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Johnson CS, Shadfar Z, Allison JR, Walsh KAJ, Partington HK. Controlling new psychoactive substances in New Zealand. AUST J FORENSIC SCI 2022. [DOI: 10.1080/00450618.2022.2067230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- CS Johnson
- Institute of Environmental Science and Research Ltd (ESR), Mt Albert Science Centre, Auckland, New Zealand
| | - Z Shadfar
- Institute of Environmental Science and Research Ltd (ESR), Mt Albert Science Centre, Auckland, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery and School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - JR Allison
- Maurice Wilkins Centre for Molecular Biodiscovery and School of Biological Sciences, University of Auckland, Auckland, New Zealand
- Digital Life Institute, University of Auckland, Auckland, New Zealand
- Biomolecular Interaction Centre, University of Canterbury, Christchurch, New Zealand
| | - KAJ Walsh
- Institute of Environmental Science and Research Ltd (ESR), Mt Albert Science Centre, Auckland, New Zealand
| | - HK Partington
- Institute of Environmental Science and Research Ltd (ESR), Mt Albert Science Centre, Auckland, New Zealand
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Imperiale TF, Daggy JK, Imler TD, Sherer EA, Kahi CJ, Larson J, Cardwell J, Johnson CS, Ahnen DJ, Antaki F, Ashley C, Baffy G, Dominitz JA, Hou J, Korsten MA, Nagar A, Promrat K, Robertson DJ, Saini S, Shergill A, Smalley WE. Prevalence of Advanced Colorectal Neoplasia in Veterans: Effects of Age, Sex, and Race/Ethnicity. J Clin Gastroenterol 2021; 55:876-883. [PMID: 34049372 DOI: 10.1097/mcg.0000000000001402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/29/2020] [Indexed: 12/10/2022]
Abstract
GOAL We sought to quantify the independent effects of age, sex, and race/ethnicity on risk of colorectal cancer (CRC) and advanced neoplasia (AN) in Veterans. STUDY We conducted a retrospective, cross-sectional study of Veterans aged 40 to 80 years who had diagnostic or screening colonoscopy between 2002 and 2009 from 1 of 14 Veterans Affairs Medical Centers. Natural language processing identified the most advanced finding and location (proximal, distal). Logistic regression was used to examine the adjusted, independent effects of age, sex, and race, both overall and in screening and diagnostic subgroups. RESULTS Among 90,598 Veterans [mean (SD) age 61.7 (9.4) y, 5.2% (n=4673) were women], CRC and AN prevalence was 1.3% (n=1171) and 8.9% (n=8081), respectively. Adjusted CRC risk was higher for diagnostic versus screening colonoscopy [odds ratio (OR)=3.79; 95% confidence interval (CI), 3.19-4.50], increased with age, was numerically (but not statistically) higher for men overall (OR=1.53; 95% CI, 0.97-2.39) and in the screening subgroup (OR=2.24; 95% CI, 0.71-7.05), and was higher overall for Blacks and Hispanics, but not in screening. AN prevalence increased with age, and was present in 9.2% of men and 3.9% of women [adjusted OR=1.90; 95% CI, 1.60-2.25]. AN risk was 11% higher in Blacks than in Whites overall (OR=1.11; 95% CI, 1.04-1.20), was no different in screening, and was lower in Hispanics (OR=0.74; 95% CI, 0.55-0.98). Women had more proximal CRC (63% vs. 39% for men; P=0.03), but there was no difference in proximal AN (38.3% for both genders). CONCLUSIONS Age and race were associated with AN and CRC prevalence. Blacks had a higher overall prevalence of both CRC and AN, but not among screenings. Men had increased risk for AN, while women had a higher proportion of proximal CRC. These findings may be used to tailor when and how Veterans are screened for CRC.
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Affiliation(s)
- Thomas F Imperiale
- Center for Innovation, Health Services Research and Development, Richard L. Roudebush VA Medical Center
- Department of Medicine, Division of Gastroenterology and Hepatology
- Regenstrief Institute Inc., Indianapolis, IN
| | | | - Timothy D Imler
- Department of Medicine, Division of Gastroenterology and Hepatology
- Regenstrief Institute Inc., Indianapolis, IN
| | | | - Charles J Kahi
- Center for Innovation, Health Services Research and Development, Richard L. Roudebush VA Medical Center
- Department of Medicine, Division of Gastroenterology and Hepatology
| | - Jason Larson
- Center for Innovation, Health Services Research and Development, Richard L. Roudebush VA Medical Center
| | - Jon Cardwell
- Center for Innovation, Health Services Research and Development, Richard L. Roudebush VA Medical Center
| | | | - Dennis J Ahnen
- Department of Medicine, University of Colorado and Denver VAMC, Boulder, CO
| | - Fadi Antaki
- Department of Medicine, John D. Dingell VAMC, Wayne State University, Detroit
| | | | - Gyorgy Baffy
- Department of Gastroenterology, VA Boston Healthcare System, Harvard Medical School, Boston, MA
| | - Jason A Dominitz
- Department of Medicine, VA Puget Sound Health Care System, University of Washington, Seattle, WA
| | - Jason Hou
- Department of Medicine, Michael E. DeBakey VAMC, Baylor University, Houston, TX
| | - Mark A Korsten
- James J. Peters VA Medical Center, Icahn School of Medicine at Mt. Sinai, Bronx, NY
| | - Anil Nagar
- West Haven VA Medical Center, Yale University School of Medicine, West Haven, CT
| | - Kittichai Promrat
- Section of Gastroenterology, Providence VAMC, Alpert Medical School of Brown University, Providence, RI
| | - Douglas J Robertson
- Geisel School of Medicine at Dartmouth and The Dartmouth Institute and the White River Junction VAMC, White River Junction, VT
| | - Sameer Saini
- VA HSR&D Center for Clinical Management Research
- Department of Internal Medicine and Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Amandeep Shergill
- Department of Medicine, San Francisco VA Medical Center, University of California at San Francisco, San Francisco, CA
| | - Walter E Smalley
- Department of Medicine, VA Tennessee Valley Healthcare System and Vanderbilt University, Nashville, TN. ✠ Dennis J. Ahnen deceased
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Johnson CS, Stansfield CR, Hassan VR, Kolbe E, Partington HK, Kappatos DC, Somerville RF. The phenomenon of para-Fluorophenylpiperazine (pFPP) in combination with the synthetic cannabinoid AMB-FUBINACA in seized plant material in New Zealand. Forensic Sci Int 2019; 307:110107. [PMID: 31951949 DOI: 10.1016/j.forsciint.2019.110107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/10/2019] [Accepted: 12/12/2019] [Indexed: 01/19/2023]
Abstract
New psychoactive substances have emerged as a vast and diverse group of illicit drugs over the past decade, with synthetic cannabinoids comprising the largest of the categories. Commonly, a single synthetic cannabinoid is applied to plant material, creating a product that is designed to be smoked by the user. The clandestine preparation process can result in an unevenly distributed product, with varying concentration within and between plant materials. This investigation describes the novel co-detection of the synthetic cannabinoid AMB-FUBINACA, with the piperazine para-fluorophenylpiperazine (pFPP), in a number of plant material samples analysed in New Zealand in 2017. Of 157 samples of plant material containing AMB-FUBINACA, pFPP was detected in 55 of them. A range of pFPP concentrations was observed between the plant material samples, as well as intra-batch variation. The presence of both drugs may be designed to enhance, prolong or balance the psychoactive effects caused from smoking the plant material. However the intended purpose has not been verified. This is the first reported combination of a synthetic cannabinoid and a piperazine in plant material.
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Affiliation(s)
- C S Johnson
- Institute of Environmental Science and Research Ltd (ESR), Auckland, New Zealand.
| | - C R Stansfield
- Institute of Environmental Science and Research Ltd (ESR), Auckland, New Zealand
| | - V R Hassan
- Institute of Environmental Science and Research Ltd (ESR), Auckland, New Zealand
| | - E Kolbe
- Institute of Environmental Science and Research Ltd (ESR), Auckland, New Zealand
| | - H K Partington
- Institute of Environmental Science and Research Ltd (ESR), Auckland, New Zealand
| | - D C Kappatos
- Institute of Environmental Science and Research Ltd (ESR), Porirua, New Zealand
| | - R F Somerville
- Institute of Environmental Science and Research Ltd (ESR), Auckland, New Zealand
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Smith J, Carlos WG, Johnson CS, Takesue B, Litzelman D. A pilot study: a teaching electronic medical record for educating and assessing residents in the care of patients. Med Educ Online 2018; 23:1447211. [PMID: 29506459 PMCID: PMC5844037 DOI: 10.1080/10872981.2018.1447211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/27/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE We tested a novel, web-based teaching electronic medical record to teach and assess residents' ability to enter appropriate admission orders for patients admitted to the intensive care unit. The primary objective was to determine if this tool could improve the learners' ability to enter an evidence-based, comprehensive initial care plan for critically ill patients. METHODS The authors created three modules using de-identifed real patient data from selected patients that were admitted to the intensive care unit. All senior residents (113 total) were invited to participate in a dedicated two-hour educational session to complete the modules. Learner performance was graded against gold standard admission order sets created by study investigators based on the latest evidence-based medicine and guidelines. RESULTS The session was attended by 39 residents (34.5% of invitees). There was an average improvement of at least 20% in users' scores across the three modules (Module 3-Module 1 mean difference 22.5%; p = 0.001 and Module 3-Module 2 mean difference 20.3%; p = 0.001). Diagnostic acumen improved in successive modules. Almost 90% of the residents reported the technology was an effective form of teaching and would use it autonomously if more modules were provided. CONCLUSIONS In this pilot project, using a novel educational tool, users' patient care performance scores improved with a high level of user satisfaction. These results identify a realistic and well-received way to supplement residents' training and assessment on core clinical care and patient management in the face of duty hour restrictions.
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Affiliation(s)
- Joshua Smith
- Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, WI, USA
| | - W. Graham Carlos
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Indiana University School of Medicine, IN, USA
| | | | - Blaine Takesue
- Department of Medicine, Regenstrief Institute, Inc, IN, USA
- Department of Medicine, Division of General Internal Medicine, Indiana University School of Medicine, IN, USA
| | - Debra Litzelman
- Department of Medicine, Regenstrief Institute, Inc, IN, USA
- Department of Medicine, Division of General Internal Medicine, Indiana University School of Medicine, IN, USA
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Abstract
BACKGROUND Rapid response teams (RRTs) improve mortality by intervening in the hours preceding arrest. Implementation of these teams varies across institutions. SETTING AND DESIGN Our health-care system has two different RRT models at two hospitals: Hospital A does not utilize a proactive rounder while Hospital B does. We studied the patterns of RRT calls at each hospital focusing on the differences between night and day and during nursing shift transitions. RESULTS The presence of proactive surveillance appeared to be associated with an increased total number of RRT calls with more than twice as many calls made at the smaller Hospital B than Hospital A. Hospital B had more calls in the daytime compared to the nighttime. Both hospitals showed a surge in the night-to-day shift transition (7-8am) compared to the preceding nighttime. Hospital A additionally showed a surge in calls during the day-to-night shift transition (7-8pm) compared to the preceding daytime. CONCLUSIONS Differences in the diurnal patterns of RRT activation exist between hospitals even within the same system. As a continuously learning system, each hospital should consider tracking these patterns to identify their unique vulnerabilities. More calls are noted between 7-8am compared to the overnight hours. This may represent the reestablishment of the 'afferent' arm of the RRT as the hospital returns to daytime staffing and activity. Factors that influence the impact of proactive rounding on RRT performance may deserve further study.
