined recurrence risk groups, 4-year bDFS for low risk was 100/ 92.9%, intermediate risk was 100/86.7%, and high risk was 94/75.4% by Phoenix/PSA lower than 0.5 ng/mL criteria. No statistically significant difference in bDFS was detected by either failure criteria based on risk group, lymph node risk, or initial PSA. Treatment was well tolerated. Subacute/late genitourinary and gastrointestinal toxicities were limited to 10% and 5%, respectively of all patients. CONCLUSIONS: Prostate IMRT plus HDR brachytherapy boost was well tolerated with appropriate PSA response and bDFS at 4 years, demonstrated in a community setting. This treatment schema provides a high BED, comparable with hypofractionated prostate regimens previously reported in the literature. Higher BED delivery should be explored in further dose escalation studies. (C) 2013 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
Chen W C; Tokita K M; Ravera J; Fu P F; Jiang Y; Kaminsky D A; Ponsky L; Ellis R J
Brachytherapy
2013
2013-09
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.brachy.2012.09.003" target="_blank" rel="noreferrer noopener">10.1016/j.brachy.2012.09.003</a>
ANTIGENIC-STIMULATION AND MULTIPLE-MYELOMA - A PROSPECTIVE-STUDY
inflammation; cancer; association; follow-up; leukemia; Oncology; rheumatoid-arthritis; risk; lymphoma; allergens; Allergy; antigens; autoimmune diseases; bacterial infections; multiple myeloma (etiology); plasma-cell; prospective studies
Background. A causal relationship between antigenic conditions and multiple myeloma was suggested by case reports. Although controlled studies identified associations with individual conditions, they failed to give overall support to the hypothesis. Using a prospective cohort representative of the U.S. population, the authors hypothesized that immune-stimulating conditions are a risk factor for multiple myeloma. Methods. The First National Health and Nutrition Examination Survey cohort of 14,407 persons were interviewed from 1971 to 1975 by the National Center for Health Statistics. Vital status with cause of death and hospitalizations were ascertained from 1982 to 1985 and in 1986. From the initial questionnaire, four risk factors were constructed: allergies (asthma, hives, hay fever, food allergies, and other allergies); autoimmune conditions (arthritis, thyroid disease and/or medication, rheumatic fever, diabetes, pernicious anemia); chronic bacterial conditions (chronic bronchitis or emphysema, chronic cough, tuberculosis, ulcers); and inflammatory conditions (gout, gallstones, recurrent or chronic enteritis, pleurisy). Results. Eighteen multiple myeloma (MM) cases were documented. The rate ratio (RR) of MM increased as the number of reported inflammatory conditions increased (one condition, RR = 2.0, 95% confidence interval [CI] = 1.2-3.3; 2 or more conditions, RR = 4.3, 95% CI = 1.5-12.4). The RR of myeloma also increased (P = 0.0002) with time since start of inflammatory conditions (RR = 1.6 for every 10 years of exposure). When cases were restricted to those with more than five years of follow-up, myeloma risk increased with the number of inflammatory conditions (two conditions, RR = 4.6, 95% CI = 1.5-13.8). Conclusions. Although the number of cases is small and exposure may be misclassified, the prospective nature of the study design strengthens the results of the study.
