Effectiveness of a group exercise program in a long-term care facility: a randomized pilot trial.
Female; Male; Aged; Sensitivity and Specificity; Prospective Studies; Age Factors; Sex Factors; Analysis of Variance; Patient Compliance; Pliability; Frail Elderly; Nursing Homes; Confidence Intervals; Inpatients; Human; Descriptive Statistics; P-Value; Repeated Measures; Data Analysis Software; Pilot Studies; Clinical Trials; Summated Rating Scaling; Clinical Assessment Tools; Analysis of Covariance; Outcomes (Health Care); Range of Motion; Random Assignment; Treatment Outcomes; Gerontologic Care; Long Term Care; Functional Status; Geriatric Functional Assessment; Crossover Design; Housing for the Elderly; Muscle Strengthening; Recreation; 80 and Over; Group Exercise – In Old Age
Objective:The purpose of this pilot was to determine whether a strength and flexibility program in frail long-term care facility (LTC) residents would result in improved function.Design:A prospective, randomized, controlled, semicrossover trial was designed with participants assigned either to group exercise (EX) or recreational therapy (C). In the EX group, the intervention continued for 1 year. In the C group, recreation continued for 6 months; these controls were then crossed over to the same exercise intervention as the EX group and followed for an additional 6 months. Functional outcomes were measured at baseline and 3, 6, 9, and 12 months for both groups.Setting:A LTC facility, which included both assisted living (AL) and nursing home (NH) residents.Participants:Twenty frail residents (5 from NH, 15 from AL) aged 75 to 99 years at one LTC facility.Intervention:After random group assignment, the EX group met 1 hour three times per week. An exercise physiologist and LTC staff conducted sessions which included seated range of motion (ROM) exercises and strength training using simple equipment such as elastic resistance bands (therabands) and soft weights. The C group met three times per week and participated in activities such as painting during the first 6 months, before crossing over to exercise.Measurements and Methods:Objective measures of physical and cognitive function were obtained at baseline and 3, 6, 9, and 12 months using the timed get-up-and-go test (TUG), Berg balance scale, physical performance test (PPT), and mini-mental status exam (MMSE). Because we were interested in the impact of exercise on multiple endpoints and to protect the type I error rate, a global hypothesis test was used.Results:There was a significant overall impact across the four measures of the exercise intervention (P = 0.013). Exercise benefit as indicated by the difference between exercise and control conditions showed exercise decreased TUG by 18 seconds, which represents an effect size (in standard deviation units) of 0.50, increased PPT scores by 1.3, with effect size = 0.40, increased Berg scores by 4.8, with effect size of 0.32, and increased MMSE by 3.1, with effect size = 0.54. Except for the Berg, 90% confidence intervals on these exercise effects excluded 0.Conclusion:Frail elderly in a LTC facility were able to participate and benefit from a strength training program. The program was delivered with low-cost equipment by an exercise physiologist and LTC staff. The advantage of such a program is that it provides recreational and therapeutic benefits.
Baum EE; Jarjoura D; Polen AE; Faur D; Rutechi G
Journal of the American Medical Directors Association
2003
2003-04-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s1525-8610(04)70279-0" target="_blank" rel="noreferrer noopener">10.1016/s1525-8610(04)70279-0</a>
Reclining chairs reduce pain from gurneys in older emergency department patients: a randomized controlled trial.
Ohio; Aged; Sensitivity and Specificity; Prospective Studies; Pain Measurement; Patient Satisfaction; Outpatients; Hospitals; Self Report; Confidence Intervals; Human; Descriptive Statistics; Funding Source; Scales; Data Analysis Software; Surveys; Coefficient Alpha; Summated Rating Scaling; Emergency Service; Community; Treatment Outcomes; Emergency Patients; Beds and Mattresses; Interior Design and Furnishings; Patient Positioning; Single-Blind Studies; 80 and Over; Pain – Prevention and Control – In Old Age
OBJECTIVES: Pain related to the gurney is a frequent complaint of older emergency department (ED) patients. The authors hypothesized that these patients may have less pain and higher satisfaction if allowed to sit in a reclining hospital chair. METHODS: A single-blind, randomized controlled trial was performed. Patients 65 years old or older who were able to sit upright, transfer, and engage in normal conversation were eligible. Severely ill or cognitively impaired patients were excluded. Patients were randomized to either remain on the gurney or transfer to the chair after initial evaluation. Patients reported pain at arrival (t0), at one hour (t1), and at two hours (t2) using a 0-10 pain scale, and satisfaction at study completion on a 0-10 scale. The primary outcome was a decrease in pain between t0 and t1 or no pain at both t0 and t1. This outcome was analyzed using a 95% confidence interval for the difference between proportions; exclusion of zero was considered significant. RESULTS: Sixty-six patients in each group were enrolled. There was no difference in demographics between groups, but the chair patients were more likely to have pain at t0 than the gurney patients. More chair patients than gurney patients had a successful primary outcome (97% vs. 76%, 21% difference, 95% CI=10% to 32%). The mean satisfaction score was higher in the chair group than in the gurney group (8.1 vs. 6.0, 2.1 difference, 95% CI=1.4% to 2.8%). CONCLUSIONS: The simple modification of allowing older ED patients to sit in reclining chairs resulted in less pain and higher satisfaction.
Wilber S T; Burger B; Gerson L W; Blanda M
Academic Emergency Medicine
2005
2005-02
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="http://doi.org/10.1111/j.1553-2712.2005.tb00846.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2005.tb00846.x</a>
Outcomes in pharyngoplasty: a 10-year experience.
Adult; Female; Male; Ohio; Child; Infant; Risk Factors; Prospective Studies; Age Factors; Sex Factors; Hospitals; Sample Size; Reoperation; Speech; Confidence Intervals; Human; Descriptive Statistics; Middle Age; Adolescence; Retrospective Design; T-Tests; Surgical Flaps; Preschool; Treatment Outcomes; Record Review; Cleft Lip; Cleft Palate; Pediatric – Ohio; Mouth Abnormalities – Surgery; Pharyngeal Diseases – Surgery; Pharynx – Surgery
Objective: The outcomes of 61 patients who underwent a pharyngoplasty for velopharyngeal insufficiency were reviewed to determine potential risk factors for reoperation.Design: This was a retrospective chart review of 61 consecutive patients over approximately 10 years (1993 to 2003). Variables analyzed included gender, cleft type, age at the time of pharyngoplasty, length of time between palate repair and pharyngoplasty, and associated syndromes.Participants: Of the 61 patients, 20 (34%) had a unilateral cleft lip and palate, 5 (8%) had a bilateral cleft lip and palate, 13 (21%) had an isolated cleft palate, 7 (11%) had a submucous cleft palate, and 16 (26%) were diagnosed with noncleft velopharyngeal insufficiency.Results: Of the 61 patients, 10 (16%) required surgical revision. No statistically significant difference was found among gender, cleft type, age at the time of pharyngoplasty, the length of time between palate repair and pharyngoplasty, and associated congenital syndromes, with respect to the need for surgical revision (p \textgreater .05). Of the surgical revisions, 50% (5) were performed for a pharyngoplasty that was placed too low.Conclusions: Because 50% of the pharyngoplasty revisions had evidence of poor velopharyngeal closure and associated hypernasality resulting from low placement of the sphincter, the pharyngoplasty needs to be placed at a high level to reduce the risk for revisional surgery. The pharyngoplasty is a good operation for velopharyngeal insufficiency with an overall success rate of 84% (51 of 61) after one operation and greater than 98% (60 of 61) after two operations.