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Affiliation(s)
- Areeba Kara
- a Assistant Professor of Clinical Medicine, IU School of Medicine , Indiana University Health Physicians , Indianapolis , IN , USA
| | - Dawson Frank Dean
- b Fellow Division of Nephrology , IU School of Medicine , Indianapolis , IN , USA
| | - Cynthia S Johnson
- c Department of Biostatistics , IU School of Medicine and Richard M. Fairbanks School of Public Health , Indianapolis , IN , USA
| | - Siu L Hui
- d Regenstrief Institute , Indiana University School of Medicine , Indianapolis , IN , USA
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Chilukuri P, Gromski MA, Johnson CS, Ceppa DKP, Kesler KA, Birdas TJ, Rieger KM, Fatima H, Kessler WR, Rex DK, Al-Haddad M, DeWitt JM. Impact of the development of an endoscopic eradication program for Barrett's esophagus with high grade dysplasia or early adenocarcinoma on the frequency of surgery. Endosc Int Open 2018; 6:E1085-E1092. [PMID: 30211296 PMCID: PMC6133650 DOI: 10.1055/a-0640-3030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 03/12/2018] [Indexed: 11/20/2022] Open
Abstract
Background and aims The impact of the advent of an institutional endoscopic eradication therapy (EET) program on surgical practice for Barrett's esophagus (BE)-associated high grade dysplasia (HGD) or suspected T1a esophageal adenocarcinoma (EAC) is unknown. The aims of this study are to evaluate the different endoscopic modalities used during development of our EET program and factors associated with the use of EET or surgery for these patients after its development. Methods Patients who underwent primary endoscopic or surgical treatment for BE-HGD or early EAC at our hospital between January 1992 and December 2014 were retrospectively identified. They were categorized by their initial modality of treatment during the first year, and the impact over time for choice of therapy was assessed by multivariable logistic regression. Results We identified 386 patients and 80 patients who underwent EET and surgery, respectively. EET included single modality therapy in 254 (66 %) patients and multimodal therapy in 132 (34 %) patients. Multivariable logistic regression showed that, for each subsequent study year, EET was more likely to be performed in patients who were older ( P = 0.0009), with shorter BE lengths ( P < 0.0001), and with a pretreatment diagnosis of HGD ( P = 0.0054) compared to surgical patients. The diagnosis of EAC did not increase the utilization of EET compared to surgery as time progressed ( P = 0.8165). Conclusion The introduction of an EET program at our hospital increased the odds of utilizing EET versus surgery over time for initial treatment of patients who were older, had shorter BE lengths or the diagnosis of BE-HGD, but not in patients with EAC.
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Affiliation(s)
- Prianka Chilukuri
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mark A. Gromski
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Duy Khanh P. Ceppa
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kenneth A. Kesler
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Thomas J. Birdas
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Karen M. Rieger
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hala Fatima
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - William R. Kessler
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Douglas K. Rex
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mohammad Al-Haddad
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John M. DeWitt
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, USA,Corresponding author John M. DeWitt, MD Indiana University School of Medicine550 University BlvdSuite 4100IndianapolisIN 46202-5250USA+1-317-948-8144
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Dose WM, Piernas-Muñoz MJ, Maroni VA, Trask SE, Bloom I, Johnson CS. Capacity fade in high energy silicon-graphite electrodes for lithium-ion batteries. Chem Commun (Camb) 2018; 54:3586-3589. [PMID: 29431845 DOI: 10.1039/c8cc00456k] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A silicon-graphite blended anode is paired with a high capacity LiFePO4 reference/counter electrode to track irreversibility and lithium inventory. The LiFePO4 electrode provides a reliable, flat potential for dQ dV-1 analysis of LixSi and LixC electrochemical reactions. We relate this electrochemistry to the morphological and physical changes taking place.
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Affiliation(s)
- W M Dose
- Chemical Sciences and Engineering Division, Argonne National Laboratory, Lemont, Illinois 60439, USA.
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Abstract
Fear of falling is associated with self-imposed restrictions of basic and instrumental activities of daily living (ADL/IADL), leading greater risk for functional decline and falls. The inability to independently grocery shop, a food-related IADL, negatively affects nutritional status and survival among seniors. Thus, this study examined the relationship between the fear of falling and difficulty with grocery shopping among seniors (n=98, mean age=82, 83% female), taking into account their functional capacity. Demographic profile, eating problems, physical fitness (mobility, balance, endurance, leg strength), and fear of falling (balance confidence, falls efficacy) were measured. Fifty-six percent of participants reported difficulty with grocery shopping. Those who reported difficulty had significantly lower scores for dynamic balance, balance confidence and fall efficacy compared to those who did not. This study revealed a relationship between the fear of falling and perceived difficulty with grocery shopping. Interventions should address fear of falling among the frail seniors.
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Affiliation(s)
- C S Johnson
- C. Shanthi Johnson, PhD, RD, Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, S4S 0A2, Canada. , Phone: 306-337-2436, Fax: 306-585-4854
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Rex DK, Ponugoti PL, Johnson CS, Kittner L, Yanda RJ. Neoplasia at 10-year follow-up screening colonoscopy in a private U.S. practice: comparison of yield to first-time examinations. Gastrointest Endosc 2018; 87:254-259. [PMID: 28478026 DOI: 10.1016/j.gie.2017.04.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 04/17/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Prior studies assessing the yield of a second screening colonoscopy performed 10 years after an initial screening colonoscopy with negative results did not include a control group of persons undergoing a first screening colonoscopy during the same time interval. Our aim was to describe the incidence of neoplasia at a second screening colonoscopy (performed at least 8 years after the first colonoscopy) in average-risk individuals and compare it with the yield of first screening examinations performed during the same time interval. METHODS Review of a database of outpatient screening colonoscopies performed between January 2010 and December 2015 in an Atlanta private practice. RESULTS A total of 2105 average-risk individuals underwent screening colonoscopy, including 470 individuals (53.6% female; mean age ± standard deviation [SD] 64.0 ± 3.9 years) who underwent a second screening examination. In those undergoing second screening, the mean (± SD) interval between examinations was 10.4 years (± 1.1 years, range 8-15 years). At second screening, the polyp detection rate, adenoma detection rate, and advanced neoplasm rate were 44.7%, 26.6%, and 7.4%, respectively. Of 40 advanced neoplasms in 35 individuals, 33 (82.5%) were proximal to the sigmoid colon, and there were no cancers. During the same interval, 1635 individuals (49.4% female; mean age [± SD] 52.6 ± 3.4 years) underwent a first screening colonoscopy. The polyp detection rate, adenoma detection rate, and advanced neoplasm detection rate were 53.5%, 32.2%, and 11.7%, respectively. Of 243 advanced neoplasms in 192 individuals, 152 (62.6%) were proximal to the sigmoid colon, and there were no cancers. After adjustment for age, sex, body mass index, and endoscopist, polyp detection rate, adenoma detection rate, and advanced neoplasm detection rate were all lower at the second screening colonoscopies than at first-time colonoscopies (all P < .001). CONCLUSIONS Despite being 10 years older, persons with a screening colonoscopy with negative results 10 years earlier had lower rates of adenoma and advanced neoplasm at the second screening examination compared with patients in the same practice undergoing a first screening colonoscopy, and they had no cancers. The fraction of advanced neoplasms that were proximal to the sigmoid colon was high in both first and second screenings. These results support the safety of the recommended 10-year interval between colonoscopies in average-risk persons with an initial examination with negative results.
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Affiliation(s)
- Douglas K Rex
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Prasanna L Ponugoti
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Cynthia S Johnson
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Lisa Kittner
- Digestive Healthcare of Georgia, Atlanta, Georgia, USA
| | - Randy J Yanda
- Digestive Healthcare of Georgia, Atlanta, Georgia, USA
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Kara A, Johnson CS, Hui SL, Kashiwagi D. Hospital-Based Clinicians' Perceptions of Geographic Cohorting: Identifying Opportunities for Improvement. Am J Med Qual 2017; 33:303-312. [PMID: 29241347 DOI: 10.1177/1062860617745123] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Members of the Society of Hospital Medicine were surveyed about geographic cohorting (GCh); 369 responses were analyzed, two thirds of which were from GCh participants. Improved collaboration with the bedside nurse, increased nonclinical interactions, decreased paging interruptions, and improved efficiency were perceived by >50%. Narrowed clinical expertise, increased fragmentation, increased face-to-face interruptions, and an adverse impact on camaraderie within the hospitalist group were reported by 25% to 50%. Academic practices were associated with positive perceptions while higher patient loads were associated with negative perceptions. Comments on GCh benefits invoked improvements in (1) interprofessional collaboration, (2) efficiency, (3) patient-centeredness, (4) nursing satisfaction, and (5) GCh mediated facilitation of other interventions. GCh downsides included (1) professional and personal dissatisfaction, (2) concerns about providing suboptimal care, and (3) implementation barriers. GCh is receiving attention. Although it facilitates important benefits, it is perceived to mediate unintended consequences, which should be addressed in redesign efforts.
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Affiliation(s)
- Areeba Kara
- 1 ASPIRE scholar, Department of General Internal Medicine, IU School of Medicine, Inpatient Medicine Indiana University Health Methodist Hospital, Indianapolis, IN
| | - Cynthia S Johnson
- 2 Department of Biostatistics, IU School of Medicine, Indianapolis, IN
| | - Siu L Hui
- 3 Regenstrief Institute, Indianapolis, IN
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Gellhaus PT, Cary C, Kaimakliotis HZ, Johnson CS, Weiner M, Koch MO, Bihrle R. Long-term Health-related Quality of Life Outcomes Following Radical Cystectomy. Urology 2017; 106:82-86. [PMID: 28456541 DOI: 10.1016/j.urology.2017.03.053] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 02/22/2017] [Accepted: 03/08/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the long-term (>5 years) health-related quality of life (HRQOL) outcomes following radical cystectomy, comparing Indiana pouch (IP), neobladder (NB), and ileal conduit (IC). MATERIALS AND METHODS The departmental radical cystectomy database was queried to identify patients who underwent radical cystectomy and urinary diversion for bladder cancer between 1991 and 2009 and had not died. Three hundred patients were identified and sent the validated Bladder Cancer Index instrument. RESULTS A total of 128 (43%) patients completed the survey. When adjusted for gender, age at surgery, surgeon, and time since surgery, IC and IP patients had significantly better urinary function than NB patients (P = .0013). Sexual bother was less in NB than IP (P = .0387). Among men ≥65 years of age, IC patients had significantly better urinary function (P = .0376) than NB patients (91.6 vs 49.4, respectively). Among men <65 years of age, IC and IP patients (76.0 and 82.8, respectively) had significantly better urinary function than NB patients (50.7) (P = .0199). Among women greater than 65 years, bowel bother was significantly better (P = .0095) for IC patients than IP patients (44.8 vs 69.5, respectively). CONCLUSION Urinary diversion type after radical cystectomy affects HRQOL differently in long-term survivors. Age and gender at surgery influenced HRQOL based on diversion procedure. Urinary function but not urinary bother was significantly better in IC and IP compared to NB diversions. Prospective longitudinal studies using validated HRQOL tools will further help guide preoperative diversion choice decisions between patient and surgeon.
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Affiliation(s)
- Paul T Gellhaus
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Clint Cary
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN; Regenstrief Institute, Inc. and Indiana University Center for Health Services and Outcomes Research, Indianapolis, IN.
| | | | - Cynthia S Johnson
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Michael Weiner
- Regenstrief Institute, Inc. and Indiana University Center for Health Services and Outcomes Research, Indianapolis, IN; Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, IN
| | - Michael O Koch
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Richard Bihrle
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
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Azar JM, Johnson CS, Frame AM, Perkins SM, Cottingham AH, Litzelman DK. Evaluation of interprofessional relational coordination and patients' perception of care in outpatient oncology teams. J Interprof Care 2016; 31:273-276. [PMID: 27936991 DOI: 10.1080/13561820.2016.1248815] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This pilot study was designed to measure teamwork and the relationship of teamwork to patient perceptions of care among 63 members of 12 oncology teams at a Cancer Centre in the Midwest. Lack of teamwork in cancer care can result in serious clinical errors, fragmentation of care, and poor quality of care. Many oncology team members, highly skilled in clinical care, are not trained to work effectively as members of a care team. The research team administered the Relational Coordination survey to core oncology team members-medical oncologists, nurse coordinators, and clinical secretaries-to measure seven dimensions of team skills (four relating to communication [frequency, timeliness, accuracy, and problem solving] and three relating to relationship [shared goals, shared knowledge, and mutual respect]) averaged to create a Relational Coordination Index. The results indicated that among the team member roles, nurse coordinator relational coordination indices were the strongest and most positively correlated with patient perception of care. Statistically significant correlations were intra-nurse coordinator relational coordination indices and two patient perception of care factors (information and education and patient's preferences). All other nurse coordinator intra-role as well as inter-role correlations were also positively correlated, although not statistically significant.