Bourguet C C; Logue E E
Cancer
1993
1993-10
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1002/1097-0142(19931001)72:7%3C2148::aid-cncr2820720714%3E3.0.co;2-q" target="_blank" rel="noreferrer noopener">10.1002/1097-0142(19931001)72:7%3C2148::aid-cncr2820720714%3E3.0.co;2-q</a>
Bleeding Outcomes Associated with Coronary Artery Bypass Graft Surgery and Recent Clopidogrel Exposure
intervention; Surgery; guidelines; Cardiovascular System & Cardiology; Myocardial infarction; controlled-trial; risk; increases; blood-transfusion; aspirin; cardiac-surgery; st-segment elevation
Background: Guidelines recommend discontinuing clopidogrel for at least 5 days before elective coronary artery bypass graft surgery (CABG) to limit blood transfusions and for at least 24 hours before urgent CABG to reduce major bleeding complications. Studies have produced conflicting results regarding whether recent exposure to clopidogrel increases bleeding, the need for intraoperative and postoperative blood products, postoperative complications, and hospital length of stay. We evaluated the effect of clopidogrel exposure on major bleeding at our institution within 5 days of CABG. Methods: We conducted a retrospective review of patients who underwent CABG at a tertiary academic medical center. The primary outcome was major bleeding, defined as transfusion of 4 units of packed red blood cells (PRBCs) and/or a need for reexploration. Secondary outcomes included non-life-threatening bleeding, defined as transfusion of 2 units but <4 units of PRBCs; postoperative complications; hospital length of stay; readmission within 30 days of the procedure; and hospital mortality. Major bleeding events were analyzed with a logistic regression model that adjusted for covariates of bleeding risk factors. Results: Of the 715 patients we reviewed, 169 patients received clopidogrel within 5 days before CABG, and 546 patients did not. A significantly higher incidence of major bleeding was observed in the clopidogrel group compared with the group not exposed to clopidogrel (32% versus 17%, P = .002). After adjusting for covariates, patients exposed to clopidogrel had significantly higher odds of major bleeding (odds ratio, 2.1; 95% confidence interval, 1.3-3.4; P = .003). The groups were similar with respect to postoperative complications, except for infection. The clopidogrel-exposed group had a significantly higher rate of leg site infections (3% versus 0.2%, P = .003). Conclusions: Clopidogrel exposure within 5 days of CABG is associated with an increased risk of major bleeding.
Blais D M; Zukkoor S M; Hayes C; Pickworth K K; Porter K; Firstenberg M S
Heart Surgery Forum
2013
2013-04
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1532/hsf98.20121101" target="_blank" rel="noreferrer noopener">10.1532/hsf98.20121101</a>
Terrestrial Activity in Pitheciins (Cacajao, Chiropotes, and Pithecia)
Zoology; behavior; risk; primates; saimiri-sciureus; predation; new-world monkeys; terrestrial; bearded; eastern brazilian amazonia; habitat use; pitheciids; rain-forest; sakis; satanas-chiropotes; seed-predator; spider monkeys
Neotropical monkeys of the genera Cacajao, Chiropotes, and Pithecia (Pitheciidae) are considered to be highly arboreal, spending most of their time feeding and traveling in the upper canopy. Until now, the use of terrestrial substrates has not been analyzed in detail in this group. Here, we review the frequency of terrestrial use among pitheciin taxa to determine the ecological and social conditions that might lead to such behavior. We collated published and unpublished data from 14 taxa in the three genera. Data were gleaned from 53 published studies (including five on multiple pitheciin genera) and personal communications of unpublished data distributed across 31 localities. Terrestrial activity was reported in 61% of Pithecia field studies (11 of 18), in 34% of Chiropotes studies (10 of 29), and 36% of Cacajao studies (4 of 11). Within Pithecia, terrestrial behavior was more frequently reported in smaller species (e.g. P. pithecia) that are vertical clingers and leapers and make extensive use of the understory than in in the larger bodied canopy dwellers of the western Amazon (e.g. P. irrorata). Terrestrial behavior in Pithecia also occurred more frequently and lasted longer than in Cacajao or Chiropotes. An apparent association was found between flooded habitats and terrestrial activity and there is evidence of the development of a local pattern of terrestrial use in some populations. Seasonal fruit availability also may stimulate terrestrial behavior. Individuals also descended to the ground when visiting mineral licks, escaping predators, and responding to accidents such as a dropped infant. Overall, the results of this review emphasize that terrestrial use is rare among the pitheciins in general and is usually associated with the exploitation of specific resources or habitat types. Am. J. Primatol. 74:1106-1127, 2012. (c) 2012 Wiley Periodicals, Inc.
Barnett A A; Boyle S A; Norconk M M; Palminteri S; Santos R R; Veiga L M; Alvim T H G; Bowler M; Chism J; Di Fiore A; Fernandez-Duque E; Guimaraes A C P; Harrison-Levine A; Haugaasen T; Lehman S; Mackinnon K C; De Melo F R; Moreira L S; Moura V S; Phillips C R; Pinto L P; Port-Carvalho M; Setz E Z F; Shaffer C; Da Silva I R; Da Silva Sdsb; Soares R F; Thompson C L; Vieira T M; Vreedzaam A; Walker-Pacheco S E; Spironello W R; Maclarnon A; Ferrari S F
American Journal of Primatology
2012
2012-12
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1002/ajp.22068" target="_blank" rel="noreferrer noopener">10.1002/ajp.22068</a>
A model intervention for elder abuse and dementia
alzheimers-disease; curricula; Geriatrics & Gerontology; referral protocols; risk; screening tools; violence
This article describes a 2-year collaborative project in Cleveland, OH, that improved the reporting and management of potential and suspected elder abuse situations involving persons with dementia. Educational curricula for cross-training, screening tools, and referral protocols were developed and tested for staff and volunteers in adult protective services and dementia care. A handbook for caregivers of persons with dementia was produced that enables caregivers to self-identify elder abuse risk and seek appropriate interventions to prevent abuse. Project organization, implementation, and evaluation are discussed along with strategies for replication in other communities.