Pryor LS; Lehman J; Parker M G; Schmidt A; Fox L; Murthy AS
Cleft Palate-Craniofacial Journal
2006
2006-03
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<a href="http://doi.org/10.1597/04-115" target="_blank" rel="noreferrer noopener">10.1597/04-115</a>
From mechanisms to management: translating the neuropathic pain consensus recommendations into clinical practice.
Adult; Female; Aged; Inflammation; Pain Measurement; Comorbidity; Education; Neoplasm Metastasis; Drugs; Perception; Clinical Trials; Middle Age; Sarcoidosis; Analgesics; Drug Therapy; Combination; Antidepressive Agents; Treatment Outcomes; Cancer Patients; Chronic Pain; Treatment Duration; Breast Neoplasms; Visual Analog Scaling; Lung Neoplasms; Melanoma; Rectal Neoplasms; Continuing (Credit); Transdermal Patches; Lidocaine – Administration and Dosage; Analgesics – Administration and Dosage; Analgesics – Adverse Effects; Cytokines – Physiology; Gabapentin – Administration and Dosage; Neural Transmission – Physiology; Neuralgia – Classification; Neuralgia – Drug Therapy; Neuralgia – Physiopathology; Opioid – Administration and Dosage; Peripheral Nervous System – Physiopathology; Tramadol – Administration and Dosage; Tricyclic – Administration and Dosage
Chronic neuropathic pain poses a treatment challenge, and is associated with significant psychologic distress, physical disability, and impaired functioning, which impact the activities of daily living. Efforts to provide relief are often inadequate and/or require polypharmacy. This has spurred interest among researchers and clinicians alike to develop early, intensive treatments that target the molecular and cellular mechanisms involved in pain transduction, transmission, and modulation, or ideally, that prevent neuropathic pain from occurring in the first place. Currently, researchers are attempting to capitalize on our understanding of neuropathic pain pathophysiology to develop drugs that interrupt distinct activities involved in its perpetuation. In this regard, several potential agents (eg, NMDA and AMPA/kainate antagonists) are in phase 2 and 3 clinical trials. In the interim, evolving data and evidence-based neuropathic treatment recommendations provide guidance for selecting first- and second-line medications that alone or in combination offer acceptable neuropathic pain control and allow clinicians to bridge the gap between current knowledge and its application in the clinical setting. Hopefully, as basic and clinical science progresses, further treatment advances and management tools will be found to improve the care of patients who live with neuropathic pain.
Chevlen E; Davies PS; Rhiner M
Journal of the American Academy of Nurse Practitioners
2005
2005-06-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Urinary retention in adults: diagnosis and initial management.
Adult; Female; Male; Human; Diagnosis; Treatment Outcomes; Severity of Illness Indices; Urologic; Urinary Catheterization – Methods; Urinary Retention – Diagnosis; Urinary Retention – Therapy
Urinary retention is the inability to voluntarily void urine. This condition can be acute or chronic. Causes of urinary retention are numerous and can be classified as obstructive, infectious and inflammatory, pharmacologic, neurologic, or other. The most common cause of urinary retention is benign prostatic hyperplasia. Other common causes include prostatitis, cystitis, urethritis, and vulvovaginitis; receiving medications in the anticholinergic and alphaadrenergic agonist classes; and cortical, spinal, or peripheral nerve lesions. Obstructive causes in women often involve the pelvic organs. A thorough history, physical examination, and selected diagnostic testing should determine the cause of urinary retention in most cases. Initial management includes bladder catheterization with prompt and complete decompression. Men with acute urinary retention from benign prostatic hyperplasia have an increased chance of returning to normal voiding if alpha blockers are started at the time of catheter insertion. Suprapubic catheterization may be superior to urethral catheterization for short-term management and silver alloy-impregnated urethral catheters have been shown to reduce urinary tract infection. Patients with chronic urinary retention from neurogenic bladder should be able to manage their condition with clean, intermittent self-catheterization; low-friction catheters have shown benefit in these patients. Definitive management of urinary retention will depend on the etiology and may include surgical and medical treatments.
Selius BA; Subedi R
American Family Physician
2008
2008
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Robotic radical hysterectomy.
Adult; Female; Human; Treatment Outcomes; Robotics; Carcinoma – Surgery; Cervix Neoplasms – Surgery; Hysterectomy – Methods
OBJECTIVE: Advanced laparoscopic procedures are increasing being used in gynecologic surgery. The da Vinci robotic system (Intuitive Surgical Corporation, Sunnyvale, CA) can further augment laparoscopic surgery. We describe our initial experience using the da Vinci robotic system to perform radical hysterectomy. STUDY DESIGN: Twenty consecutive patients with primary stage IB-IIA cervical carcinoma underwent class 3 radical hysterectomy with the use of the da Vinci robotic system. Median age was 44 years, median weight was 69.9 kg, 65% of patients had medical comorbidity, and 40% had prior abdominal surgery. RESULTS: All 20 patients successfully underwent robotic radical hysterectomy. Median operative time was 6.5 hours (3.5-8.5 hours) and median blood loss was 300 mL. All patients were discharged on the first day after surgery. At median follow-up of 2 years (0.6-3 years), 90% of patients are alive and disease free. CONCLUSION: We report the first series of robotic radical hysterectomy for early stage cervical cancer. All cases were successfully performed robotically with minimal complications and all patients were discharged on postoperative day 1.
Fanning J; Fenton B; Purohit M
American Journal of Obstetrics & Gynecology
2008
2008-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.ajog.2007.11.002" target="_blank" rel="noreferrer noopener">10.1016/j.ajog.2007.11.002</a>
Hemipelvic amputations for recalcitrant pelvic osteomyelitis.