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Affiliation(s)
- Jose M Azar
- a Department of Medicine , Indiana University School of Medicine , Indianapolis , Indiana , USA.,b Indiana University Health , Indiana University School of Medicine , Indianapolis , Indiana , USA
| | - Cynthia S Johnson
- c Department of Biostatistics, Health Information and Translational Sciences , Indiana University School of Medicine , Indianapolis , Indiana , USA
| | - Amie M Frame
- d Indiana University Center for Aging Research , Regenstrief Institute, Inc ., Indianapolis , Indiana , USA
| | - Susan M Perkins
- c Department of Biostatistics, Health Information and Translational Sciences , Indiana University School of Medicine , Indianapolis , Indiana , USA
| | - Ann H Cottingham
- a Department of Medicine , Indiana University School of Medicine , Indianapolis , Indiana , USA
| | - Debra K Litzelman
- a Department of Medicine , Indiana University School of Medicine , Indianapolis , Indiana , USA.,b Indiana University Health , Indiana University School of Medicine , Indianapolis , Indiana , USA.,e Health Services Research , Regenstrief Institute, Inc ., Indianapolis , Indiana , USA
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Welch JL, Bartlett Ellis RJ, Perkins SM, Johnson CS, Zimmerman LM, Russell CL, Richards C, Guise DM, Decker BS. Knowledge and Awareness Among Patients with Chronic Kidney Disease Stage 3. Nephrol Nurs J 2016; 43:513-519. [PMID: 30550080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Knowledge is a prerequisite for changing behavior, and is useful for improving outcomes and reducing mortality rates in patients diagnosed with chronic kidney disease (CKD). The purpose of this article is to describe baseline CKD knowledge and awareness obtained as part of a larger study testing the feasibility of a self-management intervention. Thirty patients were recruited who had CKD Stage 3 with coexisting diabetes and hypertension. Fifty-four percent of the sample were unaware of their CKD diagnosis. Participants had a moderate amount of CKD knowledge. This study suggests the need to increase knowledge in patients with CKD Stage 3 to aid in slowing disease progression.
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Affiliation(s)
- Janet L Welch
- Professor of Nursing, Indiana University, Indianapolis, IN
| | | | - Susan M Perkins
- Professor of Biostatistics, Indiana University, Indianapolis, IN
| | | | - Lani M Zimmerman
- Professor of Nursing, University of Nebraska Medical Center, Lincoln, NE
| | - Cynthia L Russell
- Professor of Nursing, University of Missouri-Kansas City, Kansas City, MO
| | | | | | - Brian S Decker
- Assistant Professor of Clinical Medicine, Indiana University, Indianapolis, IN
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Affiliation(s)
| | - James P. Sampson
- Department of Human Services & Studies, The Florida State University, Tallahassee, FL
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15
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Affiliation(s)
- Cynthia S. Johnson
- Counselor Education and School of Psychology, California
State University-Long Beach, Long Beach, California 90840
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16
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Affiliation(s)
- Cynthia S. Johnson
- School of Psychology, California State University-Long
Beach, Long Beach, California 90840
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Kara A, Johnson CS, Murray M, Dillon J, Hui SL. Can the identification of an idle line facilitate its removal? A comparison between a proposed guideline and clinical practice. J Hosp Med 2016; 11:489-93. [PMID: 26929120 DOI: 10.1002/jhm.2573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/31/2016] [Accepted: 02/02/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND There are 250,000 cases of central line-associated blood stream infections in the United States annually, some of which may be prevented by the removal of lines that are no longer needed. OBJECTIVE To test the performance of criteria to identify an idle line as a guideline to facilitate its removal. METHODS Patients with central lines on the wards were identified. Criteria for justified use were defined. If none were met, the line was considered "idle." We proposed the guideline that a line may be removed the day following the first idle day and compared actual practice with our proposed guideline. RESULTS One hundred twenty-six lines in 126 patients were observed. Eighty-three (65.9%) were peripherally inserted central catheters. Twenty-seven percent (n= 34) were placed for antibiotics. Seventy-six patients had lines removed prior to discharge. In these patients, the line was in place for 522 days, of which 32.7% were idle. The most common reasons to justify the line included parenteral antibiotics and meeting systemic inflammatory response (SIRS) criteria. In 11 (14.5%) patients, the line was removed prior to the proposed guideline. Most (n = 36, 47.4%) line removals were observed to be in accordance with our guideline. In another 29 (38.2%), line removal was delayed compared to our guideline. CONCLUSIONS Idle days are common. Central line days may be reduced by the consistent daily reevaluation of a line's justification using defined criteria. The practice of routine central line placement for prolonged antibiotics and the inclusion of SIRS criteria to justify the line may need to be reevaluated. Journal of Hospital Medicine 2016;11:489-493. © 2016 Society of Hospital Medicine.
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Affiliation(s)
- Areeba Kara
- Inpatient Medicine, Indiana University Health Physicians, and Indiana University School of Medicine, Indianapolis, Indiana
| | - Cynthia S Johnson
- Indiana University School of Medicine and Department of Biostatistics, Richard M. Fairbanks School of Public Health, Indianapolis, Indiana
| | - Michelle Murray
- Internal Medicine-Pediatrics residency, Indiana University, School of Medicine, Indianapolis, Indiana
| | - Jill Dillon
- Methodist Hospital, Indiana University Health, Indianapolis, Indiana
| | - Siu L Hui
- Regenstrief Institute, Indianapolis, Indiana
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Estabrook NC, Lutz ST, Johnson CS, Lo SS, Henderson MA. Does Graded Prognostic Assessment outperform Recursive Partitioning Analysis in patients with moderate prognosis brain metastases? CNS Oncol 2016; 5:69-76. [PMID: 26985694 DOI: 10.2217/cns.15.45] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To compare the clinical utility of the Recursive Partitioning Analysis (RPA) and Graded Prognostic Assessment (GPA) in predicting outcomes for moderate prognosis patients with brain metastases. METHODS & MATERIALS We reviewed 101 whole brain radiotherapy cases. RPA and GPA were calculated. Overall survival was compared. RESULTS Sixty-eight patients had moderate prognosis. RPA patient characteristics for increased death hazard were ≤10 WBRT fractions or no surgery/radiosurgery. GPA patients had increased death risk with no surgery/radiosurgery or lower Karnofsky Performance Status. CONCLUSION The indices have similar predicted survival. Patients scored by RPA with longer radiation schedules had longer survival; patients scored by GPA did not. This indicates GPA is more clinically useful, leaving less room for subjective treatment choices.
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Affiliation(s)
- Neil C Estabrook
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Stephen T Lutz
- Blanchard Valley Regional Cancer Center, Findlay, OH, USA
| | - Cynthia S Johnson
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Simon S Lo
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Mark A Henderson
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
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19
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Adra N, Albany C, Brames MJ, Case-Eads S, Johnson CS, Liu Z, Fausel CA, Breen T, Hanna NH, Hauke RJ, Picus J, Einhorn LH. Phase II study of fosaprepitant + 5HT3 receptor antagonist + dexamethasone in patients with germ cell tumors undergoing 5-day cisplatin-based chemotherapy: a Hoosier Cancer Research Network study. Support Care Cancer 2016; 24:2837-42. [PMID: 26838019 DOI: 10.1007/s00520-016-3100-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/24/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE A phase III study adding aprepitant to a 5HT3 receptor antagonist (5HT3-RA) plus dexamethasone in germ cell tumor (GCT) patients treated with 5-day cisplatin combination chemotherapy demonstrated a significant improvement in complete response (CR) (J Clin Onc 30:3998-4003, 2012). Fosaprepitant has demonstrated non-inferiority compared to aprepitant in single-day cisplatin chemotherapy and is approved as a single-dose alternative. This single-arm phase II study is the first clinical trial evaluating fosaprepitant in patients receiving multi-day cisplatin regimen. METHODS GCT patients receiving a 5-day cisplatin combination chemotherapy were enrolled. Fosaprepitant 150 mg was given IV on days 3 and 5. A 5HT3-RA days 1-5 (days 1, 3, and 5, if palonosetron) plus dexamethasone 20 mg days 1 and 2 and 4 mg po bid days 6, 7, and 8 was administered. Rescue antiemetics were allowed. The primary objective was to determine the CR rate-no emetic episodes or use of rescue medications. Accrual of 64 patients was planned with expected CR > 27 %. RESULTS Sixty-five patients were enrolled of whom 54 were eligible for analysis. Median age was 33. Fifty-one patients received bleomycin, etoposide, and cisplatin (BEP) chemotherapy. CR was observed in 13 (24.1 %) patients (95 % Agresti-Coull binomial C.I. 14.5 %, 37.1 %). CONCLUSION The data in this phase II study, in contrast to our prior phase III study, appears to indicate a lower CR rate with the substitution of fosaprepitant for aprepitant. It is unknown whether the substitution of fosaprepitant for aprepitant provides the same benefit in multi-day cisplatin that was achieved with single-day cisplatin. Trial registration Clinical trial information NCT01736917.
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Affiliation(s)
- Nabil Adra
- Division of Hematology/Oncology, Melvin & Bren Simon Cancer Center, Indiana University School of Medicine, 535 Barnhill Drive, RT 400, Indianapolis, IN, 46202, USA.
| | - Costantine Albany
- Division of Hematology/Oncology, Melvin & Bren Simon Cancer Center, Indiana University School of Medicine, 535 Barnhill Drive, RT 400, Indianapolis, IN, 46202, USA
| | - Mary J Brames
- Division of Hematology/Oncology, Melvin & Bren Simon Cancer Center, Indiana University School of Medicine, 535 Barnhill Drive, RT 400, Indianapolis, IN, 46202, USA
| | - Somer Case-Eads
- Division of Hematology/Oncology, Melvin & Bren Simon Cancer Center, Indiana University School of Medicine, 535 Barnhill Drive, RT 400, Indianapolis, IN, 46202, USA
| | - Cynthia S Johnson
- Department of Biostatistics, Indiana University, Indianapolis, IN, USA
| | - Ziyue Liu
- Department of Biostatistics, Indiana University, Indianapolis, IN, USA
| | - Christopher A Fausel
- Division of Hematology/Oncology, Melvin & Bren Simon Cancer Center, Indiana University School of Medicine, 535 Barnhill Drive, RT 400, Indianapolis, IN, 46202, USA
| | - Timothy Breen
- Hoosier Cancer Research Network, Indianapolis, IN, USA
| | - Nasser H Hanna
- Division of Hematology/Oncology, Melvin & Bren Simon Cancer Center, Indiana University School of Medicine, 535 Barnhill Drive, RT 400, Indianapolis, IN, 46202, USA
| | - Ralph J Hauke
- Methodist Hospital/Nebraska Cancer Specialists, Omaha, NE, USA
| | - Joel Picus
- Division of Hematology/Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Lawrence H Einhorn
- Division of Hematology/Oncology, Melvin & Bren Simon Cancer Center, Indiana University School of Medicine, 535 Barnhill Drive, RT 400, Indianapolis, IN, 46202, USA
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20
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Imler TD, Morea J, Kahi C, Cardwell J, Johnson CS, Xu H, Ahnen D, Antaki F, Ashley C, Baffy G, Cho I, Dominitz J, Hou J, Korsten M, Nagar A, Promrat K, Robertson D, Saini S, Shergill A, Smalley W, Imperiale TF. Corrigendum: Multi-Center Colonoscopy Quality Measurement Utilizing Natural Language Processing. Am J Gastroenterol 2015; 110:1743. [PMID: 26673514 DOI: 10.1038/ajg.2015.349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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21
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Kara A, Johnson CS, Nicley A, Niemeier MR, Hui SL. Redesigning inpatient care: Testing the effectiveness of an accountable care team model. J Hosp Med 2015; 10:773-9. [PMID: 26286828 DOI: 10.1002/jhm.2432] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 05/27/2015] [Accepted: 06/27/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND US healthcare underperforms on quality and safety metrics. Inpatient care constitutes an immense opportunity to intervene to improve care. OBJECTIVE Describe a model of inpatient care and measure its impact. DESIGN A quantitative assessment of the implementation of a new model of care. The graded implementation of the model allowed us to follow outcomes and measure their association with the dose of the implementation. SETTING AND PATIENTS Inpatient medical and surgical units in a large academic health center. INTERVENTION Eight interventions rooted in improving interprofessional collaboration (IPC), enabling data-driven decisions, and providing leadership were implemented. MEASUREMENTS Outcome data from August 2012 to December 2013 were analyzed using generalized linear mixed models for associations with the implementation of the model. Length of stay (LOS) index, case-mix index-adjusted variable direct costs (CMI-adjusted VDC), 30-day readmission rates, overall patient satisfaction scores, and provider satisfaction with the model were measured. RESULTS The implementation of the model was associated with decreases in LOS index (P < 0.0001) and CMI-adjusted VDC (P = 0.0006). We did not detect improvements in readmission rates or patient satisfaction scores. Most providers (95.8%, n = 92) agreed that the model had improved the quality and safety of the care delivered. CONCLUSIONS Creating an environment and framework in which IPC is fostered, performance data are transparently available, and leadership is provided may improve value on both medical and surgical units. These interventions appear to be well accepted by front-line staff. Readmission rates and patient satisfaction remain challenging.