Anetzberger G J; Palmisano B R; Sanders M; Bass D; Dayton C; Eckert S; Schimer M R
Gerontologist
2000
2000-08
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1093/geront/40.4.492" target="_blank" rel="noreferrer noopener">10.1093/geront/40.4.492</a>
Intercostal Artery Laceration Following Thoracentesis
cage; chest roentgenography; complications; General & Internal Medicine; hemothorax; intercostal artery laceration; median sternotomy; pneumothorax; pulmonary hemorrhage; Respiratory System; rib; risk; thoracentesis; thoracocentesis; thoracotomy
Intercostal artery laceration is an unusual complication following thoracentesis, and has been reported only in elderly patients. We report a case of a 78-year-old man who developed a massive hemothorax following thoracentesis. Post-thoracentesis radiograph revealed a substantial increase in pleural fluid, and emergency chest tube insertion identified the hemothorax. He underwent right thoracotomy for repair of the intercostal artery laceration.
Yacovone M L; Kartan R; Bautista M
Respiratory Care
2010
2010-11
Journal Article
n/a
The heart of women's health
cardiovascular health; disease; gender-differences; General & Internal Medicine; risk; symptoms
Plate D S; Hughes S
American Family Physician
2006
2006-10
Journal Article
n/a
RADIOTHERAPY AND SURVIVAL IN PROSTATE CANCER PATIENTS: A POPULATION-BASED STUDY
active surveillance; brachytherapy; carcinoma; external-beam radiotherapy; failure; management; Nuclear Medicine & Medical Imaging; Oncology; outcomes; Population-based study; Prostate cancer; radiation-therapy; radical prostatectomy; Radiology; risk; survival; Treatment modalities
Purpose: To investigate the association of overall and disease-specific survival with the five standard treatment modalities for prostate cancer (CaP): radical prostatectomy (RP), brachytherapy (BT), external beam radiotherapy, androgen deprivation therapy, and no treatment (NT) within 6 months after CaP diagnosis. Methods and Materials: The study population included 10,179 men aged 65 years and older with incident CaP diagnosed between 1999 and 2001. Using the linked Ohio Cancer Incidence Surveillance System, Medicare, and death certificate files, overall and disease-specific survival through 2005 among the five clinically accepted therapies were analyzed. Results: Disease-specific survival rates were 92.3% and 23.9% for patients with localized vs. distant disease at 7 years, respectively. Controlling for age, race, comorbidities, stage, and Gleason score, results from the Cox multiple regression models indicated that the risk of CaP-specific death was significantly reduced in patients receiving RP or BT, compared with NT. For localized disease, compared with NT, in the monotherapy cohort, RP and BT were associated with reduced hazard ratios (HR) of 0.25 and 0.45 (95% confidence intervals 0.13-0.48 and 0.23-0.87, respectively), whereas in the combination therapy cohort, HR were 0.40 (0.17-0.94) and 0.46 (0.270.80), respectively. Conclusions: The present population-based study indicates that RP and BT are associated with improved survival outcomes. Further studies are warranted to improve clinical determinates in the selection of appropriate management of CaP and to improve predictive modeling for which patient subsets may benefit most from definitive therapy vs. conservative management and/or observation. (C) 2009 Elsevier Inc.
