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Chu MP, Many G, Isquith DA, McKeeth S, Williamson J, Neradilek MB, Colletti P, Zhao XQ. Metabolic and inflammatory risk reduction in response to lipid-lowering and lifestyle modification in the medically underserved individuals. Am J Prev Cardiol 2021; 7:100227. [PMID: 34401861 PMCID: PMC8358155 DOI: 10.1016/j.ajpc.2021.100227] [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] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/20/2021] [Accepted: 07/24/2021] [Indexed: 10/26/2022] Open
Abstract
Introduction Medically underserved (US) populations have an increased level of atherosclerotic cardiovascular disease (ASCVD) risk, however, few studies investigated ASCVD risk reduction in US. Methods Of 217 subjects with ApoB ≥120 mg/dL and carotid atherosclerosis (≥15% stenosis by ultrasound) enrolled in the Carotid Plaque Composition by MRI (CPC) study between 2005 and 2011, US (n=33) was defined as those without adequate healthcare insurance, while AS (n=184) included those with adequate healthcare coverage. All subjects received atorvastatin-based lipid therapies and lifestyle intervention for 2 years. Metabolic and inflammatory risk factors were compared between AS and US. Results At baseline, compared to AS, US displayed higher levels of metabolic and inflammatory risk including systolic blood pressure (140±27 vs. 131±18 mmHg, p=0.04), fasting glucose (125±59 vs. 102±22 mg/dL, p=0.03) and fasting insulin (39±33 vs. 28±20 µU/dL, p=0.03) which resulted in higher insulin resistance (HOMA-IR 2.2±0.4 vs. 1.3±0.1, p=0.03), and hsCRP (5.6±1.5 vs. 2.8±0.2 mg/L, p=0.03). Over 2 years of intervention, US and AS showed similar reductions in LDL-C (-10.7% vs. -16% per year, p=0.2), triglycerides (-16.7% vs. -15.9% per year, p=0.4), and hsCRP (-0.11% vs. -0.04% per year, p=0.1). However, US continued to show significantly higher levels of fasting blood glucose (115±6.0 vs. 101±2.0 mg/dL, p=0.03) and HOMA-IR (1.9±0.2 vs. 1.5±0.1, p=0.047), and hsCRP (3.9±0.7 vs. 1.9±0.2 mg/L, p<0.001) than AS following 2 years of interventions. Conclusions US displayed higher ASCVD risk than AS at baseline and over 2 years despite similar reductions following the intervention. These findings highlight the unmet needs for improved intervention strategies and implementation methods for ASCVD risk reduction in US. Clinical Trial Registration NCT00715273 at ClinicalTrials.gov.
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Affiliation(s)
- Michael P Chu
- Clinical Atherosclerosis Research Lab, University of Washington Division of Cardiology; Seattle, WA, United States
| | - Gina Many
- (GM) Community Health of Central Washington; Yakima, WA, United States
| | - Daniel A Isquith
- Clinical Atherosclerosis Research Lab, University of Washington Division of Cardiology; Seattle, WA, United States
| | - Susan McKeeth
- Clinical Atherosclerosis Research Lab, University of Washington Division of Cardiology; Seattle, WA, United States
| | - Jayne Williamson
- Clinical Atherosclerosis Research Lab, University of Washington Division of Cardiology; Seattle, WA, United States
| | - Moni B Neradilek
- Clinical Atherosclerosis Research Lab, University of Washington Division of Cardiology; Seattle, WA, United States
| | - Patrick Colletti
- University of Southern California, Keck Hospital of USC; Los Angeles, CA, United States
| | - Xue-Qiao Zhao
- Clinical Atherosclerosis Research Lab, University of Washington Division of Cardiology; Seattle, WA, United States.,(GM) Community Health of Central Washington; Yakima, WA, United States.,University of Southern California, Keck Hospital of USC; Los Angeles, CA, United States
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Somayaji R, Neradilek MB, Szpiro AA, Lofy KH, Jackson ML, Goss CH, Duchin JS, Neuzil KM, Ortiz JR. Effects of Air Pollution and Other Environmental Exposures on Estimates of Severe Influenza Illness, Washington, USA. Emerg Infect Dis 2021; 26. [PMID: 32310747 PMCID: PMC7181929 DOI: 10.3201/eid2605.190599] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Ecologic models of influenza burden may be confounded by other exposures that share winter seasonality. We evaluated the effects of air pollution and other environmental exposures in ecologic models estimating influenza-associated hospitalizations. We linked hospitalization data, viral surveillance, and environmental data, including temperature, relative humidity, dew point, and fine particulate matter for 3 counties in Washington, USA, for 2001-2012. We used negative binomial regression models to estimate the incidence of influenza-associated respiratory and circulatory (RC) hospitalizations and to assess the effect of adjusting for environmental exposures on RC hospitalization estimates. The modeled overall incidence rate of influenza-associated RC hospitalizations was 31/100,000 person-years. The environmental parameters were statistically associated with RC hospitalizations but did not appreciably affect the event rate estimates. Modeled influenza-associated RC hospitalization rates were similar to published estimates, and inclusion of environmental covariates in the model did not have a clinically important effect on severe influenza estimates.