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Affiliation(s)
- Areeba Kara
- Indiana University Health Physicians, Inpatient Medicine, Indiana University School of Medicine, IU Center for Health Innovation and Implementation Science, Indianapolis, Indiana
| | - Cynthia S Johnson
- Department of Biostatistics, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, Indianapolis, Indiana
| | - Amy Nicley
- Inpatient Programs and Accountable Care Units, Indiana University Health, Indianapolis, Indiana
| | - Michael R Niemeier
- Retired Chief Medical Officer Indiana University Health Methodist Hospital, Indianapolis, Indiana
| | - Siu L Hui
- Regenstrief Institute and Professor Emeritus Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
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22
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Austin JK, Haber LC, Dunn DW, Shore CP, Johnson CS, Perkins SM. Children with new onset seizures: A prospective study of parent variables, child behavior problems, and seizure occurrence. Epilepsy Behav 2015; 53:73-7. [PMID: 26520879 PMCID: PMC4674332 DOI: 10.1016/j.yebeh.2015.09.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 08/29/2015] [Accepted: 09/15/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Parent variables (stigma, mood, unmet needs for information and support, and worry) are associated with behavioral difficulties in children with seizures; however, it is not known how this relationship is influenced by additional seizures. This study followed children (ages 4-14 years) and their parents over a 24-month period (with data collected at baseline and 6, 12, and 24 months) and investigated the effect of an additional seizure on the relationship between parenting variables and child behavior difficulties. METHODS The sample was parents of 196 children (104 girls and 92 boys) with a first seizure within the past 6 weeks. Child mean age at baseline was 8 years, 3 months (SD 3 years). Data were analyzed using t-tests, chi-square tests, and repeated measures analyses of covariance. RESULTS Relationships between parent variables, additional seizures, and child behavior problems were consistent across time. Several associations between parent variables and child behavior problems were stronger in the additional seizure group than in the no additional seizure group. CONCLUSIONS Findings suggest that interventions that assist families to respond constructively to the reactions of others regarding their child's seizure condition and to address their needs for information and support could help families of children with continuing seizures to have an improved quality of life.
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Affiliation(s)
- Joan K. Austin
- Indiana University School of Nursing, Indianapolis, IN,Corresponding Author: Joan K. Austin, 3040 N Ramble Road West, Bloomington, IN, 47408,
| | | | - David W. Dunn
- Department of Psychiatry and Department of Neurology, Indiana University School of Medicine, Indianapolis, IN
| | | | - Cynthia S. Johnson
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
| | - Susan M. Perkins
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
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23
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Umoren RA, Gardner A, Stone GS, Helphinstine J, Machogu EP, Huskins JC, Johnson CS, Ayuo PO, Mining S, Litzelman DK. Career choices and global health engagement: 24-year follow-up of U.S. participants in the Indiana University-Moi University elective. Healthc (Amst) 2015; 3:185-9. [PMID: 26699341 DOI: 10.1016/j.hjdsi.2015.10.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 09/25/2015] [Accepted: 10/01/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Global health experiences evoke a profound awareness of cultural differences, inspire learners to prioritize professional values, and provide a lens for addressing global health care challenges. This study compares the long-term career and practice choices of participants in a 2-month Indiana University-Moi University, Kenya elective from 1989-2013 with those of a control group. METHODS Global health elective (GHE) participants and a random sample of alumni without GHE experience were surveyed on their clinical practice, public health and global health activities. RESULTS Responses from 176 former participants were compared with a control group of 177 alumni. GHE participants were more likely than similar controls to provide care to underserved U.S. populations (p=0.037), spend time in global health, public health, and public policy activities (p=0.005) and be involved in global health advocacy (p=0.001). Using multivariable analysis, GHE participants were more likely to be generalists (p<0.05), report that healthcare costs influenced medical decision-making (p<0.05), and provide healthcare outside the U.S. for ≥1 week/year (p<0.001). CONCLUSIONS Many years out of training, GHE participants were more likely to be generalists working with underserved populations, to be cost-conscious in their healthcare decision-making, and to be involved in global health, public health or public policy. IMPLICATIONS With the primary care provider shortage and need for greater awareness among providers of healthcare costs, our study shows that that global health experiences may yield broader benefits to the U.S. medical system.
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Affiliation(s)
- Rachel A Umoren
- Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, IN, United States; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States.
| | - Adrian Gardner
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States; Moi University School of Medicine, Eldoret, Kenya
| | - Geren S Stone
- Global Primary Care (GPC) Program, Center for Global Health, Division of General Medicine, Department of Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Jill Helphinstine
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Emily P Machogu
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States; Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Jordan C Huskins
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Cynthia S Johnson
- Department of Biostatistics, Indiana University, Indianapolis, IN, United States
| | - Paul O Ayuo
- Moi University School of Medicine, Eldoret, Kenya
| | | | - Debra K Litzelman
- Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, IN, United States; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States; Indiana University Center for Global Health, Indianapolis, IN, United States
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Bauer NS, Szczepaniak D, Sullivan PD, Mooneyham G, Pottenger A, Johnson CS, Downs SM. Group Visits to Improve Pediatric Attention-Deficit Hyperactivity Disorder Chronic Care Management. J Dev Behav Pediatr 2015; 36:553-61. [PMID: 26414089 DOI: 10.1097/dbp.0000000000000207] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Children with attention-deficit hyperactivity disorder (ADHD) may experience continued impairment at home and school even after medication initiation. Group visits offer a way for pediatricians to provide more time to address ongoing needs. A pilot study was undertaken to examine whether a group visit model improved ADHD management in the pediatric medical home. METHODS Parents and children aged 6 to 18 years with ADHD were recruited and randomized to group visits or a usual care control. Data included attendance at ADHD follow-up visits, parent-rated ADHD symptoms, adaptive functioning, and quality of life. Longitudinal linear mixed models (continuous variables) and generalized linear mixed models (binary outcomes) were used to compare groups. In our statistical models, child and family were random effects; study assignment was a fixed effect. RESULTS Twenty families representing 29 children participated (intervention: 9 parents/13 children and control: 11 parents/16 children). Aside from race, baseline characteristics of participants were similar. None of the intervention families missed the expected 5 ADHD follow-up visits over 1 year; control families missed 1 or more visits over the same period. Intervention families reported an improved level of adaptive functioning at 12 months compared with control (mean severity score: 3.7 vs 4.4, p = .003). All families reported greater limitations and poorer quality of life compared with national norms. CONCLUSION Group visits in the pediatric medical home can improve adherence, and preliminary results show a variety of improvements for the family.
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Affiliation(s)
- Nerissa S Bauer
- *Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN; †Section of Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN; ‡Regenstrief Institute, Inc., Indianapolis, IN; §Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
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25
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Lasley FD, Mannina EM, Johnson CS, Perkins SM, Althouse S, Maluccio M, Kwo P, Cárdenes H. Treatment variables related to liver toxicity in patients with hepatocellular carcinoma, Child-Pugh class A and B enrolled in a phase 1-2 trial of stereotactic body radiation therapy. Pract Radiat Oncol 2015; 5:e443-e449. [PMID: 25899219 DOI: 10.1016/j.prro.2015.02.007] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 02/06/2015] [Accepted: 02/11/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE An analysis was performed on patients enrolled in a phase 1-2 trial using stereotactic body radiation therapy for hepatocellular carcinoma evaluating variables influencing liver toxicity. METHODS AND MATERIALS Thirty-eight Child-Pugh class A (CPC-A) (39 lesions) and 21 CPC-B patients (26 lesions) were followed for ≥6 months. Six months local control using modified Response Evaluation Criteria in Solid Tumors criteria, progression-free survival, overall survival, and grade III/IV treatment-related toxicity at 3 months were analyzed. RESULTS Median follow-up was 33.3 months (2.8-61.1 months) for CPC-A and 46.3 months (3.7-70.4 months) for CPC-B patients. Local control at 6 months was 92% for CPC-A and 93% for CPC-B. Kaplan-Meier estimated 2- and 3-year local control was 91% for CPC-A and 82% for CPC-B (P = .61). Median overall survival was 44.8 months and 17.0 months for CPC-A and CPC-B. Kaplan-Meier estimated 2- and 3-year overall survival was 72% and 61% for CPC-A and 33% and 26% for CPC-B (P = .03). Four (11%) CPC-A patients and 8 CPC-B patients (38%) experienced grade III/IV liver toxicity. Overall, CPC-A patients with ≥grade III liver toxicity had 4.59 (95% confidence interval, 1.19-17.66) times greater risk of death than those without toxicity (P = .0268). No such correlation was seen for CPC-B patients; however, 3 of these CPC-B patients underwent orthotopic liver transplant. CPC-B patients experiencing grade III/IV liver toxicity had significantly higher mean liver dose, higher dose to one-third normal liver, and larger volumes of liver receiving doses <2.5 to 15 Gy in 2.5-Gy increments. For CPC-A patients, there was no critical liver dose or volume constraint correlated with toxicity. CONCLUSIONS In our experience, liver stereotactic body radiation therapy is a safe therapy for patients with hepatocellular carcinoma in the context of liver cirrhosis; however, for CPC-B patients, careful attention should be paid to low-dose volumes that could potentially result in increased liver toxicity.
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Affiliation(s)
| | - Edward M Mannina
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Cynthia S Johnson
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Susan M Perkins
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sandra Althouse
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mary Maluccio
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Paul Kwo
- Department of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Higinia Cárdenes
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana.
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Imler TD, Morea J, Kahi C, Sherer EA, Cardwell J, Johnson CS, Xu H, Ahnen D, Antaki F, Ashley C, Baffy G, Cho I, Dominitz J, Hou J, Korsten M, Nagar A, Promrat K, Robertson D, Saini S, Shergill A, Smalley W, Imperiale TF. Multi-center colonoscopy quality measurement utilizing natural language processing. Am J Gastroenterol 2015; 110:543-52. [PMID: 25756240 DOI: 10.1038/ajg.2015.51] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 01/02/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND An accurate system for tracking of colonoscopy quality and surveillance intervals could improve the effectiveness and cost-effectiveness of colorectal cancer (CRC) screening and surveillance. The purpose of this study was to create and test such a system across multiple institutions utilizing natural language processing (NLP). METHODS From 42,569 colonoscopies with pathology records from 13 centers, we randomly sampled 750 paired reports. We trained (n=250) and tested (n=500) an NLP-based program with 19 measurements that encompass colonoscopy quality measures and surveillance interval determination, using blinded, paired, annotated expert manual review as the reference standard. The remaining 41,819 nonannotated documents were processed through the NLP system without manual review to assess performance consistency. The primary outcome was system accuracy across the 19 measures. RESULTS A total of 176 (23.5%) documents with 252 (1.8%) discrepant content points resulted from paired annotation. Error rate within the 500 test documents was 31.2% for NLP and 25.4% for the paired annotators (P=0.001). At the content point level within the test set, the error rate was 3.5% for NLP and 1.9% for the paired annotators (P=0.04). When eight vaguely worded documents were removed, 125 of 492 (25.4%) were incorrect by NLP and 104 of 492 (21.1%) by the initial annotator (P=0.07). Rates of pathologic findings calculated from NLP were similar to those calculated by annotation for the majority of measurements. Test set accuracy was 99.6% for CRC, 95% for advanced adenoma, 94.6% for nonadvanced adenoma, 99.8% for advanced sessile serrated polyps, 99.2% for nonadvanced sessile serrated polyps, 96.8% for large hyperplastic polyps, and 96.0% for small hyperplastic polyps. Lesion location showed high accuracy (87.0-99.8%). Accuracy for number of adenomas was 92%. CONCLUSIONS NLP can accurately report adenoma detection rate and the components for determining guideline-adherent colonoscopy surveillance intervals across multiple sites that utilize different methods for reporting colonoscopy findings.