Adult; Female; Male; Aged; Prospective Studies; Human; Middle Age; Retrospective Design; Treatment Outcomes; 80 and Over; Antibiotics – Therapeutic Use; Recurrence – Prevention and Control; Palliative Care – Methods; Hemipelvectomy – Methods; Hemipelvectomy – Psychosocial Factors; Osteomyelitis – Drug Therapy; Osteomyelitis – Microbiology; Osteomyelitis – Surgery; Paraplegia – Psychosocial Factors; Pelvic Bones – Surgery; Wound Infection – Drug Therapy; Wound Infection – Microbiology
Ziran BH; Smith WR; Rao N
Injury
2008
2008-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.injury.2007.12.002" target="_blank" rel="noreferrer noopener">10.1016/j.injury.2007.12.002</a>
TREATMENT OF MOOD DISORDERS: A SURPRISING OMISSION, AND THE ROLE OF LAMOTRIGINE AS A PROTOTYPICAL BIPOLAR ANTIDEPRESSANT.
Treatment Outcomes; Affective Disorders – Drug Therapy; Bipolar Disorder – Drug Therapy; Lamotrigine – Therapeutic Use
Sparhawk Roger; Lembke Anna
Primary Psychiatry
2010
2010-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Review: evidence for the effectiveness of surgery for low back pain, radiculopathy, and spinal stenosis is limited.
Spinal Fusion; Descriptive Statistics; Clinical Trials; Systematic Review; Laminectomy; Treatment Outcomes; Chronic Pain; Diskectomy; Spinal Stenosis – Surgery; Low Back Pain – Surgery; Radiculopathy – Surgery
Rothschild B; Chou R
ACP Journal Club
2009
2009-10-20
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<a href="http://doi.org/10.7326/0003-4819-151-8-200910200-02011" target="_blank" rel="noreferrer noopener">10.7326/0003-4819-151-8-200910200-02011</a>
Incrimination of a 'culprit' lesion evidence from cardiac magnetic resonance imaging.
Adult; Female; Magnetic Resonance Imaging; Electrocardiography; Angioplasty; Treatment Outcomes; Percutaneous Coronary; Transluminal; Coronary Arteriosclerosis – Diagnosis; Coronary Arteriosclerosis – Therapy
Mikolich J R; Mignella RJ
Journal of the American College of Cardiology (JACC)
2010
2010-04-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.jacc.2009.06.069" target="_blank" rel="noreferrer noopener">10.1016/j.jacc.2009.06.069</a>
Improving Outcomes in Early-Stage Breast Cancer.
Physician-Patient Relations; Neoplasm Staging; Prognosis; Survival; Education; Practice Guidelines; Antineoplastic Agents; Adjuvant; Chemotherapy; Treatment Outcomes; Race Factors; Early Detection of Cancer; Lumpectomy; Continuing (Credit); Breast Neoplasms – Mortality; Breast Neoplasms – Pathology; Breast Neoplasms – Therapy; Breast Neoplasms – Classification; Breast Neoplasms – Psychosocial Factors; Hormonal – Therapeutic Use
Glück Stefan; Mamounas Terry; Klem Jennifer
Oncology (08909091)
2010
2010-10-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Hospital outcomes and disposition of trauma patients who are intubated because of combativeness.
Adult; Female; Male; Ohio; Incidence; Intubation; Human; Chi Square Test; Case Control Studies; Retrospective Design; Violence; Physical; Restraint; Intratracheal; Treatment Outcomes; Nonparametric Statistics; Trauma Severity Indices; Length of Stay – Statistics and Numerical Data; Wounds and Injuries – Complications; Hypnotics and Sedatives – Therapeutic Use; Lorazepam – Therapeutic Use; Patient Discharge – Statistics and Numerical Data; Pneumonia – Epidemiology
BACKGROUND:: The purpose of this study was to determine whether trauma patients who are intubated because of combativeness, and not because of medical necessity, have more complications resulting in longer lengths of stay. METHODS:: Data were retrospectively collected from 2001 through 2004 on trauma patients who were intubated because of combative behavior before hospital admission (group 1, N = 34). Cases were matched 1:2 by age, sex, injury severity score (ISS), and injury to controls each who were not intubated (group 2, N = 68). Additionally, there were 187 patients identified who were intubated because of medical necessity before hospital admission; these represented unmatched intubated controls and were divided based on ISS \textless15 (group 3, N = 58) and ISS \textgreater15 (group 4, N = 129). RESULTS:: There were no significant differences between groups 1, 2, and 3 with regard to age, sex, or ISS. There was no significant difference between the groups 1 and 2 in frequency of head injuries as demonstrated by positive computed tomography (50 vs. 37%, p = 0.28); however, there was a significant difference in frequency of neurologic deficit at discharge (33 vs. 6%, p = 0.006). There was a significant difference in the frequency of head injuries between groups 1 and 3 (50 vs. 22%, p = 0.006); however, there was no significant difference in neurologic deficit at discharge (33 vs. 22%, p = 0.24). There was a significant difference in hospital length of stay between groups 1 and 2 (7.4 +/- 5.9 vs. 4.3 +/- 4.5 days, p = 0.0009). The incidence of pneumonia was significantly greater in group 1 than in group 2 (29 vs. 0%, p \textless 0.0001). The amount of lorazepam in average mg per day was also significantly greater in group 1 versus group 2 (4.4 +/- 11.5 vs. 0.4 +/- 1.6, p \textless 0.0001). There was also a difference in the discharge status, with significantly fewer group 1 cases being discharged home compared with group 2 (56 vs. 91%, p \textless 0.0001). There was no significant difference between groups 1 and 3 with regard to length of stay, ventilator days, pneumonia, or discharge status. There was a significant difference between groups 1 and 3 in the amount of lorazepam per day (4.4 +/- 11.5 vs. 0.4 +/- 1.6, p = 0.002). CONCLUSION:: The results from this study indicate that trauma patients who are intubated because of combativeness, and not because of medical necessity, have longer lengths of stay, increased incidence of pneumonia, and poorer discharge status when compared with matched controls. The outcomes of this group are similar to that of patients who are intubated because of medical necessity.
Muakkassa FF; Marley RA; Workman MC; Salvator AE
Journal of Trauma
2010
2010-06
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<a href="http://doi.org/10.1097/TA.0b013e3181dcd137" target="_blank" rel="noreferrer noopener">10.1097/TA.0b013e3181dcd137</a>
The role of transcervical thymectomy in patients with hyperparathyroidism.