Zhou E H; Ellis R T; Cherullo E; Colussi V; Xu F; Chen W D; Gupta S; Whalen C C; Bodner D; Resnick M I; Rimm A A; Koroukian S M
International Journal of Radiation Oncology Biology Physics
2009
2009-01
Journal Article
<a href="http://doi.org/10.1016/j.ijrobp.2008.04.001" target="_blank" rel="noreferrer noopener">10.1016/j.ijrobp.2008.04.001</a>
Estrogen prevents neuroprotection by caffeine in the mouse 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine model of Parkinson's disease
adenosine; adenosine A(2A) receptor; c57bl/6 mice; coffee consumption; cytochromes p450; dopamine; estradiol; gender; methylxanthine; mptp-induced neurotoxicity; Neurosciences & Neurology; ovariectomy; risk; striatal dopamine; striatum; twins
Epidemiological studies have strongly linked caffeine consumption with a reduced risk of developing Parkinson's disease (PD) in men. Interestingly, in women, this inverse association is present only in those who have not taken postmenopausal estrogens, suggesting an interaction between the influences of estrogen and caffeine use on the risk of PD. To explore a possible biological basis for this interaction, we systematically investigated how the neuroprotective effect of caffeine is influenced by gender, ovariectomy (OVX), and then exogenous estrogen in the mouse 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) model of PD. (1) Caffeine treatment produced a dose-dependent attenuation of MPTP-induced striatal dopamine loss in both young and retired breeder (RB) male, but not female, mice. (2) In female mice (both young and RB), caffeine was less potent or altogether ineffective as a neuroprotectant after sham surgery compared to OVX or after OVX plus estrogen replacement compared to OVX plus placebo treatment. (3) Estrogen treatment also prevented the protection of caffeine against dopamine loss in young male mice. (4) Consistent with the putative protective effect of estrogen, female and OVX plus estrogen mice were relatively resistant to MPTP toxicity compared to male and OVX plus placebo mice, respectively. (5) There was no overall difference in brain levels of caffeine and its metabolites between OVX plus placebo and OVX plus estrogen mice. Together, these results suggest that estrogen can occlude and thereby prevent the neuroprotective effect of caffeine in a model of PD neurodegeneration, supporting a biological basis for the interaction between estrogen and caffeine in modifying the risk of PD.
Xu K; Xu Y H; Brown-Jermyn D; Chen J F; Ascherio A; Dluzen D E; Schwarzschild M A
Journal of Neuroscience
2006
2006-01
Journal Article
<a href="http://doi.org/10.1523/jneurosci.3008-05.2006" target="_blank" rel="noreferrer noopener">10.1523/jneurosci.3008-05.2006</a>
Emergency Department Performance Measures Updates: Proceedings of the 2014 Emergency Department Benchmarking Alliance Consensus Summit
care; costs; Emergency Medicine; operations; outcomes; patient satisfaction; project; publication guidelines; quality improvement; risk; stay
ObjectivesThe objective was to review and update key definitions and metrics for emergency department (ED) performance and operations. MethodsForty-five emergency medicine leaders convened for the Third Performance Measures and Benchmarking Summit held in Las Vegas, February 21-22, 2014. Prior to arrival, attendees were assigned to workgroups to review, revise, and update the definitions and vocabulary being used to communicate about ED performance and operations. They were provided with the prior definitions of those consensus summits that were published in 2006 and 2010. Other published definitions from key stakeholders in emergency medicine and health care were also reviewed and circulated. At the summit, key terminology and metrics were discussed and debated. Workgroups communicated online, via teleconference, and finally in a face-to-face meeting to reach consensus regarding their recommendations. Recommendations were then posted and open to a 30-day comment period. Participants then reanalyzed the recommendations, and modifications were made based on consensus. ResultsA comprehensive dictionary of ED terminology related to ED performance and operation was developed. This article includes definitions of operating characteristics and internal and external factors relevant to the stratification and categorization of EDs. Time stamps, time intervals, and measures of utilization were defined. Definitions of processes and staffing measures are also presented. Definitions were harmonized with performance measures put forth by the Centers for Medicare and Medicaid Services (CMS) for consistency. ConclusionsStandardized definitions are necessary to improve the comparability of EDs nationally for operations research and practice. More importantly, clear precise definitions describing ED operations are needed for incentive-based pay-for-performance models like those developed by CMS. This document provides a common language for front-line practitioners, managers, health policymakers, and researchers. (C) 2015 by the Society for Academic Emergency Medicine
Wiler J L; Welch S; Pines J; Schuur J; Jouriles N; Stone-Griffith S
Academic Emergency Medicine
2015
2015-05
Journal Article
<a href="http://doi.org/10.1111/acem.12654" target="_blank" rel="noreferrer noopener">10.1111/acem.12654</a>
Integrating health and vocational psychology: HIV and employment
aids; clients; counseling psychology; gay; model; protease inhibitors; Psychology; rational suicide; risk; social-justice; women
This article introduces the Major Contribution on integrating health and vocational psychology, using persons with HIV who have work-related concerns as an example. The authors describe the demographics associated with HIV disease and new treatments that have allowed people with HIV to remain healthy and continue working, or consider returning to work. They also outline the purposes of the Major Contribution and conclude with a call for more focus on traditionally disenfranchised populations, especially those who are members of multiple groups facing discrimination.