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Affiliation(s)
- Timothy D Imler
- 1] Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA [2] Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA [3] Department of Biomedical Informatics, Regenstrief Institute, LLC, Indianapolis, Indiana, USA
| | - Justin Morea
- 1] Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA [2] Department of Biomedical Informatics, Regenstrief Institute, LLC, Indianapolis, Indiana, USA
| | - Charles Kahi
- 1] Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA [2] Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA [3] Center of Innovation, Health Services Research and Development, Richard L, Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | | | - Jon Cardwell
- Center of Innovation, Health Services Research and Development, Richard L, Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Cynthia S Johnson
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Huiping Xu
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Dennis Ahnen
- Division of Gastroenterology, University of Colorado, Denver, Colorado, USA
| | - Fadi Antaki
- Division of Gastroenterology, Wayne State University, Detroit, Michigan, USA
| | - Christopher Ashley
- Division of Gastroenterology, Albany Medical College, Albany, New York, USA
| | - Gyorgy Baffy
- Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Ilseung Cho
- Division of Gastroenterology, New York University School of Medicine, New York, New York, USA
| | - Jason Dominitz
- Division of Gastroenterology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jason Hou
- Division of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
| | - Mark Korsten
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, Bronx, New York, USA
| | - Anil Nagar
- Division of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kittichai Promrat
- Division of Gastroenterology, Brown Medical School, Providence, Rhode Island, USA
| | - Douglas Robertson
- Division of Gastroenterology, The Dartmouth Institute, Lebanon, New Hampshire, USA
| | - Sameer Saini
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
| | - Amandeep Shergill
- Division of Gastroenterology, University of California at San Francisco, San Francisco, California, USA
| | - Walter Smalley
- Division of Gastroenterology, Vanderbilt University, Nashville, Tennessee, USA
| | - Thomas F Imperiale
- 1] Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA [2] Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA [3] Center of Innovation, Health Services Research and Development, Richard L, Roudebush VA Medical Center, Indianapolis, Indiana, USA [4] Health Services Research, Regenstrief Institute, Indianapolis, Indiana, USA
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Imperiale TF, Juluri R, Sherer EA, Glowinski EA, Johnson CS, Morelli MS. A risk index for advanced neoplasia on the second surveillance colonoscopy in patients with previous adenomatous polyps. Gastrointest Endosc 2014; 80:471-8. [PMID: 24890416 DOI: 10.1016/j.gie.2014.03.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 03/24/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Predicting the risk of advanced colorectal neoplasia on the second surveillance colonoscopy could help tailor surveillance. OBJECTIVE To derive and validate a risk index for advanced neoplasia on the second surveillance colonoscopy. DESIGN Retrospective cohort. SETTING Single-specialty practice; Veterans Affairs Medical Center. PATIENTS A total of 965 patients with baseline adenomatous polyps, 2 surveillance colonoscopies, and no reported family history of colorectal cancer; validation cohort of 372. INTERVENTIONS Multivariable logistic regression including demographics and previous colonoscopy results; derivation and validation of a risk index. MAIN OUTCOME MEASUREMENTS Advanced adenoma (≥1 cm in size, villous histology, or high-grade dysplasia) on the second surveillance colonoscopy. RESULTS Mean age was 57.8 ± 9.8 years, 62% were men, and 36% had an advanced adenoma on the index colonoscopy. Associated with advanced adenoma on the second surveillance colonoscopy were age at index colonoscopy (scored 0 for younger than 55 years of age, 1 for 55-59 years of age, 2 for 60-64 years of age, and 3 for older than 65 years of age) and previous findings (non-neoplastic, nonadvanced, advanced [scored 0, 1, and 2, respectively]) on index colonoscopy and the first surveillance colonoscopy, with scores ranging from 1 to 7. Risks of advanced adenoma on the second surveillance colonoscopy with scores of 5 or less and more than 5 were 4.8% (95% confidence interval, 3.5%-6.4%) and 14.9% (95% confidence interval, 7.4%-25.7%), respectively, comprising 93% and 7%, respectively, of the cohort. Corresponding results in the validation cohort were 5.6% and 19.2%, respectively, comprising 86.1% and 13.9%, respectively, of the cohort. LIMITATIONS Retrospective study with potential for selection bias. CONCLUSION This index stratifies the risk of advanced adenoma on the second surveillance colonoscopy. If validated independently, it may be useful for tailoring surveillance.
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Affiliation(s)
- Thomas F Imperiale
- Division of Gastroenterology and Hepatology, Department of Medicine, Indianapolis University School of Medicine, Indianapolis, Indiana, USA; Regenstrief Institute, Inc, Indianapolis, Indiana, USA; Center of Excellence for Implementation of Evidence-based Practice, Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Ravi Juluri
- Division of Gastroenterology and Hepatology, Department of Medicine, Indianapolis University School of Medicine, Indianapolis, Indiana, USA
| | - Eric A Sherer
- Department of Chemical Engineering, Louisiana Tech University, Ruston, Louisiana, USA
| | - Elizabeth A Glowinski
- Indianapolis Gastroenterology Research Foundation, Indianapolis University School of Medicine, Indianapolis, Indiana, USA
| | - Cynthia S Johnson
- Department of Biostatistics, Indianapolis University School of Medicine, Indianapolis, Indiana, USA
| | - Michael S Morelli
- Indianapolis Gastroenterology Research Foundation, Indianapolis University School of Medicine, Indianapolis, Indiana, USA
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Cottingham AH, Alder C, Austrom MG, Johnson CS, Boustani MA, Litzelman DK. New workforce development in dementia care: screening for "caring": preliminary data. J Am Geriatr Soc 2014; 62:1364-8. [PMID: 24916743 DOI: 10.1111/jgs.12886] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The United States has a significant shortage of trained geriatricians and of nurses, social workers, and paraprofessionals educated to care for elderly adults. As the aging population continues to grow, providing high-quality care will require new models that better address the many needs of aging individuals and their caregivers, using cost-effective strategies. Responding to this need, the Indiana University Center for Aging Research implementation scientists developed, tested, and are now scaling up a successful collaborative care coordination model for older adults with dementia, depression, or both: the Aging Brain Care program. This model now includes a newly created frontline care provider position, the Care Coordinator Assistant. The Care Coordinator Assistant works with individuals and caregivers to monitor biopsychosocial needs and deliver evidence-based and individualized care protocols, with close supervision from the registered nurse Care Coordinator. Recognizing that current hiring practices for frontline providers were insufficient to screen for critical abilities expected in this new position, including the ability to express "caring" and empathy, a new screening process was created building on the Multiple Mini Interview (MMI) format. The Care Coordinator Assistant MMI comprised six stations, each created to simulate challenging scenarios that will be frequently encountered and to assess important candidate abilities. Overall, the six-station MMI, with two to three items per station, provided factorially valid measures and good predictive ability. The process did not appear to be overly burdensome for candidates, and interviewers noted that it was helpful in discriminating between candidates.
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Affiliation(s)
- Ann H Cottingham
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana; Health Services Research, Regenstrief Institute, Indianapolis, Indiana
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Chiorean EG, Schneider BP, Akisik FM, Perkins SM, Anderson S, Johnson CS, DeWitt J, Helft P, Clark R, Johnston EL, Spittler AJ, Deluca J, Bu G, Shahda S, Loehrer PJ, Sandrasegaran K, Cardenes HR. Phase 1 pharmacogenetic and pharmacodynamic study of sorafenib with concurrent radiation therapy and gemcitabine in locally advanced unresectable pancreatic cancer. Int J Radiat Oncol Biol Phys 2014; 89:284-91. [PMID: 24726286 DOI: 10.1016/j.ijrobp.2014.02.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 12/19/2013] [Accepted: 02/14/2014] [Indexed: 12/21/2022]
Abstract
PURPOSE To define the safety, efficacy, and pharmacogenetic and pharmacodynamic effects of sorafenib with gemcitabine-based chemoradiotherapy (CRT) in locally advanced pancreatic cancer. METHODS AND MATERIALS Patients received gemcitabine 1000 mg/m(2) intravenously weekly × 3 every 4 weeks per cycle for 1 cycle before CRT and continued for up to 4 cycles after CRT. Weekly gemcitabine 600 mg/m(2) intravenously was given during concurrent intensity modulated radiation therapy of 50 Gy to gross tumor volume in 25 fractions. Sorafenib was dosed orally 400 mg twice daily until progression, except during CRT when it was escalated from 200 mg to 400 mg daily, and 400 mg twice daily. The maximum tolerated dose cohort was expanded to 15 patients. Correlative studies included dynamic contrast-enhanced MRI and angiogenesis genes polymorphisms (VEGF-A and VEGF-R2 single nucleotide polymorphisms). RESULTS Twenty-seven patients were enrolled. No dose-limiting toxicity occurred during induction gemcitabine/sorafenib followed by concurrent CRT. The most common grade 3/4 toxicities were fatigue, hematologic, and gastrointestinal. The maximum tolerated dose was sorafenib 400 mg twice daily. The median progression-free survival and overall survival for 25 evaluable patients were 10.6 and 12.6 months, respectively. The median overall survival for patients with VEGF-A -2578 AA, -1498 CC, and -1154 AA versus alternate genotypes was 21.6 versus 14.7 months. Dynamic contrast-enhanced MRI demonstrated higher baseline K(trans) in responding patients. CONCLUSIONS Concurrent sorafenib with CRT had modest clinical activity with increased gastrointestinal toxicity in localized unresectable pancreatic cancer. Select VEGF-A/VEGF-R2 genotypes were associated with favorable survival.
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Affiliation(s)
- E Gabriela Chiorean
- Department of Medicine, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana; Department of Medicine, University of Washington, Seattle, Washington.
| | - Bryan P Schneider
- Department of Medicine, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Fatih M Akisik
- Department of Radiology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Susan M Perkins
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Stephen Anderson
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Cynthia S Johnson
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - John DeWitt
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Paul Helft
- Department of Medicine, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Romnee Clark
- Department of Medicine, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Erica L Johnston
- Department of Medicine, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - A John Spittler
- Department of Medicine, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Jill Deluca
- Department of Radiation Oncology, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Guixue Bu
- Department of Radiology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Safi Shahda
- Department of Medicine, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Patrick J Loehrer
- Department of Medicine, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Kumar Sandrasegaran
- Department of Radiology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Higinia R Cardenes
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana
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Bade K, MacPhail ME, Johnson CS, Kahi CJ, Rex DK. New colonoscope technology: impact on image capture and quality and on confidence and accuracy of endoscopy-based polyp discrimination. Endoscopy 2014; 46:172-8. [PMID: 24500976 DOI: 10.1055/s-0033-1353602] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS A newer colonoscope series has optical magnification and improvement in image freezing function. We aimed to assess the impact on image capture, image quality, and polyp discrimination. PATIENTS AND METHODS In consecutive patients undergoing outpatient colonoscopy images of colorectal polyps were taken with Olympus 190 or 180 series instruments. The number of image captures needed to obtain an adequate image, quality of stored images, proportion of polyps with a high confidence estimate of likely histology, and accuracy of interpretations were compared. RESULTS An acceptable image at the first attempt was obtained in 97.3 % of photos with the 190 device vs. 83.8 % with the 180 instrument (P < 0.001). In the 190 group narrowband imaging (NBI) provided high confidence readings in 9 % more cases than in the 180 group, but did not improve accuracy of polyp categorization. The quality of the stored images was judged better for the 190 device. However, when images that had provided high confidence estimates of polyp histology were re-interpreted later by the original endoscopist, there was agreement with the original interpretation for > 98 % of polyps in both the 180 group and the 190 group. A second endoscopist agreed with the original high confidence interpretations for 90 % of polyps imaged with either the 180 or the 190 scope. CONCLUSION The new colonoscope had less image blurring, improved subjective quality of stored images, and increased the proportion of high confidence endoscopic estimates of polyp histology, but did not improve accuracy in estimating polyp histology.