Adult; Female; Postoperative Complications; Male; Aged; Human; Middle Age; Retrospective Design; Surgery; Treatment Outcomes; Endocrine; Hyperparathyroidism – Etiology; Hyperparathyroidism – Pathology; Hyperparathyroidism – Surgery; Hypocalcemia – Etiology; Thoracic Surgery – Methods; Thymus Gland – Pathology; Thymus Gland – Surgery
Welch K; McHenry CR
American journal of surgery
2012
2012-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.amjsurg.2011.09.013" target="_blank" rel="noreferrer noopener">10.1016/j.amjsurg.2011.09.013</a>
The After Discharge Care Management of Low Income Frail Elderly (AD-LIFE) Randomized Trial: Theoretical Framework and Study Design.
Aged; Frail Elderly; Study Design; Conceptual Framework; Health Care Delivery; Transitional Programs; Models; Theoretical; Treatment Outcomes; Multidisciplinary Care Team; Medical Practice; Poverty; 80 and Over; Evidence-Based; Chronic Disease – Therapy; After Care – Methods; Disease Management – Methods; Integrated – Methods; Randomized Controlled Trials – Evaluation
Interdisciplinary care management is advocated for optimal care of patients with many types of chronic illnesses; however, few models exist that have been tested using randomized trials. The purpose of this report is to describe the theoretical basis for the After Discharge Management of Low Income Frail Elderly (AD-LIFE) trial, which is an ongoing 2-group randomized trial (total n = 530) to test a chronic illness management and transitional care intervention. The intervention is based on Wagner's chronic illness care model and involves comprehensive posthospitalization nurse-led interdisciplinary care management for low income frail elders with chronic illnesses, employs evidence-based protocols that were developed using the Assessing Care of Vulnerable Elders (ACOVE) guidelines, emphasizes patient activation, and integrates with community-based long-term care and other community agencies. The primary aim of the AD-LIFE trial is to test a chronic illness management intervention in vulnerable patients who are eligible for Medicare and Medicaid. This model, with its standardized, evidence-based medical and psychosocial intervention protocols, will be easily transportable to other sites interested in optimizing outcomes for chronically ill older adults. If the results of the AD-LIFE trial demonstrate the superiority of the intervention, then this data will be important for health care policy makers. ( Population Health Management 2011;14:137-142)
Allen Kyle R; Hazelett Susan E; Jarjoura David; Wright Kathy; Fosnight Susan M; Kropp Denise J; Hua Keding; Pfister Eugene W
Population Health Management
2011
2011-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1089/pop.2010.0016" target="_blank" rel="noreferrer noopener">10.1089/pop.2010.0016</a>
The Better Weight-Better Sleep Study: A Pilot Intervention in Primary Care.
Adult; Female; Male; Aged; Primary Health Care; Behavior Therapy; Human; Funding Source; Repeated Measures; Scales; Data Analysis Software; Middle Age; Adolescence; Regression; Treatment Outcomes; Randomized Controlled Trials; Cognitive Therapy; Sleep; Obesity – Prevention and Control; Sleep Disorders – Complications
Objective: To explore the feasibility of integrating sleep management interventions with dietary and exercise interventions for obesity in a 12-week randomized trial. Methods: We randomized 49 overweight or obese adult patients either to a better weight (BW) cognitive behavioral intervention, or to a combination of the BW intervention and a better sleep intervention, better weight-better sleep (BWBS). Results: The BWBS group lost weight faster (P=.04), and coping self-efficacy accelerated (P=.01). Conclusions: These preliminary results merit replication in a larger primary care-based trial with a longer continuous intervention and followup period.
Logue Everett E; Bourguet Claire C; Palmieri Patrick A; Scott Edward D; Matthews Beth A; Dudley Patricia; Chipman Katie J
American Journal of Health Behavior
2012
2012-06-05
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<a href="http://doi.org/10.5993/AJHB.36.3.4" target="_blank" rel="noreferrer noopener">10.5993/AJHB.36.3.4</a>
Modern outcomes of inflammatory breast cancer.
Adult; Female; Aged; Survival; Radiation Dosage; Antibodies; Human; Middle Age; Retrospective Design; Receptors; Hydrocarbons; Treatment Outcomes; Breast Neoplasms; 80 and Over; Antineoplastic Agents – Therapeutic Use; Breast Neoplasms – Mortality; Breast Neoplasms – Pathology; Monoclonal – Therapeutic Use; Breast Neoplasms – Therapy; Cell Surface – Analysis; Combined Modality Therapy – Methods; Cyclic – Therapeutic Use; Hydrocarbons – Therapeutic Use; Lumpectomy – Statistics and Numerical Data; Proteins – Analysis
Purpose: To report contemporary outcomes for inflammatory breast cancer (IBC) patients treated in the modern era of trastuzumab and taxane-based chemotherapy. Methods and Materials: We retrospectively reviewed the charts of 104 patients with nonmetastatic IBC treated between January 2000 and December 2009. Patients who received chemotherapy, surgery, and radiation therapy were considered to have completed the intended therapy. Kaplan-Meier curves estimated locoregional control (LRC), distant metastases-free survival (DMFS), and overall survival. Results: The median follow-up time was 34 months; 57 (55%) patients were estrogen receptor progesterone receptor (ER/PR) negative, 34 (33%) patients were human epidermal growth factor receptor 2 (her2)/neu amplified, and 78 (75%) received definitive postoperative radiation. Seventy-five (72%) patients completed all of the intended therapy, of whom 67 (89%) received a taxane and 18/28 (64%) of her2/neu-amplified patients received trastuzumab. For the entire cohort, the 5-year rates of overall survival, LRC, and DMFS were 46%, 83%, and 44%, respectively. The ER/PR-negative patients had a 5-year DMFS of 39% vs. 52% for ER/PR-positive patients (p = 0.03). The 5-year DMFS for patients who achieved a pathologic complete response compared with those who did not was 83% vs. 44% (p \textless 0.01). Those patients who received \textgreater60.4 Gy (n = 15) to the chest wall had a 5-year LRC rate of 100% vs. 83% for those who received 45 to 60.4 Gy (n = 49; p = 0.048). On univariate analysis, significant predictors of DMFS included achieving a complete response to neoadjuvant chemotherapy (hazard ratio [HR] = 5.8; 95% confidence interval [CI] = 1.4-24.4; p = 0.02) and pathologically negative lymph nodes (HR = 4.1; 95% CI = 1.4-11.9; p \textless 0.01), but no factor was significant on multivariate analysis. Conclusions: For IBC patients, the rate of distant metastases is still high despite excellent local control, particularly for patients who received \textgreater60.4 Gy to the chest wall. Despite the use of taxanes and trastuzumab, outcomes remain modest, particularly for those with ER/PR-negative disease and those without a pathologic complete response.