Werth J L; Borges N J; McNally C J; Maguire C P; Britton P J
Counseling Psychologist
2008
2008-01
Journal Article
<a href="http://doi.org/10.1177/0011000007309636" target="_blank" rel="noreferrer noopener">10.1177/0011000007309636</a>
Association of Thyroid, Breast and Renal Cell Cancer: A Population-based Study of the Prevalence of Second Malignancies
age; carcinoma; multiple primary breast; Oncology; primary tumors; risk; Surgery; united-states; women
Analysis of the National Cancer Institute's Surveillance, Epidemiology, and End Results data has shown that the incidence of thyroid cancer is higher in patients with a preexisting malignancy and that the incidence of other malignancies is higher in patients with thyroid cancer. The purpose of this study was to evaluate the prevalence of a second malignancy in patients treated for thyroid, breast or renal cell cancer and determine what associations, if any, exist between these cancers. This study utilized the novel data system, Explorys, as its population base. Patient cohorts were constructed using ICD-9 codes, and prevalence rates were obtained for each cancer. Rates of second malignancy were obtained and compared to the baseline prevalence for a particular malignancy. Female thyroid cancer patients had a 0.67- and twofold increase in prevalence of a subsequent breast and renal cell cancer. Female breast and renal cell cancer patients had a twofold and 1.5-fold increase in the prevalence of thyroid cancer, respectively. Male patients with thyroid cancer had a 29- and 4.5-fold increase in prevalence of subsequent breast and renal cell cancer. Male patients with breast and renal cell cancer had an increased prevalence of subsequent thyroid cancer, 19- and threefold, respectively. Our study demonstrated a bidirectional association between thyroid, breast and renal cancer in both male and female patients. This may have important implications for patient follow-up and screening after treatment of a primary cancer.
Van Fossen V L; Wilhelm S M; Eaton J L; McHenry C R
Annals of Surgical Oncology
2013
2013-04
Journal Article
<a href="http://doi.org/10.1245/s10434-012-2718-3" target="_blank" rel="noreferrer noopener">10.1245/s10434-012-2718-3</a>
Malabsorption-associated warfarin resistance
5-mg; absorption; absorption; Albuterol; Anticoagulants; Aspirin; Atorvastatin calcium; coumarin anticoagulant drugs; Diazepam; Dosage; Fluticasone; genotype; hereditary; International normalized ratio; Metoprolol tartrate; patient; pharmacodynamics; Pharmacology & Pharmacy; resistance; risk; Salmeterol; short-bowel syndrome; Venous thrombosis; Warfarin sodium
Purpose. A case of malabsorption-associated warfarin resistance is reported. Summary. A 42-year-old, 111-kg, Caucasian man arrived at the emergency department with atypical pleuritic chest pain. The chest pain was associated with shortness of breath, diaphoresis, nausea, vomiting, and tachycardia. The patient's medical history was significant for multiple episodes of deep venous thrombosis (DVT) in the left upper extremity and both lower extremities, a right above-the-knee amputation due to complications of a previous DVT, insertion of a vena cava filter, pulmonary embolism (PE), asthma, hypertension, and multiple myocardial infarctions. During admission, he was diagnosed presumptively with PE. All potential causes of interference with warfarin absorption were investigated and ruled out. IN. warfarin therapy at a conventional initial dosage of 5 mg once daily was started on hospital day 2. The International Normalized Ratio (INR) reached the therapeutic range after increasing the i.v. warfarin dosage to 7.5 mg once daily on hospital day 6. The ability to obtain a therapeutic INR on a relatively low dosage of i.v. warfarin but not high dosages of oral warfarin strongly suggests an inherent warfarin malabsorption defect in this patient. Conclusion. A 42-year-old man with a history of recurrent thromboembolisms demonstrated resistance to oral warfarin therapy due to warfarin malabsorption.