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Affiliation(s)
- Kaely Bade
- Department of Medicine, Indiana University, Indianapolis, United States
| | | | - Cynthia S Johnson
- Department of Biostatistics, Indiana University, Indianapolis, United States
| | - Charles J Kahi
- Department of Gastroenterology, Indiana University, Indianapolis, United States
| | - Douglas K Rex
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University Hospital, Indianapolis, United States
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Kahi CJ, Vemulapalli KC, Johnson CS, Rex DK. Improving measurement of the adenoma detection rate and adenoma per colonoscopy quality metric: the Indiana University experience. Gastrointest Endosc 2014; 79:448-54. [PMID: 24246797 DOI: 10.1016/j.gie.2013.10.013] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 10/03/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND The adenoma detection rate (ADR) is a validated marker of colonoscopy quality. However, the optimal measurement method is unclear. OBJECTIVE The aims of our study were to (1) define benchmarks for the number of adenomas per screening colonoscopy (APC) quality metric; (2) study the association between ADRs for screening, surveillance, and diagnostic indications; and (3) explore the association of the screening ADR with an overall ADR inclusive of all colonoscopy indications. DESIGN Retrospective study. SETTING University hospital and associated ambulatory surgery center endoscopy units. PATIENTS Patients aged ≥50 years who underwent colonoscopy for screening, surveillance, or diagnostic indications by 20 endoscopists between January 1, 1999 and April 30, 2012. INTERVENTION Colonoscopy. MAIN OUTCOME MEASUREMENTS ADR, APC for screening, surveillance, and diagnostic indications. RESULTS A total of 21,766 colonoscopies were included. The indication was screening in 7434 (34.2%), surveillance in 8338 (38.3%), and diagnostic in 5994 (27.5%). The screening ADRs and APCs were significantly correlated (R = 0.91; P < .0001). For men, an ADR of 25% corresponded to an APC of 0.46 (95% confidence interval [CI], 0.35-0.57); for women, an ADR of 15% corresponded to an APC of 0.20 (95% CI, 0.13-0.27). Overall, the ADR stratified by colonoscopy indication was highest for surveillance, followed by screening, then diagnostic. For men, a screening ADR of 25% corresponded to a surveillance ADR of 31.9% (95% CI, 24.8%-38.9%); for women, an ADR of 15% corresponded to a surveillance ADR of 24.3% (95% CI, 18.3%-30.5%). The corresponding diagnostic ADRs were 17.0% (95% CI, 12.4%-21.6%) and 15.4% (95% CI, 11.5%-19.3%), respectively. There was significant correlation between screening ADR and an overall ADR inclusive of all colonoscopy indications. LIMITATIONS External generalizability, retrospective design. CONCLUSION We propose minimum screening APC detection benchmarks of 0.50 for men and 0.20 for women. ADRs for screening, surveillance, and diagnostic colonoscopy are correlated and can be used to derive a simplified overall ADR inclusive of all colonoscopy indications.
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Affiliation(s)
- Charles J Kahi
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA; Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, USA
| | - Krishna C Vemulapalli
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Cynthia S Johnson
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Douglas K Rex
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Byars AW, deGrauw TJ, Johnson CS, Perkins SM, Fastenau PS, Dunn DW, Austin JK. Language and social functioning in children and adolescents with epilepsy. Epilepsy Behav 2014; 31:167-71. [PMID: 24434307 PMCID: PMC4527048 DOI: 10.1016/j.yebeh.2013.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/01/2013] [Accepted: 11/09/2013] [Indexed: 10/25/2022]
Abstract
Individuals with epilepsy have difficulties with social function that are not adequately accounted for by seizure severity or frequency. This study examined the relationship between language ability and social functioning in 193 children with epilepsy over a period of 36months following their first recognized seizure. The findings show that children with persistent seizures have poorer language function, even at the onset of their seizures, than do their healthy siblings, children with no recurrent seizures, and children with recurrent but not persistent seizures. They continue to demonstrate poorer language function 36months later. This poor language function is associated with declining social competence. Intervention aimed at improving social competence should include consideration of potential language deficits that accompany epilepsy and social difficulty.
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Affiliation(s)
- Anna W. Byars
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, USA,Corresponding author at: Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 2015, Cincinnati, Ohio 45229, USA. Fax: +1 513 636 1888. (A.W. Byars)
| | - Ton J. deGrauw
- Children's Health Care of Atlanta, Emory University School of Medicine, USA
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Jackson IL, Xu PT, Nguyen G, Down JD, Johnson CS, Katz BP, Hadley CC, Vujaskovic Z. Characterization of the dose response relationship for lung injury following acute radiation exposure in three well-established murine strains: developing an interspecies bridge to link animal models with human lung. Health Phys 2014; 106:48-55. [PMID: 24276549 DOI: 10.1097/hp.0b013e3182a32ccf] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Approval of radiation countermeasures through the FDA Animal Rule requires pivotal efficacy screening in one or more species that are expected to react with a response similar to humans (21 C.F.R. § 314.610, drugs; § 601.91, biologics). Animal models used in screening studies should reflect the dose response relationship (DRR), clinical presentation, and pathogenesis of lung injury in humans. Over the past 5 y, the authors have characterized systematically the temporal onset, dose-response relationship (DRR), and pathologic outcomes associated with acute, high dose radiation exposure in three diverse mouse strains. In these studies, C57L/J, CBA/J, and C57BL/6J mice received wide field irradiation to the whole thorax with shielding of the head, abdomen, and forelimbs. Doses were delivered at a rate of 69 cGy min using an x-ray source operated at 320 kVp with half-value layer (HVL) of 1 mm Cu. For all strains, radiation dose was associated significantly with 180 d mortality (p < 0.0001). The lethal dose for 50% of animals within the first 180 d (LD50/180) was 11.35 Gy (95% CI 11.1-11.6 Gy) for C57L/J mice, 14.17 Gy (95% CI 13.9-14.5 Gy) for CBA/J mice, and 14.10 Gy (95% CI 12.2-16.4 Gy) for C57BL/6J mice. The LD50/180 in the C57L/J strain was most closely analogous to the DRR for clinical incidence of pneumonitis in non-human primates (10.28 Gy; 95% CI 9.9-10.7 Gy) and humans (10.60 Gy; 95% CI 9.9-12.1 Gy). Furthermore, in the C57L/J strain, there was no gender-specific difference in DRR (p = 0.5578). The reliability of the murine models is demonstrated by the reproducibility of the dose-response and consistency of disease presentation across studies.Health Phys. 106(1):000-000; 2014.
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Affiliation(s)
- Isabel L Jackson
- *University of Maryland School of Medicine, Baltimore, MD, 21201; †Duke University Medical Center, Durham, NC 27710; ‡Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA; §Indiana University School of Medicine, Indianapolis, IN; **Baylor University College of Medicine, Houston, TX
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Farese AM, Brown CR, Smith CP, Gibbs AM, Katz BP, Johnson CS, Prado KL, MacVittie TJ. The ability of filgrastim to mitigate mortality following LD50/60 total-body irradiation is administration time-dependent. Health Phys 2014; 106:39-47. [PMID: 24276548 PMCID: PMC3888641 DOI: 10.1097/hp.0b013e3182a4dd2c] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The identification of the optimal administration schedule for an effective medical countermeasure is critical for the effective treatment of individuals exposed to potentially lethal doses of radiation. The efficacy of filgrastim (Neupogen®), a potential medical countermeasure, to improve survival when initiated at 48 h following total body irradiation in a non-human primate model of the hematopoietic syndrome of the acute radiation syndrome was investigated. Animals were exposed to total body irradiation, antero-posterior exposure, total midline tissue dose of 7.5 Gy, (target lethal dose 50/60) delivered at 0.80 Gy min, using linear accelerator-derived 6 MV photons. All animals were administered medical management. Following irradiation on day 0, filgrastim (10 μg kg d) or the control (5% dextrose in water) was administered subcutaneously daily through effect (absolute neutrophil count ≥ 1,000 cells μL for three consecutive days). The study (n = 80) was powered to demonstrate a 25% improvement in survival following the administration of filgrastim or control beginning at 48 ± 4 h post-irradiation. Survival analysis was conducted on the intention-to-treat population using a two-tailed null hypothesis at a 5% significance level. Filgrastim, initiated 48 h after irradiation, did not improve survival (2.5% increase, p = 0.8230). These data demonstrate that efficacy of a countermeasure to mitigate lethality in the hematopoietic syndrome of the acute radiation syndrome can be dependent on the interval between irradiation and administration of the medical countermeasure.
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Affiliation(s)
- Ann M Farese
- *Radiation Oncology Department, University of Maryland, School of Medicine, Baltimore, MD; †Department of Biostatistics, Indiana University, Indianapolis, IN
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Al-Haddad M, DeWitt J, Sherman S, Schmidt CM, LeBlanc JK, McHenry L, Coté G, El Chafic AH, Luz L, Stuart JS, Johnson CS, Klochan C, Imperiale TF. Performance characteristics of molecular (DNA) analysis for the diagnosis of mucinous pancreatic cysts. Gastrointest Endosc 2014; 79:79-87. [PMID: 23845445 DOI: 10.1016/j.gie.2013.05.026] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 05/22/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Diagnosis of mucinous pancreatic cysts (MPCs) is challenging due to the poor sensitivity of cytology provided by EUS-guided-FNA (EUS-FNA). OBJECTIVE To quantify the test characteristics of molecular (DNA) analysis in suspected low-risk MPCs. DESIGN A prospective cohort study performed in between 2008 and 2011. SETTING Academic referral center. PATIENTS Consecutive patients who underwent EUS-FNA of suspected MPCs. INTERVENTION EUS-FNA and molecular (DNA) analysis of cyst fluid. MAIN OUTCOME MEASUREMENTS The sensitivity and specificity of molecular analysis in the diagnosis of MPCs using the criterion standard of surgical pathology in resected cysts. RESULTS Patients with suspected MPCs underwent EUS-FNA and cyst fluid DNA analysis. Surgical resection was performed in 48 patients (17%), confirming a mucinous pathology in 38 (79%). In this group, molecular analysis had a sensitivity of 50% and a specificity of 80% in identifying MPCs (accuracy of 56.3%). The combination of molecular analysis with cyst fluid carcinoembryonic antigen (CEA) and cytology resulted in higher MPC diagnostic performance than either one of its individual components, with a sensitivity, specificity, and accuracy of 73.7%, 70%, and 72.9%, respectively. There was no significant difference in accuracy between molecular analysis and CEA/cytology in this group. LIMITATIONS Single-center experience. CONCLUSION Molecular analysis aids in the diagnosis of MPCs when cytology is nondiagnostic or cyst fluid is insufficient for CEA or its level is indeterminate. Our results do not support the routine use of molecular analysis, which should be used selectively after review of imaging findings and cyst fluid studies. Further studies are needed to assess DNA's performance in malignant cysts.
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Affiliation(s)
- Mohammad Al-Haddad
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - John DeWitt
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Stuart Sherman
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - C Max Schmidt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Julia K LeBlanc
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Lee McHenry
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Gregory Coté
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Abdul Hamid El Chafic
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Leticia Luz
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Cynthia S Johnson
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Christen Klochan
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Thomas F Imperiale
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Morelli MS, Glowinski EA, Juluri R, Johnson CS, Imperiale TF. Yield of the second surveillance colonoscopy based on the results of the index and first surveillance colonoscopies. Endoscopy 2013; 45:821-6. [PMID: 24019133 DOI: 10.1055/s-0033-1344582] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND STUDY AIMS The risk of advanced colorectal neoplasia (ACN) after the first surveillance colonoscopy is not well quantified. The aim of the current study was to quantify the risk of ACN on the second surveillance colonoscopy based on previous colonoscopic findings. PATIENTS AND METHODS This was a single-site study of patients with index adenomas who underwent two surveillance colonoscopies. ACN was defined as advanced adenoma (≥ 1 cm, villous histology, or high-grade dysplasia) or as "high-risk" findings (advanced adenoma or ≥ 3 non-advanced adenoma [NAA]). RESULTS Among 509 patients with low-risk index findings, 61 (12.0 %; 95 % confidence interval [CI], 9.3 % - 15.1 %) had high-risk findings on the first surveillance colonoscopy, 11 of whom (18.0 %; 95 %CI 9.4 % - 30.0 %) had high-risk findings on second surveillance colonoscopy compared with 39 (8.7 %; 95 %CI 6.3 % - 11.7 %) of the remaining 448 patients who had normal or low-risk findings on the first surveillance colonoscopy (relative risk [RR] = 2.07; 95 %CI 1.12 - 3.83). Among 456 patients with high-risk index findings, 91 (20.0 %; 95 %CI 16.3 % - 23.9 %) had high-risk findings on the first surveillance colonoscopy, 20 of whom (22.0 %; 95 %CI 14.0 % - 31.9 %) had high-risk findings on second surveillance colonoscopy compared with 40 (11.0 %; 95 %CI 8.0 % - 146 %) of the remaining 365 patients who had normal or low-risk findings on first surveillance colonoscopy (RR = 2.01; 95 %CI 1.04 - 3.32). Results were similar when only advanced adenomas were considered. CONCLUSIONS Patients with high-risk findings on index and first surveillance colonoscopies require close surveillance. Those with low-risk findings on index colonoscopy and normal/non-advanced findings on the first surveillance colonoscopy have low subsequent risk of ACN. These and previous data may be useful for generating recommendations for the timing of the second surveillance colonoscopy.