Rehman S; Reddy CA; Tendulkar RD; Rehman Sana; Reddy Chandana A; Tendulkar Rahul D
International Journal of Radiation Oncology, Biology, Physics
2012
2012-11
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<a href="http://doi.org/10.1016/j.ijrobp.2012.01.030" target="_blank" rel="noreferrer noopener">10.1016/j.ijrobp.2012.01.030</a>
Fidaxomicin after Vancomycin for Patients with Multiple C. difficile Recurrences.
Aged; Treatment Outcomes; Antibiotics – Therapeutic Use; Clostridium Infections – Drug Therapy; Vancomycin – Administration and Dosage; Recurrence – Prevention and Control
Watkins Richard R
Hospital Medicine Alert
2012
2012-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Efficacy of intravenous lidocaine to reduce pain and distress associated with propofol infusion in pediatric patients during procedural sedation.
Female; Male; Child; Infant; Prospective Studies; Pain Measurement; Analysis of Variance; Placebos; Injections; Human; Chi Square Test; Preschool; Intravenous; Anesthetics; Treatment Outcomes; Double-Blind Studies; Hypnotics and Sedatives – Administration and Dosage; Lidocaine – Administration and Dosage; Local – Administration and Dosage; Propofol – Administration and Dosage
BACKGROUND: Research suggests that young children experience an increased incidence and severity of discomfort during propofol infusion. Evaluations of varied interventions to reduce or eliminate this discomfort with adult subjects suggest that premedication with intravenously administered lidocaine (0.5 mg/kg) offers the best overall effectiveness. OBJECTIVE: Because this regimen's efficacy in a pediatric population is undocumented, we conducted a randomized, double-blind, placebo-controlled study to determine the effectiveness of intravenous lidocaine pretreatment to alleviate pain in pediatric subjects before propofol infusion. METHODS: Subjects (aged 2-7 years) scheduled for painless diagnostic procedures received either a saline placebo or 1 of 2 lidocaine doses before administering propofol. To capture the patient's baseline behavioral state, a trained observer administered the validated Face, Legs, Activity, Cry, Consolability Pain Assessment Scale before propofol infusion. During deep sedation induction, the sedating physician, a trained research assistant, and the patient's parent documented maximum distress using a 100-mm visual analog scale (VAS). RESULTS: Ninety-one subjects participated. We found no difference in VAS pain scores between groups pretreated with lidocaine 0.25 mg/kg, lidocaine 0.5 mg/kg, and placebo. Statistical analysis also found no interrater differences between parents, physician, or observer VAS scores. CONCLUSIONS: Our data do not support using lidocaine pretreatment to alleviate pain/discomfort in pediatric patients during propofol infusion.
Depue K; Christopher NC; Raed M; Forbes ML; Besunder J; Reed MD
Pediatric emergency care
2013
2013-01
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<a href="http://doi.org/10.1097/PEC.0b013e31827b227e" target="_blank" rel="noreferrer noopener">10.1097/PEC.0b013e31827b227e</a>
Uncomplicated Pure Cellulitis: No Need to Cover for MRSA?
Treatment Outcomes; Cellulitis; Methicillin-Resistant Staphylococcus Aureus; Antibiotics – Therapeutic Use; Community-Acquired Infections – Drug Therapy; Staphylococcal Infections – Drug Therapy; Cellulitis – Drug Therapy; Cellulitis – Diagnosis; Cellulitis – Microbiology; Streptococcal Infections – Drug Therapy
Watkins Richard R
Infectious Disease Alert
2013
2013-06
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Early use of Daptomycin Compared to Vancomycin for MRSA Bacteremia.
Costs and Cost Analysis; Comparative Studies; Retrospective Design; Treatment Outcomes; Methicillin-Resistant Staphylococcus Aureus; Treatment Duration; Antibiotics – Therapeutic Use; Bacteremia – Drug Therapy; Vancomycin – Administration and Dosage; Daptomycin – Administration and Dosage
Watkins Richard R
Hospital Medicine Alert
2013
2013-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Clinical impact of temporary therapy interruptions on anticoagulation control in patients treated with warfarin.
Female; Male; Aged; Prospective Studies; International Normalized Ratio; Drug Administration Schedule; Preoperative Care; Postoperative Care; Human; Middle Age; Retrospective Design; Dose-Response Relationship; Drug; Treatment Outcomes; Drug Monitoring; Anticoagulants – Therapeutic Use; Anticoagulants – Administration and Dosage; Atrial Fibrillation – Drug Therapy; Blood Coagulation Disorders – Drug Therapy; Coronary Thrombosis – Drug Therapy; Euthanasia; Passive; Venous Thromboembolism – Drug Therapy; Warfarin – Administration and Dosage; Warfarin – Therapeutic Use
This retrospective cohort study was completed to describe the impact of short-term therapy interruptions on anticoagulation control in patients receiving warfarin. Patients seen in a pharmacist-managed anticoagulation clinic were included if they were on a stable warfarin dose and then underwent a planned interruption in therapy. Patients were excluded if phytonadione was administered before the interruption or if medications known to interact with warfarin were altered during the interruption. Data were analyzed for 2 groups: (1) patients with a single interruption in therapy (group 1) and (2) patients with a single interruption in therapy plus patients with an extended interruption in therapy (group 2). The primary endpoint was the change in weekly maintenance warfarin dose from preinterruption to postinterruption. Evaluation of 199 patients resulted in 31 interruptions in group 1 and 34 interruptions in group 2. A change in dose was required in 58% of patients in group 1 and 56% of patients in group 2. The mean absolute change in dose was 2.03 ± 2.79 mg (P \textless 0.003) in group 1 and 1.96 ± 2.72 mg (P \textless 0.002) in group 2. For the majority of patients, the dose change represented \textless10% of their preinterruption weekly dose. Of patients requiring a dose change, 50% required an increase in dose. In conclusion, close follow-up is warranted after a warfarin therapy interruption as dose adjustments will likely be needed to regain anticoagulation control and the direction of this dose change cannot be predicted.
Boros Melanie L; Rybarczyk Amy M; Gallegos Patrick J; Zimmerman Jacob P
American Journal of Therapeutics
2013
2013-05
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="http://doi.org/10.1097/MJT.0b013e31824ea644" target="_blank" rel="noreferrer noopener">10.1097/MJT.0b013e31824ea644</a>
Efficacy of Higher-dose Oseltamivir in Adults with Influenza A and B.
Prospective Studies; Multicenter Studies; Dose-Response Relationship; Treatment Outcomes; Influenza A Virus; Influenza B Virus; Influenza – Drug Therapy; Oseltamivir – Adverse Effects; Oseltamivir – Therapeutic Use
Watkins Richard R
Infectious Disease Alert
2014
2014-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Steroids for Severe Community-Acquired Pneumonia: More Evidence or More Uncertainty?