Sabol B J; Basa R R; Wilkins C E
American Journal of Health-System Pharmacy
2009
2009-09
Journal Article
<a href="http://doi.org/10.2146/ajhp080477" target="_blank" rel="noreferrer noopener">10.2146/ajhp080477</a>
Quantitative ultrasound of the calcaneus as a screening tool to detect osteoporosis - Different reference ranges for Caucasian women, African American women, and Caucasian men
bone-mineral density; classification; discordance; elderly men; Endocrinology & Metabolism; fracture; fractures; osteoporosis; population; postmenopausal women; quantitative ultrasound; race; risk; sex; T-score; t-scores; testosterone
The interpretation of results measured by quantitative ultrasound (QUS) of the heel depends on the population studied. We measured estimated bone mineral density (BMD) of the heel using the Hologic Sahara sonometer. People were studied at county fairs, health fairs, and churches. Subjects were not on treatments that would affect bone density, other than calcium supplementation. This included 823 Caucasian women, 131 African American women, and 301 Caucasian men. In contrast to women, for Caucasian men the squared term for age was not significant, and a straight line of decline was the best fit for estimated BMD. African American women had a standard deviation larger than that reported by Hologic for Caucasian women. We compared a history of self-reported fractures with a subject's estimated BMD. An estimated BMD of 0.57 gm/cm(2) included 75% of all fractures. This cutoff point was associated with increased fracture prevalence in subjects over age 50, relative risk of 1.4. This result corresponds to the Hologic data T-score of -0.2. When used as a screening tool for osteoporosis fracture risk, an estimated BMD of 0.57 gm/cm2 seems reasonable in those subjects over age 50.
Rothenberg R J; Boyd J L; Holcomb J R
Journal of Clinical Densitometry
2004
2004
Journal Article
<a href="http://doi.org/10.1385/jcd:7:1:101" target="_blank" rel="noreferrer noopener">10.1385/jcd:7:1:101</a>
Fatalism and revolution: expanding our understanding of fatalism during a unique political opening in Egypt
Arab spring protests; Area Studies; civilizations; clash; Egyptian revolution; explanatory style; Fatalism; Islamic modernism; risk; suicide
Fatalism is the belief that major life events are outside of our individual control. We examine two distinct types of fatalism - theological and empirical fatalism in Egypt during a unique 'moment of madness' immediately following the revolution of 2011 when the political system was in upheaval and many thought all things were politically possible. Drawing on a non-proportional quota survey of 136 Egyptian metropolitan adults in the midst of the 2012 Egyptian Presidential elections, we find that empirical fatalism (belief that fate controls) and theological fatalism (belief that an omniscient God controls) are uncorrelated and have quite distinct social correlates and implications for protest action. Empirical fatalism is tied to being older and female and is a significant deterrent to protest potential. Theological fatalism, which is more widespread, is stronger among the less educated and men but has no effects on protest potential. In contrast with arguments about the anti-modernism of Islamic beliefs, Muslims in general and the more intensely religious Muslims are less likely to be empirically fatalistic. Our results suggest that, at least in Egypt, there are at least two distinct types of fatalism and, while empirical fatalism discourages protests, theological fatalism does not. We discuss the implications of these findings for the further study of fatalism and its impact on political and social action.