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Parkunan V, Johnson CS, Xu L, Peng Y, Tolin SA, Eisenback JD. Induction and Maintenance of Systemic Acquired Resistance by Acibenzolar-S-Methyl in Three Cultivated Tobacco Types. Plant Dis 2013; 97:1221-1226. [PMID: 30722429 DOI: 10.1094/pdis-07-11-0618-re] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Induction and maintenance of systemic acquired resistance (SAR) in 'N' gene containing burley, flue-cured, and oriental tobacco cultivars were assessed by monitoring decreases in the number of local lesions caused by Tobacco mosaic virus (TMV) following treatment with acibenzolar-S-methyl (ASM). Leaf samples were collected from lower, middle, and top positions on seedlings at 3-day intervals over 21 days following ASM treatment and subsequent inoculation with TMV under laboratory conditions. Local lesion number for each leaf was recorded 7 days postinoculation. Reductions in TMV local lesion numbers on ASM-treated versus nontreated tobacco varied over time, and differed for each tobacco type. Based on reduced local lesion numbers, SAR was induced in burley and flue-cured tobacco by 3 and 6 days postinoculation, respectively, while oriental tobacco responded by 9 days. SAR was maintained in burley tobacco from 3 to 9 days after ASM application, and from 9 to 15 days after application in oriental tobacco. ASM treatment reduced local lesion numbers in flue-cured tobacco significantly at 6, 12, and 21 days postapplication, but not at 15 and 18 days after treatment. The SAR response was similar among lower, middle, and top leaves with no effect of ASM on response by leaf position, although TMV local lesion numbers were greater on lower leaves than on middle and top leaves 6 days after treatment, but significantly less on lower leaves 18 days after treatment compared to middle and top leaves.
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Affiliation(s)
- V Parkunan
- Virginia Tech Southern Piedmont Agricultural Research and Extension Center, Blackstone, VA 23824
| | - C S Johnson
- Virginia Tech Southern Piedmont Agricultural Research and Extension Center, Blackstone, VA 23824
| | - L Xu
- Laboratory for Interdisciplinary Statistical Analysis, Department of Statistics, Virginia Tech, Blacksburg, VA 24061
| | - Y Peng
- Laboratory for Interdisciplinary Statistical Analysis, Department of Statistics, Virginia Tech, Blacksburg, VA 24061
| | - S A Tolin
- Department of Plant Pathology, Physiology, and Weed Science, Virginia Tech, Blacksburg, VA 24061
| | - J D Eisenback
- Department of Plant Pathology, Physiology, and Weed Science, Virginia Tech, Blacksburg, VA 24061
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Kahi CJ, Ballard D, Shah AS, Mears R, Johnson CS. Impact of a quarterly report card on colonoscopy quality measures. Gastrointest Endosc 2013; 77:925-31. [PMID: 23472996 DOI: 10.1016/j.gie.2013.01.012] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 01/01/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Colonoscopy quality is operator-dependent. Studies assessing the effect of interventions to decrease variation in colonoscopy quality have shown inconsistent results. Since 2009, endoscopists at our university-affiliated, Veterans Affairs medical center have received a quarterly "report card" summarizing individual colonoscopy quality indicators as part of an ongoing quality assurance program. OBJECTIVE To determine the effect of the quality report card intervention on colonoscopy performance. DESIGN Retrospective study. SETTING Tertiary-care, academic, university-affiliated, Veterans Affairs medical center in Indianapolis, Indiana. PATIENTS Data from 6 endoscopists practicing at the Roudebush Veterans Affairs Medical Center were included. Patients were average-risk, aged 50 years or older, undergoing their first screening colonoscopy. INTERVENTION Quarterly report card. The study time frame was July 1, 2008 to December 31, 2008 (before-intervention) and April 1, 2009 to March 31, 2011 (intervention). MAIN OUTCOME MEASUREMENTS The primary outcomes were cecal intubation and adenoma detection rates (ADR), adjusted for physician, patient age, and sex. Multivariable logistic regression was performed to determine factors associated with adenoma detection. RESULTS A total of 928 patients (male 93%, white 78%) were included (before-intervention 336; intervention 592). There were no significant differences in patient age, sex, smoking status, body mass index, bowel preparation quality, colonoscope model, and proportion of colonoscopies performed with a trainee between the before-intervention and intervention phases. In the intervention phase, the adjusted adenoma detection and cecal intubation rates were significantly higher: 53.9% (95% confidence interval [CI], 49.7%-58.1%) vs 44.7% (95% CI, 39.1%-50.4%); P = .013 and 98.1% (95% CI, 96.7%-99.0%) vs 95.6% (95% CI, 92.5%-97.5%); P = .027, respectively. A higher ADR trend in the intervention phase was found for 5 of the 6 physicians. The increment in ADR was due mostly to increased detection of proximal adenomas. There were no significant changes in serrated polyp detection, advanced neoplasm detection, number of adenomas detected per colonoscopy, and mean size of adenomas after implementation of the intervention. The report card intervention remained significantly associated with higher ADRs after adjustment for patient age, sex, and physician (odds ratio 1.45; 95% CI, 1.08-1.94). LIMITATIONS Single center, small number of endoscopists. CONCLUSION A quarterly report card was associated with improved colonoscopy quality indicators. This intervention is practical to generate and implement and may serve as a model for quality improvement programs in different patient and physician groups.
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Affiliation(s)
- Charles J Kahi
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Goodman B, Johnson CS, Gebregziabher N, Maluccio MA, Helft PR, Chiorean EG, Cardenes HR. Stereotactic body radiotherapy response and local control rates for hepatic oligometastases. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.3546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3546 Background: Stereotactic body radiation therapy (SBRT) is a non-invasive, effective technique in the treatment of hepatic oligometastases from solid tumors. We present response and local control rates from our single institution experience. Methods: We treated 79 metastatic liver lesions from 64 different patients using stereotactic body radiation therapy. One colorectal cancer patient was treated three times and four patients were treated twice. Among the 79 metastatic liver lesions treated, 85% had prior chemotherapy. The primary cancer site included: Colorectal 66%, Non-colorectal GI 14%, Breast 6%, Ovarian 5%, NSCLC 3%, and other 6%. The mean GTV size was 37.3 (cc). The mean GTV diameter was 3.1 (cm). The median total dose was 54 (Gy) with the minimum and maximum total dose being 30 and 60 (Gy). Results: The overall local control rate was 94.2%, with estimates at 12, 24, 36, and 48 months being 96.1%, 87.9%, 87.9% and 87.9% following SBRT treatment. When comparing colorectal cancer patients vs all other primary cancer sites, the one year local control rate was 93.4% and 100%. The two and three year local control rates for colorectal cancer vs other primary cancer sites were 84.9% vs 90.9%. Best response was examined as a 4 level response (CR,PR,SD,PD) per the RECIST criteria. Overall, 67% of patients had a response, and less than 3% of patients had progression with SBRT treatment. For colorectal cancer patients, 79% had a response to treatment. Only 21% of colorectal cancer patients did not respond, however, the majority of these patients still had stable disease following treatment. Non-colorectal primary site cancers had a response in 50% of the lesions following SBRT treatment. The remaining 50% of non-colorectal primary cancers were stable following SBRT treatment and none progressed. The median dose for CR, PR, or SD was 54 Gy. The median dose for patients with progressive disease was less than 50 Gy. The observed CTC toxicities were limited with mostly grade 1-2 toxicity and only two grade 4 and one grade 5 toxicity. Conclusions: Stereotactic body radiation therapy is an effective treatment option for patients with hepatic oligometastases with a limited toxicity profile.
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Affiliation(s)
| | | | | | - Mary A. Maluccio
- Indiana University Department of General Surgery, Indianapolis, IN
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Buelow JM, Johnson CS, Perkins SM, Austin JK, Dunn DW. Creating Avenues for Parent Partnership (CAPP): an intervention for parents of children with epilepsy and learning problems. Epilepsy Behav 2013; 27:64-9. [PMID: 23376338 DOI: 10.1016/j.yebeh.2012.12.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 12/11/2012] [Accepted: 12/12/2012] [Indexed: 11/26/2022]
Abstract
Caregivers of children with both epilepsy and learning problems need assistance to manage their child's complex medical and mental health problems. We tested the cognitive behavioral intervention "Creating Avenues for Parent Partnership" (CAPP) which was designed to help caregivers develop knowledge as well as the confidence and skills to manage their child's condition. The CAPP intervention consisted of a one-day cognitive behavioral program and three follow-up group sessions. The sample comprised 31 primary caregivers. Caregivers reported that the program was useful (mean = 3.66 on a 4-point scale), acceptable (mean = 4.28 on a 5-point scale), and "pretty easy" (mean = 1.97 on a 4-point scale). Effect sizes were small to medium in paired t tests (comparison of intervention to control) and paired analysis of key variables in the pre- and post-tests. The CAPP program shows promise in helping caregivers build skills to manage their child's condition.
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Affiliation(s)
- Janice M Buelow
- Indiana University School of Nursing, Indianapolis, IN 46202, USA.
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Welch JL, Astroth KS, Perkins SM, Johnson CS, Connelly K, Siek KA, Jones J, Scott LL. Using a mobile application to self-monitor diet and fluid intake among adults receiving hemodialysis. Res Nurs Health 2013; 36:284-98. [PMID: 23512869 DOI: 10.1002/nur.21539] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2013] [Indexed: 11/09/2022]
Abstract
Hemodialysis patients have difficulty self-managing a complex dietary and fluid regimen. The purpose of this feasibility study was to pilot test an electronic self-monitoring intervention based on social cognitive theory. During a 6-week intervention, 24 participants self-monitored diet and fluid intake using the Dietary Intake Monitoring Application (DIMA), and 20 participants served as controls by monitoring their activity using the Daily Activity Monitor Application (DAMA). Results from this pilot study suggest the intervention is feasible and acceptable, although few significant effects on outcomes were found in this small sample. The DIMA has potential to facilitate dietary and fluid self-monitoring but requires additional refinement and further testing.
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Affiliation(s)
- Janet L Welch
- Indiana University School of Nursing, 1111 Middle Drive, NU E403, Indianapolis, IN, USA.
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Ramnath N, Daignault-Newton S, Dy GK, Muindi JR, Adjei A, Elingrod VL, Kalemkerian GP, Cease KB, Stella PJ, Brenner DE, Troeschel S, Johnson CS, Trump DL. A phase I/II pharmacokinetic and pharmacogenomic study of calcitriol in combination with cisplatin and docetaxel in advanced non-small-cell lung cancer. Cancer Chemother Pharmacol 2013; 71:1173-82. [PMID: 23435876 DOI: 10.1007/s00280-013-2109-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 02/04/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Preclinical studies demonstrated antiproliferative synergy of 1,25-D3 (calcitriol) with cisplatin. The goals of this phase I/II study were to determine the recommended phase II dose (RP2D) of 1,25-D3 with cisplatin and docetaxel and its efficacy in metastatic non-small-cell lung cancer. METHODS Patients were ≥18 years, PS 0-1 with normal organ function. In the phase I portion, patients received escalating doses of 1,25-D3 intravenously every 21 days prior to docetaxel 75 mg/m(2) and cisplatin 75 mg/m(2) using standard 3 + 3 design, targeting dose-limiting toxicity (DLT) rate <33 %. Dose levels of 1,25-D3 were 30, 45, 60, and 80 mcg/m(2). A two-stage design was employed for phase II portion. We correlated CYP24A1 tagSNPs with clinical outcome and 1,25-D3 pharmacokinetics (PK). RESULTS 34 patients were enrolled. At 80 mcg/m(2), 2/4 patients had DLTs of grade 4 neutropenia. Hypercalcemia was not observed. The RP2D of 1,25-D3 was 60 mcg/m(2). Among 20 evaluable phase II patients, there were 2 confirmed, 4 unconfirmed partial responses (PR), and 9 stable disease (SD). Median time to progression was 5.8 months (95 % CI 3.4, 6.5), and median overall survival 8.7 months (95 % CI 7.6, 39.4). CYP24A1 SNP rs3787554 (C > T) correlated with disease progression (P = 0.03) and CYP24A1 SNP rs2762939 (C > G) trended toward PR/SD (P = 0.08). There was no association between 1,25-D3 PK and CYP24A1 SNPs. CONCLUSIONS The RP2D of 1,25-D3 with docetaxel and cisplatin was 60 mcg/m(2) every 21 days. Pre-specified endpoint of 50 % confirmed RR was not met in the phase II study. Functional SNPs in CYP24A1 may inform future studies individualizing 1,25-D3.