Treatment Outcomes; Severity of Illness; Community-Acquired Pneumonia – Drug Therapy; Community-Acquired Pneumonia – Radiography; Hydrocortisone – Administration and Dosage; Hydrocortisone – Adverse Effects; Hydrocortisone – Therapeutic Use
Watkins Richard R
Internal Medicine Alert
2015
2015-05-15
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Antibiotics for Acute Appendicitis.
Postoperative Complications; Antibiotics; Length of Stay; Decision Making; Appendectomy; Tomography; Human; Multicenter Studies; X-Ray Computed; Intravenous; Administration; Treatment Outcomes; Patient Education; Randomized Controlled Trials; Emergency Treatment; Antibiotics – Therapeutic Use; Appendicitis – Ultrasonography; Appendicitis – Drug Therapy; Appendicitis – Surgery
The article reports that patients with uncomplicated acute appendicitis can fair well without surgery as compared to clinical trial patients who underwent surgery, and states that patients had lower risk of complications during the one-year follow-up period.
Watkins Richard R
Internal Medicine Alert
2015
2015-09-15
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Longer Course Therapy for Lyme Disease Is Not Beneficial.
Quality of Life; Netherlands; Treatment Outcomes; Treatment Duration; Antibiotics – Pharmacodynamics; Ceftriaxone – Administration and Dosage; Antibiotics – Administration and Dosage; Doxycycline – Administration and Dosage; Clarithromycin – Administration and Dosage; Hydroxychloroquine – Administration and Dosage; Lyme Disease – Drug Therapy; Randomized Controlled Trials – Netherlands
A randomized, placebo-controlled clinical trial from the Netherlands found that longer-term antibiotic therapy fo r Lyme disease did not improve health-related quality o f life compared to a standard course of treatment.
Watkins Richard R
Infectious Disease Alert
2016
2016-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Both Azithromycin and Doxycycline Achieve a High Rate of Cure for Chlamydia.
Treatment Outcomes; Azithromycin – Administration and Dosage; Azithromycin – Pharmacodynamics; Chlamydia Infections – Drug Therapy; Doxycycline – Administration and Dosage; Doxycycline – Pharmacodynamics
Although a well-conducted randomized clinical trial did not show that azithromycin was non-inferior to doxycycline for the treatment of chlamydia, both treatments resulted in a high rate of cure (97% and 100%, respectively).
Watkins Richard R
Infectious Disease Alert
2016
2016-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Reported Beta-lactam Allergy Is Associated with More Adverse Events Among Inpatients...MacFadden DR, LaDelfa A, Leen J, et al. Impact of reported beta-lactam allergy on inpatient outcomes: A multicenter prospective cohort study. Clin Infect Dis 2016;63:904-910
Antibiotics; Treatment Outcomes; Drug Hypersensitivity; Adverse Health Care Event – Risk Factors; Lactam
The article focuses on a study conducted on patients allergic to Beta-Lactam antibiotics by increasing its dose. Topics discussed include collection of patients' demographic and allergy history data and performing penicillin skin testing (PST), occurrence of any treatment related adverse event, and comparison of patients given beta-lactam treatment inspite of allergy with the patients who did not report any allergy.
Watkins Richard R
Infectious Disease Alert
2016
2016-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Cranberry Capsules Are Not Effective in Preventing Bacteriuria with Pyuria in Elderly Women in Nursing Homes...Ju th a n i-M e h ta M , Van N ess PH, B ianco L, e t al. Effect o f c ra n b e rry capsules o n b a cteriu ria plus pyu ria a m o n g o ld e r w o m e n in nursing h o m e s: A ra n d o m iz e d clinical trial. JAMA 2 0 16 O c t 2 7 . d o i: 10 . 10 0 1 /ja m a .2 0 1 6 .1 6 1 4 1 .
Female; Aged; Human; Treatment Outcomes; Urinary Tract Infections – Prevention and Control – In Old Age; Bacteriuria – Prevention and Control – In Old Age; Cranberry Juice – Therapeutic Use
A randomized, double-blind, placebo-controlled trial found that giving cranberry capsules to elderly women residing in nursing homes did not result in any significant benefits, including no reduction in symptomatic urinary tract infections.
Watkins Richard R
Infectious Disease Alert
2016
2016-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Cranberry Capsules Are Not Effective in Preventing Bacteriuria with Pyuria in Elderly Women in Nursing Homes.
Female; Aged; Hospitalization; Odds Ratio; Mortality; Drug Utilization; Confidence Intervals; Inpatients; Women's Health; Descriptive Statistics; Drug Resistance; Microbial; Treatment Outcomes; Randomized Controlled Trials; Double-Blind Studies; Fluid Intake; Gerontologic Care; Long Term Care; Nursing Home Patients; 80 and Over; Antibiotics – Therapeutic Use; Capsules – Administration and Dosage – In Old Age; Cranberry – Therapeutic Use – In Old Age; Plant Extracts – Therapeutic Use – In Old Age; Urinary Tract Infections – Prevention and Control – In Old Age
A randomized, double-blind, placebo-controlled trial found that giving cranberry capsules to elderly women residing in nursing homes did not result in any significant benefits, including no reduction in symptomatic urinary tract infections.
Watkins Richard R
Internal Medicine Alert
2016
2016-12-30
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Fecal Transplant vs. Oral Vancomycin Taper for Recurrent Clostridium difficile Infection.
Recurrence; Costs and Cost Analysis; Enema; Administration; Oral; Treatment Outcomes; Randomized Controlled Trials; Cost Benefit Analysis; Microbiota; Transplant Donors; Vancomycin – Therapeutic Use; Clostridium Infections – Drug Therapy; Clostridium Infections – Prevention and Control; Clostridium Infections – Therapy; Feces – Transplantation; Recurrence – Therapy; Vancomycin – Administration and Dosage; Vancomycin – Economics
In a small randomized, controlled trial that compared fecal microbiota transplant (FMT) administered by enema to a six-week oral vancomycin taper, FMT was not more effective for patients with recurrent Clostridium difficile infection.
Watkins Richard R
Infectious Disease Alert
2017
2017-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Restricting Fluoroquinolone Use Reduces Clostridium difficile Infection More Than Infection Control Methods.
Infection Control; Treatment Outcomes; Clostridium Difficile; Antiinfective Agents; Clostridium Infections – Drug Therapy; Fluoroquinolone – Administration and Dosage; Fluoroquinolone – Adverse Effects; Fluoroquinolone – Pharmacodynamics
An observational study from England showed that restricting fluoroquinolone use reduced incidence of Clostridium difficile infection more than would be predicted by improved infection control methods alone.