Rashwan B; Jenkins J C
Journal of North African Studies
2017
2017
Journal Article
<a href="http://doi.org/10.1080/13629387.2017.1316716" target="_blank" rel="noreferrer noopener">10.1080/13629387.2017.1316716</a>
Nicotine Exacerbates Brain Edema during In Vitro and In Vivo Focal Ischemic Conditions
acetylcholine-receptor subtypes; barrier; cigarette-smoking; exposure; middle cerebral-artery; occlusion; permeability; Pharmacology & Pharmacy; rat; risk; stroke; water
We have previously shown that nicotine, the addictive component of tobacco products, alters the blood-brain barrier (BBB) Na+, K+, 2Cl(-) cotransporter (NKCC) during in vitro hypoxia-aglycemia exposure. Attenuation of abluminal NKCC suggests that accumulation of ions in the brain extracellular fluid would result in an increase of fluid or cytotoxic edema in the brain during hypoxia-aglycemia or stroke conditions. To further investigate whether nicotine products have the potential to worsen stroke outcome by increasing edema formation, two separate models to mimic stroke conditions were utilized to decipher the effects of short-term and long-term administrations of nicotine products on brain edema following stroke. Oxygen glucose deprivation (OGD) was studied in rat hippocampal slices with short-term or long-term exposure to nicotine and cigarette smoke constituents. During short-term exposure, the presence of nicotine at a concentration mimicking heavy smokers increased water content of hippocampal slices during OGD. Furthermore, long-term 1-week administration of nicotine increased water content in hippocampal slices that could be attenuated with nicotine acetylcholine receptor (nAChR) antagonists, suggesting nicotine increase edema during OGD via nAChRs. A second model of focal ischemia, middle cerebral artery occlusion, showed an increase of infarct size during short-term exposure to nicotine and an increase of edema during both short-term and long-term administration of nicotine, compared with saline controls. These findings support the paradigm that nicotine products not only increase the incidence of stroke but also have the potential to worsen stroke outcome by increased edema formation.
Paulson J R; Yang T Z; Selvaraj P K; Mdzinarishvili A; Van der Schyf C J; Klein J; Bickel U; Abbruscato T J
Journal of Pharmacology and Experimental Therapeutics
2010
2010-02
Journal Article
<a href="http://doi.org/10.1124/jpet.109.157776" target="_blank" rel="noreferrer noopener">10.1124/jpet.109.157776</a>
Why are some species more commonly afflicted by arthritis than others? A comparative study of spondyloarthropathy in primates and carnivores
ankylosing spondylitis; arthritis; body size; carnivores; comparative study; disease; disease risk; Environmental Sciences & Ecology; Evolutionary Biology; extinction; Genetics &; gorilla-gorilla; group-size; Heredity; inflammatory arthritis; IUCN threat status; joint; museum specimens; population-density; primates; reactive arthritis; rheumatoid-arthritis; risk; spondyloarthropathy
Spondyloarthropathy is a painful arthritic affliction of humans that also occurs in wild mammals. Important questions remain concerning the underlying causes of spondyloarthropathy in mammals, particularly regarding whether it is infectious in origin or driven by genetic predisposition and environmental stressors. Moreover, spondyloarthropathy has negative effects on host fitness, leading to potential conservation concerns if it impacts threatened species. Using a comparative data set on the prevalence of joint disease in 34 primate species and 100 carnivore species, we tested predictions involving the epidemiological correlates of spondyloarthropathy in wild mammals. Analyses revealed that 5.6% of primates and 3.6% of carnivores exhibited signs of spondyloarthropathy, with maximum incidence as high as 22% in great apes and 27% in bears. We tested whether prevalence of spondyloarthropathy increases with population density and group size, greater contact with soil, a slower host life history, increased ranging, dietary factors and body mass. We found general support for an effect of body mass, with larger bodied primates and carnivores exhibiting a higher prevalence of spondyloarthropathy. In addition, more threatened species experienced higher rates of spondyloarthropathy, with this association influenced by body mass and phylogeny. The effect of body mass could reflect that larger animals are exposed to more pathogens through greater consumption of resources, or that joints of larger bodied mammals experience greater biomechanical stresses, resulting in inflammation and activation of local joint infections.