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Affiliation(s)
- N Ramnath
- Division of Medical Oncology, Department of Internal Medicine, University of Michigan Comprehensive Cancer Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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Albany C, Brames MJ, Fausel C, Johnson CS, Picus J, Einhorn LH. Randomized, Double-Blind, Placebo-Controlled, Phase III Cross-Over Study Evaluating the Oral Neurokinin-1 Antagonist Aprepitant in Combination With a 5HT3 Receptor Antagonist and Dexamethasone in Patients With Germ Cell Tumors Receiving 5-Day Cisplatin Combination Chemotherapy Regimens: A Hoosier Oncology Group Study. J Clin Oncol 2012; 30:3998-4003. [PMID: 22915652 DOI: 10.1200/jco.2011.39.5558] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Aprepitant, a 5-HT3 receptor antagonist (5HT3-RA), and dexamethasone are standard antiemetic therapy for prevention of single-day, cisplatin-induced nausea and vomiting. We conducted a double-blind, placebo-controlled phase III cross-over study that compared aprepitant to placebo combined with standard antiemetic prophylaxis (a 5HT3-RA and dexamethasone) in patients receiving 5 days of cisplatin combination chemotherapy for testicular cancer. Patients and Methods Patients receiving two consecutive identical courses of a 5-day cisplatin-based chemotherapy were randomly assigned to aprepitant 125 mg on day 3 and 80 mg per day on days 4 through 7 or to placebo with the initial course and crossover to the opposite treatment with the second course. The primary objective was complete response (CR). Secondary end points were emetic episodes (acute and delayed), nausea measurement based on a visual analog scale (VAS), and patient-stated preference after the second study cycle. Results In all, 71 patients were screened for the study and 69 were evaluable. Thirty-five patients were randomly assigned to receive aprepitant and 34 to receive placebo for the first course. Forty-two percent achieved CR with aprepitant compared with 13% with placebo (P < .001). Eleven patients (16.2%) had at least one emetic episode during the aprepitant cycle versus 32 patients (47.1%) with placebo. Thirty-eight patients preferred the aprepitant cycle whereas 11 preferred placebo (P < .001). There was no statistical difference in VAS for nausea, but it was numerically superior with aprepitant. There was no toxicity with aprepitant compared with placebo. Conclusion There was a significant improvement in CR rate with aprepitant combined with a 5HT3-RA and dexamethasone. Patient preference strongly favored the aprepitant cycle.
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Affiliation(s)
- Costantine Albany
- Costantine Albany, Mary J. Brames, Christopher Fausel, Cynthia S. Johnson, and Lawrence H. Einhorn, Indiana University School of Medicine, Indianapolis, IN; and Joel Picus, Washington University School of Medicine, StLouis, MO
| | - Mary J. Brames
- Costantine Albany, Mary J. Brames, Christopher Fausel, Cynthia S. Johnson, and Lawrence H. Einhorn, Indiana University School of Medicine, Indianapolis, IN; and Joel Picus, Washington University School of Medicine, StLouis, MO
| | - Christopher Fausel
- Costantine Albany, Mary J. Brames, Christopher Fausel, Cynthia S. Johnson, and Lawrence H. Einhorn, Indiana University School of Medicine, Indianapolis, IN; and Joel Picus, Washington University School of Medicine, StLouis, MO
| | - Cynthia S. Johnson
- Costantine Albany, Mary J. Brames, Christopher Fausel, Cynthia S. Johnson, and Lawrence H. Einhorn, Indiana University School of Medicine, Indianapolis, IN; and Joel Picus, Washington University School of Medicine, StLouis, MO
| | - Joel Picus
- Costantine Albany, Mary J. Brames, Christopher Fausel, Cynthia S. Johnson, and Lawrence H. Einhorn, Indiana University School of Medicine, Indianapolis, IN; and Joel Picus, Washington University School of Medicine, StLouis, MO
| | - Lawrence H. Einhorn
- Costantine Albany, Mary J. Brames, Christopher Fausel, Cynthia S. Johnson, and Lawrence H. Einhorn, Indiana University School of Medicine, Indianapolis, IN; and Joel Picus, Washington University School of Medicine, StLouis, MO
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Helft PR, Champion VL, Eckles R, Johnson CS, Meslin EM. Cancer patients' attitudes toward future research uses of stored human biological materials. J Empir Res Hum Res Ethics 2012; 2:15-22. [PMID: 19385847 DOI: 10.1525/jer.2007.2.3.15] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
THE POLICY DEBATE CONCERNING INFORMED consent for future, unspecified research of stored human biological materials (HBM) would benefit from an understanding of the attitudes of individuals who contribute tissue specimens to HBM repositories. Cancer patients who contributed leftover tissue to the Indiana University Cancer Center Tissue Bank under such conditions were recruited for a mail survey study of their attitudes. Our findings suggest that a clear majority of subjects would permit unlimited future research on stored HBMs without re-contact and reconsent, and a significant minority appear to desire ongoing control over future research uses of their tissue. These differences merit further investigation and suggest that a policy of blanket consent for all future, unspecified research would be premature.
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Affiliation(s)
- Paul R Helft
- Indiana University-Purdue University at Indianapolis
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Johnson CS. The effects of home based nutrition and exercise interventions in improving functional capacity and preventing falls among older adults. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040590e.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
In the study we describe adaptive functioning in children with epilepsy whose primary caregivers identified them as having learning problems. This was a cross-sectional study of 50 children with epilepsy and learning problems. Caregivers supplied information regarding the child's adaptive functioning and behavior problems. Children rated their self-concept and completed a battery of neuropsychological tests. Mean estimated IQ (PPVT-III) in the participant children was 72.8 (SD = 18.3). On average, children scored 2 standard deviations below the norm on the Vineland Adaptive Behavior Scale-II and this was true even for children with epilepsy who had estimated IQ in the normal range. In conclusion, children with epilepsy and learning problems had relatively low adaptive functioning scores and substantial neuropsychological and mental health problems. In epilepsy, adaptive behavior screening can be very informative and guide further evaluation and intervention, even in those children whose IQ is in the normal range.
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Affiliation(s)
- Janice M Buelow
- Department of Biostatistics, Indiana University School of Nursing, Indianapolis, IN 46202, USA.
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Plett PA, Sampson CH, Chua HL, Joshi M, Booth C, Gough A, Johnson CS, Katz BP, Farese AM, Parker J, MacVittie TJ, Orschell CM. Establishing a murine model of the hematopoietic syndrome of the acute radiation syndrome. Health Phys 2012; 103:343-55. [PMID: 22929467 PMCID: PMC3743168 DOI: 10.1097/hp.0b013e3182667309] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The authors have developed a murine model of the Hematopoietic Syndrome of the Acute Radiation Syndrome (H-ARS) for efficacy testing of medical countermeasures (MCM) against radiation according to the FDA Animal Rule. Ten- to 12-wk-old male and female C57BL/6 mice were exposed to the LD50/30-LD70/30 dose of total body irradiation (TBI, (137)Cs, 0.62-0.67 Gy min(-1)) in the morning hours when mice were determined to be most radiosensitive, and they were assessed for 30-d survival and mean survival time (MST). Antibiotics were delivered in drinking water on days 4-30 post-TBI at a concentration based on the amount of water that lethally-irradiated mice were found to consume. The fluoroquinolones, ciprofloxacin and levofloxacin, as well as the tetracycline doxycycline, and aminoglycoside neomycin, all significantly increased MST of decedent mice, while ciprofloxacin (p = 0.061) and doxycycline + neomycin (p = 0.005) showed at least some efficacy to increase 30-d survival. Blood sampling (30 μL/mouse every fifth day) was found to negatively impact 30-d survival. Histopathology of tissues harvested from nonmoribund mice showed expected effects of lethal irradiation, while moribund mice were largely septicemic with a preponderance of enteric organisms. Kinetics of loss and recovery of peripheral blood cells in untreated mice and those treated with two MCM, granulocyte-colony stimulating factor and Amifostine further characterized and validated this model for use in screening studies and pivotal efficacy studies of candidate MCM for licensure to treat irradiated individuals suffering from H-ARS.
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Affiliation(s)
- P. Artur Plett
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Hui Lin Chua
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mandar Joshi
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | | | - Barry P. Katz
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ann M. Farese
- University of Maryland at Baltimore School of Medicine, Baltimore, MD, USA
| | - Jeffrey Parker
- University of Maryland at Baltimore School of Medicine, Baltimore, MD, USA
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Al-Haddad M, McKenna D, Ko J, Sherman S, Selzer DJ, Mattar SG, Imperiale TF, Rex DK, Nakeeb A, Jeong SM, Johnson CS, Freeman LJ. Deep sedation in natural orifice transluminal endoscopic surgery (NOTES): a comparative study with dogs. Surg Endosc 2012; 26:3163-73. [PMID: 22580877 DOI: 10.1007/s00464-012-2309-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 04/02/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Natural orifice transluminal endoscopic surgery (NOTES) has been mostly performed with the animal under general and inhalational anesthesia (IA-NOTES). To date, NOTES using propofol sedation (PS-NOTES) has not been investigated. This study aimed to assess the feasibility and safety of PS-NOTES for transgastric oophorectomy with carbon dioxide insufflation and to compare its success rates with those of conventional IA-NOTES. METHODS In this prospective randomized study, NOTES oophorectomy was performed for 19 female dogs randomized to two conditions: PS (study group) and IA (control group). Sedation success rates (ability to visualize and resect ovaries without converting to IA), operative success rates (ability to resect and retrieve both ovaries in full using only NOTES), and vital parameters including hemodynamic and respiratory changes were documented. RESULTS In the PS-NOTES group (n = 9), the sedation success rate was 100 %. The operative success rate was 67 % (6 of 9 animals) compared with 80 % (8 of 10 animals) in the IA-NOTES group. No purposeful movement occurred during surgical manipulation and no respiratory or cardiovascular complications in occurred the PS group. Heart rate (HR) and end-tidal carbon dioxide (ETCO(2)) were significantly higher in the PS group than in the IA group. Blood pressure (BP) was significantly higher in the PS group only during the middle part of the procedure. Only mild respiratory depression was noted in the PS group, as indicated by elevated but acceptable ETCO(2). Elevations in BP and HR are thought to be related to elevated CO(2) but did not appear to have an adverse impact on the course of the procedure. Recovery was uneventful for all the animals. CONCLUSION The use of PS-NOTES appears to be feasible, resulting in outcomes comparable with those for IA in dogs. Further studies are needed to determine the applicability of this concept in human NOTES.
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Affiliation(s)
- Mohammad Al-Haddad
- Department of Medicine, Division of Gastroenterology, Indiana University School of Medicine, 550 N University Boulevard, UH 4100, Indianapolis, IN 46202, USA.
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Cary KC, Johnson CS, Cheng L, Koch MO. A Critical Assessment of Post-Prostatectomy Prostate Specific Antigen Doubling Time Acceleration—Is it Stable? J Urol 2012; 187:1614-9. [DOI: 10.1016/j.juro.2011.12.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Indexed: 10/28/2022]
Affiliation(s)
- K. Clint Cary
- Departments of Urology, Pathology and Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Cynthia S. Johnson
- Departments of Urology, Pathology and Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Liang Cheng
- Departments of Urology, Pathology and Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Michael O. Koch
- Departments of Urology, Pathology and Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
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