Watkins Richard R
Infectious Disease Alert
2017
2017-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Fungal Endophthalmitis: Another Risk Associated With Intravenous Drug Use.
Substance Abuse; Treatment Outcomes; Fungemia; Intravenous Drug Users; Visual Acuity; Antifungal Agents – Administration and Dosage; Communicable Diseases – Risk Factors; Endophthalmitis – Risk Factors; Endophthalmitis – Surgery; Eye Infections; Fungal – Risk Factors; Intravenous – Complications; Vision Disorders – Risk Factors
A retrospective cohort study found that endogenous fungal endophthalmitis is associated with intravenous drug use and frequently results in poor visual outcomes despite appropriate surgical and antifungal therapy.
Watkins Richard R
Infectious Disease Alert
2017
2017-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Dual Antibiotic Therapy Is Not Routinely Necessary for Uncomplicated Cellulitis.
Treatment Outcomes; Antibiotics – Therapeutic Use; Cellulitis – Drug Therapy; Cephalexin – Therapeutic Use
SYNOPSIS: A randomized, multicenter, placebo-controlled clinical trial that enrolled patients presenting to emergency departments with uncomplicated cellulitis found the addition of trimethoprim-sulfamethoxazole to cephalexin did not lead to better outcomes.
Watkins Richard R
Internal Medicine Alert
2017
2017-09-30
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Dual Antibiotic Therapy Is Not Routinely Necessary for Uncomplicated Cellulitis.
Treatment Outcomes; Abscess – Surgery; Cellulitis – Drug Therapy; Cephalexin – Therapeutic Use; Drainage – Methods; Trimethoprim-Sulfamethoxazole Combination – Therapeutic Use
A randomized, multicenter, placebo-controlled clinical trial that enrolled patients presenting to emergency departments with uncomplicated cellulitis found the addition of trimethoprim-sulfamethoxazole to cephalexin did not lead to better outcomes.
Watkins Richard R
Infectious Disease Alert
2017
2017-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Clindamycin Improves Outcomes in Necrotizing Fasciitis due to Group A Streptococcus.
Debridement; Treatment Outcomes; Streptococcus; Clindamycin – Therapeutic Use; Fasciitis; Necrotizing – Drug Therapy; Necrotizing – Therapy
Despite aggressive surgical and medical therapy (i.e., debridement and potent intravenous antibiotics), necrotizing fasciitis (NF) remains a devastating infection with a mortality rate of 15-36%. Recent Infectious Diseases Society of America (IDSA) guidelines recommend using clindamycin in the treatment of NF, although strong scientific evidence is lacking. Therefore, Andreoni and colleagues aimed to determine whether clindamycin improves outcomes in NF by modulating virulence factors of clindamycin-susceptible and clindamycinresistant strains of invasive Group A Streptococcus (GAS) in vitro and using a mouse model. The investigators injected either a clindamycinsusceptible or a clindamycin-resistant GAS clinical isolate into the flanks of mice, and then treated them with either low-dose clindamycin, high-dose clindamycin, or saline. The mice were sacrificed on day 3 post-inoculation, and the size of the resulting skin lesions and their bacterial counts were measured. Also, biopsy material from a patient with NF of the arm who underwent multiple debridements (on days 0, 2, and 4) was prepared in the same fashion as the mouse tissue. This patient was treated with intravenous ceftriaxone 2 g daily and clindamycin 900 mg qid. Treatment with clindamycin in the mice that were infected with clindamycin-susceptible strains significantly reduced skin lesion sizes, but the bacterial burden was the same compared to the untreated animals. Interestingly, the animals infected with clindamycin-resistant strains who received clindamycin also had smaller skin lesions but reduced bacterial counts. When mice were injected with a clindamycin dose lower than the MIC of the infecting strain, the severity of the clinical manifestations was similar or slightly less compared to the untreated ones. In both the clindamycin-susceptible and clindamycin-resistant groups, GAS virulence factors DNase and SLO were inhibited by clindamycin. However, the in vitro model showed sub-inhibitory clindamycin concentrations caused upregulation of GAS virulence factors in both the clindamycin-susceptible and clindamycin-resistant GAS isolates. In the debrided tissue from the patient with NF, clindamycin concentration in the necrotic tissue was 10 times higher than the MIC of the infecting GAS strain. The bacterial load in the necrotic tissue was 106 CFU/g compared to 103 in the apparently adjacent healthy tissue. DNase activity was greater in the tissue with the higher bacterial counts and, by the second debridement (day 2), was undetectable.
Watkins Richard R
Hospital Medicine Alert
2017
2017-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Cefazolin Leads to Better Outcomes for Methicillin-susceptible Staphylococcus aureus Bacteremia Than Nafcillin or Oxacillin.
Treatment Outcomes; Staphylococcal Infections – Drug Therapy; Treatment Outcomes – Evaluation; Bacteremia – Drug Therapy; Cefazolin – Therapeutic Use; Drug Therapy – Evaluation; Nafcillin – Therapeutic Use; Oxacillin – Therapeutic Use; Vancomycin – Therapeutic Use
A retrospective study that included patients from 119 Veterans Affairs hospitals found lower mortality and a similar recurrence rate for methicillin-susceptible Staphylococcus aureus bacteremia treated with cefazolin compared to nafcillin and oxacillin.
Watkins Richard R
Infectious Disease Alert
2017
2017-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Early Uncomplicated Appendicitis-Who Can We Treat Nonoperatively?
Adult; Female; Male; Aged; Young Adult; Prospective Studies; Patient Selection; Drug Administration Schedule; Appendectomy; Injections; Human; Middle Age; Adolescence; Retrospective Design; Intravenous; Administration; Oral; Treatment Outcomes; Severity of Illness Indices; Antibiotics – Therapeutic Use; Ampicillin – Therapeutic Use; Appendicitis – Diagnosis; Appendicitis – Drug Therapy; Appendicitis – Surgery; Enzyme Inhibitors – Therapeutic Use; Penicillins – Therapeutic Use
This study evaluated nonoperative treatment for mild appendicitis and reviewed selection criteria to be used in introducing this option into clinical practice. A retrospective review of 73 consecutive cases of appendicitis treated by a single surgeon from 2011 to 2013 was completed. Patients who were diagnosed with mild appendicitis meeting the criteria of an APPENDICITIS scoring algorithm proposed in this manuscript were considered for nonoperative management. An additional 17 patients with mild appendicitis were offered and successfully treated nonoperatively between 2014 and 2016 and reviewed. Of these original 73 patients, 37 had moderate to severe appendicitis and directly underwent appendectomy. The remaining patients were diagnosed with mild appendicitis and considered eligible for nonoperative management. Of these, 14 patients were offered nonoperative therapy. Thirteen responded successfully; one patient responded partially, but later opted for surgery. In 2014, this scoring system and preliminary results were shared with the other surgeons in our department. Nonoperative management was then selectively adopted by a few of the surgeons from 2014 to 2016 with another 17 patients (APPENDICITIS score of 0 or 1) being offered and successfully managed nonoperatively. Patients with mild or early appendicitis can be successfully managed nonoperatively. A proposed APPENDICITIS scoring system may provide a helpful mnemonic for successfully selecting patients for this option.