Nunn C L; Rothschild B; Gittleman J L
Journal of Evolutionary Biology
2007
2007-03
Journal Article
<a href="http://doi.org/10.1111/j.1420-9101.2006.01276.x" target="_blank" rel="noreferrer noopener">10.1111/j.1420-9101.2006.01276.x</a>
Contamination rates of blood cultures obtained by dedicated phlebotomy vs intravenous catheter
decision-analysis; epidemiology; febrile children; General & Internal Medicine; hospital; infection-control; management; occult bacteremia; pediatric emergency; quality-control methods; resource utilization; risk
Context Blood culture is the criterion standard for identifying children with bacteremia. However, elevated false-positive rates are common and are associated with substantial health care costs. Objective To compare contamination rates in blood culture specimens obtained from separate sites vs through newly inserted intravenous catheters. Design, Setting, and Participants Observational study conducted January 1998 through December 1999 among patients aged 18 years or younger who were seen at a US children's hospital emergency department and had a blood culture obtained as part of their care. Medical records were reviewed in all cases with a positive blood culture. Patients with indwelling vascular catheters were excluded. Intervention All phlebotomy was performed by emergency department registered nurses. During the baseline phase, blood specimens for culture were obtained simultaneously with intravenous catheter insertion. During the postintervention phase, specimens were obtained by a separate, dedicated procedure. Main Outcome Measure Contamination rate in the postintervention period compared with the baseline period. Results A total of 4108 blood cultures were evaluated, including 2108 during the baseline phase and 2000 in the postintervention phase. The false-positive blood culture rate decreased from 9.1% to 2.8% (P<.001). A statistical process control chart demonstrated a steady-state process in the baseline phase and the establishment of a significantly improved steady state in the postintervention phase. Young age was associated with increased contamination rate in both the baseline and postintervention periods. Conclusion Blood culture contamination rates were lower when specimens were drawn from a separate site compared with when they were drawn through a newly inserted intravenous catheter.
Norberg A; Christopher N C; Ramundo M L; Bower J R; Berman S A
Jama-Journal of the American Medical Association
2003
2003-02
Journal Article
<a href="http://doi.org/10.1001/jama.289.6.726" target="_blank" rel="noreferrer noopener">10.1001/jama.289.6.726</a>
Predicting locoregional recurrence after neoadjuvant chemotherapy in patients with breast cancer.
Female; Humans; Treatment Outcome; Prognosis; Clinical Trials as Topic; Research Design; Breast Neoplasms/*diagnosis/drug therapy/therapy; Neoadjuvant Therapy; Risk; *Neoplasm Recurrence; Local
Mamounas Terry P
Clinical advances in hematology & oncology : H&O
2013
2013-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Elapsed time from symptom onset and acute myocardial infarction in a community hospital.
Humans; Middle Aged; Time Factors; Aged; Cohort Studies; Prognosis; Hospitals; Thrombolytic Therapy; Electrocardiography; Risk; Heart Arrest/etiology; Heart Ventricles; *Myocardial Infarction/diagnosis/therapy; *Patient Admission; Angina Pectoris/complications; Chest Pain/etiology; Coronary Artery Bypass; Tachycardia/etiology; Community; Angioplasty; Balloon; Coronary
STUDY OBJECTIVE: Previous reports have emphasized that thrombolytic therapy for acute myocardial infarction should be initiated within three or four hours of symptom onset to obtain the best clinical outcomes. However, our clinical impression was that late arrivers, who often do not receive thrombolytic therapy, have a good short-term prognosis. Therefore, we investigated the relationships among the elapsed time from symptom onset, thrombolytic therapy, and short-term prognosis in acute myocardial infarction patients. The research hypothesis was that late arrivers have a better in-hospital prognosis because they have less severe disease that may involve spontaneous thrombolysis. DESIGN: Observational cohort study based on reviewing medical records and emergency department service logs. SETTING: 500-bed teaching hospital with medical school affiliation in northeastern Ohio. TYPE OF PARTICIPANTS: Four hundred consecutive patients with acute infarction confirmed by chest pain and positive ECGs or elevated cardiac enzymes. MEASUREMENTS AND MAIN RESULTS: Patients arriving early (elapsed time less than or equal to 1.5 hours) were more likely to be in Killip class III or IV (P = .04) or to have hypotension (P = .0004); and they experienced twofold increased odds of ventricular tachycardia (P = .007), cardiac arrest (P = .03), or death (P = .01). Patients arriving late (elapsed time greater than 3.5 hours) were more likely to have a history of angina (P = .002) and had a better short-term prognosis. CONCLUSIONS: Time of ED arrival after onset of acute myocardial infarction symptoms distinguishes two patient groups that differ in their risk of in-hospital complications. Late arrivers have better short-term prognoses and less (acutely) severe disease, and may have less need for thrombolytic therapy because of possible spontaneous thrombolysis. Patients with prior angina may need education on seeking care if their symptoms change.
Logue EE; Ognibene A; Marquinez C; Jarjoura D
Annals of emergency medicine
1991
1991-04
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<a href="http://doi.org/10.1016/s0196-0644(05)81650-6" target="_blank" rel="noreferrer noopener">10.1016/s0196-0644(05)81650-6</a>