Horattas Mark C; HORATTAS ILEANA K; VASILIOU ELYA M
American Surgeon
2018
2018-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Should Acute Appendicitis Be Managed Without Appendectomy?
Medically Uninsured; Appendectomy; Office Visits; Treatment Outcomes; Abdominal Abscess; Cecal Neoplasms; Clostridium Infections; Intestinal Obstruction; Readmission; Appendicitis – Therapy
Watkins Richard R
Internal Medicine Alert
2019
2019-01-30
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Trauma history as a resilience factor for patients recovering from total knee replacement surgery.
Female; Male; Ohio; Aged; Risk Factors; Pain Measurement; Arthroplasty; Psychological Tests; Human; Descriptive Statistics; Funding Source; Scales; Middle Age; Coefficient Alpha; Effect Size; Clinical Assessment Tools; Impact of Events Scale; T-Tests; Trauma; Stress; Recovery; Replacement; Psychological; Post-Traumatic; Stress Disorders; STATISTICS; RESEARCH funding; POST-traumatic stress disorder; DESCRIPTIVE statistics; TREATMENT effectiveness; CONVALESCENCE; CORRELATION (Statistics); EFFECT sizes (Statistics); LIFE change events; LIFE skills; OHIO; PAIN measurement; PSYCHOLOGICAL tests; REHABILITATION; RESILIENCE (Personality trait); STRESS (Psychology); T-test (Statistics); TOTAL knee replacement; WOUNDS & injuries; Treatment Outcomes; Bivariate Statistics; Center for Epidemiological Studies Depression Scale; Functional Status; Hardiness; 80 and Over; Knee – Psychosocial Factors; Knee – Rehabilitation; TOTAL knee replacement – Psychological aspects
Research concerning the impact of trauma history on individuals' ability to cope with subsequent events is mixed. While many studies find that trauma history increases vulnerability for conditions such as post-traumatic stress disorder and chronic pain, others reveal that there are benefits associated with moderate levels of stress (e.g. development of coping skills). Objective: The present study investigated whether the experience of prior traumatic stressors would serve as a risk or resilience factor based on physical and emotional outcomes among patients recovering from total knee replacement surgery (TKR). Design: 110 patients undergoing unilateral, TKR completed surveys before surgery, as well as one and three months following the procedure. Results: Contrary to hypotheses, patients who reported more prior traumas experienced less severe pain and functional limitations at one- (β = −.259,p = .006) and three-month follow-up assessments (β = −.187,p = .04). A similar pattern emerged when specific types of traumas (e.g. interpersonal) were examined in relation to physical recovery. Further, patients’ trauma history was negatively related to symptoms of post-traumatic stress three-months following surgery (e.g. Avoidance:β = −.200,p = .037). Conclusion: Trauma history represents a source of resilience, rather than vulnerability, within the context of arthroplastic surgery. [ABSTRACT FROM PUBLISHER]
Cremeans-Smith Julie K; Greene Kenneth; Delahanty Douglas L
Psychology & Health
2015
2015-09
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="http://doi.org/10.1080/08870446.2014.1001391" target="_blank" rel="noreferrer noopener">10.1080/08870446.2014.1001391</a>
Treatment of asymptomatic hyperuricemia and prevention of vascular disease: a decision analytic approach.
Female; Humans; Male; Middle Aged; Aged; Follow-Up Studies; Treatment Outcome; Severity of Illness Index; Prospective Studies; Sex Factors; Risk Assessment; Decision Support Techniques; Probability; Human; Middle Age; *Markov Chains; Allopurinol/*therapeutic use; CARDIOVASCULAR DISEASE; DECISION ANALYSIS; Gout Suppressants/*therapeutic use; HYPERURICEMIA; Hyperuricemia/complications/*diagnosis/*drug therapy; Uric Acid/blood; Vascular Diseases/etiology/*prevention & control; Treatment Outcomes; Severity of Illness Indices; Gout Suppressants – Therapeutic Use; Allopurinol – Therapeutic Use; Hyperuricemia – Complications; Hyperuricemia – Diagnosis; Hyperuricemia – Drug Therapy; Uric Acid – Blood; Vascular Diseases – Etiology; Vascular Diseases – Prevention and Control
OBJECTIVE: Elevated serum urate may be associated with an increase in cardiovascular (CV) disease. Treating asymptomatic hyperuricemia with urate-lowering drugs such as allopurinol may reduce CV events. We designed a model to simulate the effect of allopurinol treatment on reducing frequency of CV events in individuals with elevated serum urate. METHODS: A Markov state-transition model was constructed to assess occurrence of vascular events (VE) for 2 treatment strategies: treat all asymptomatic individuals with allopurinol (Treat All) and treat only if symptomatic (Treat Symptomatic). The model simulated a hypothetical cohort of 50-year-old men with different serum urate concentrations (6-6.9 and 7-7.9 mg/dl) followed over 20 years. Age and sex subgroups were analyzed. Model inputs were derived from current literature. The main outcome measures were mean number of VE and mean number of deaths from VE. RESULTS: For 50-year-old men with serum urate 6.0-6.9 mg/dl, individuals in the Treat All strategy have a 30% reduction in the mean number of VE compared to those in the Treat Symptomatic strategy (mean VE: 0.078 vs 0.11), and a 39% reduction in mean number of deaths from VE. At higher serum urate concentrations, treatment is more effective in reducing the mean number of VE and mean number of deaths from VE (38% event, 54% death). Results for women show similar trends. As the cohort ages, treatment has less effect on reducing VE. The number needed to treat to prevent 1 event is 20 (men, 7.0-7.9 mg/dl). CONCLUSION: The model predicts that treating asymptomatic hyperuricemia with allopurinol is most effective in preventing VE at a serum urate above 7.0 mg/dl in men and 5.0 mg/dl in women.
Akkineni Roopa; Tapp Stephanie; Tosteson Anna N A; Lee Alexandra; Miller Katherine L; Choi Hyon K; Zhu Yanyan; Albert Daniel A
The Journal of rheumatology
2014
2014-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3899/jrheum.121231" target="_blank" rel="noreferrer noopener">10.3899/jrheum.121231</a>