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Schiffman CJ, Hannay WM, Whitson AJ, Neradilek MB, Matsen FA, Hsu JE. Impact of previous non-arthroplasty surgery on clinical outcomes after primary anatomic shoulder arthroplasty. J Shoulder Elbow Surg 2020; 29:2056-2064. [PMID: 32331844 DOI: 10.1016/j.jse.2020.01.088] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/13/2020] [Accepted: 01/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The objectives of this study were to address the following questions regarding previous non-arthroplasty surgery prior to primary anatomic shoulder arthroplasty (either total shoulder arthroplasty [TSA] or ream-and-run arthroplasty): (1) To what degree is primary anatomic shoulder arthroplasty after prior non-arthroplasty surgery associated with inferior clinical outcomes and higher revision rates compared with arthroplasty without previous surgery? (2) Does type, approach, or timing of previous surgery affect outcomes after anatomic arthroplasty? METHODS A retrospective review of a primary shoulder arthroplasty database was performed and identified 640 patients undergoing anatomic shoulder arthroplasty (345 TSAs and 295 ream-and-run arthroplasties). Of these patients, 183 (29%) underwent previous non-arthroplasty surgery. Baseline and demographic information, 2-year postoperative outcome scores, and revision surgical procedures with associated culture results were collected. RESULTS In patients undergoing TSA, previous non-arthroplasty surgery was associated with a significantly lower 2-year Simple Shoulder Test (SST) score (P = .010), percentage maximum possible improvement (MPI) (P = .024), and Single Assessment Numeric Evaluation (SANE) score (P < .001) and a higher rate of reoperation (P < .001). In patients undergoing ream-and-run arthroplasty, previous non-arthroplasty surgery was associated with a nonsignificantly lower 2-year SST score, percentage MPI, and SANE score and higher reoperation rate. Prior fracture surgery carried a higher risk of reoperation than other types of surgery including rotator cuff repair and instability surgery. Among TSA and ream-and-run arthroplasty cases with prior non-arthroplasty surgery, prior open surgery and the time interval from most recent surgery were associated with nonsignificant differences in the 2-year SST score, percentage MPI, SANE score, and revision risk. CONCLUSION Previous surgery is associated with inferior clinical outcomes and higher revision rates in patients undergoing index TSA but not in those undergoing the ream-and-run procedure. Patients with previous fracture surgery carry the highest risk of reoperation.
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Affiliation(s)
- Corey J Schiffman
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Willam M Hannay
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Anastasia J Whitson
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | | | - Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.
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Eschenroeder LW, Nguyen VP, Neradilek MB, Li S, Dardas TF. Patterns of Hospital Bypass and Interhospital Transfer Among Patients With Heart Failure. J Card Fail 2020; 26:762-768. [DOI: 10.1016/j.cardfail.2020.04.015] [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] [Received: 12/28/2019] [Revised: 04/03/2020] [Accepted: 04/22/2020] [Indexed: 11/30/2022]
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Matsen FA, Whitson AJ, Pottinger PS, Neradilek MB, Hsu JE. Cutaneous microbiology of patients having primary shoulder arthroplasty. J Shoulder Elbow Surg 2020; 29:1671-1680. [PMID: 32247723 DOI: 10.1016/j.jse.2019.12.031] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 12/16/2019] [Accepted: 12/21/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Shoulder periprosthetic infections are predominantly caused by bacteria residing in the skin of healthy individuals. Knowledge of the factors associated with the loads of the different cutaneous bacteria in individuals having shoulder arthroplasty may help identify patients at higher risk of periprosthetic infection and help guide preventive measures. For this reason, we tested the hypothesis that easy-to-obtain preoperative characteristics were significantly associated with the cutaneous microbiology and the loads of specific bacteria in shoulders having joint replacement. METHODS This study identified the microbiology of the unprepared epidermal skin surface and of the dermal edge freshly incised at surgery in 332 patients having primary shoulder arthroplasty. The load of bacteria in each sample was characterized as a value based on the laboratory report: 0 for "no growth"; 0.1 for "one colony only" or for "broth only"; and 1, 2, 3, and 4 for 1+, 2+, 3+, and 4+ growth, respectively. The relationships between preoperative patient characteristics and these semiquantitative results of the cutaneous cultures were analyzed. RESULTS Cultures of the unprepared epidermal skin surface showed positive results for a wide variety of organisms, including Cutibacterium in 72%, coagulase-negative Staphylococcus in 61%, and a spectrum of other organisms in 32%. By contrast, cultures of the freshly incised dermal edge showed a great preponderance of Cutibacterium (34%) in comparison to low levels of coagulase-negative Staphylococcus (8%) and other organisms (2%). An increased dermal load of Cutibacterium was significantly associated with male sex, younger patient age, American Society of Anesthesiologists class 1, use of testosterone supplements, prior shoulder surgery, and higher Cutibacterium loads on the unprepared skin surface. CONCLUSIONS Although the microbiology of the unprepared skin surface is diverse, the same is not true for the freshly incised dermis, where Cutibacterium is the predominant organism. Readily available preoperative patient characteristics are significantly associated with the load of Cutibacterium in the incised dermis. Preoperative cultures of the unprepared skin surface appear to be a new method for predicting the type and load of bacteria found in the freshly incised dermis at the time of surgery. Additional studies are needed to determine whether preoperative cultures of the unprepared epidermal skin surface can provide a method for identifying patients at increased risk of shoulder periprosthetic infections.
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Affiliation(s)
- Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA.
| | - Anastasia J Whitson
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Paul S Pottinger
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington Medical Center, Seattle, WA, USA
| | | | - Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
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Somerson JS, Hsu JE, Neradilek MB, Matsen FA. Response to Weber and McFarland regarding: "Analysis of 4063 complications of shoulder arthroplasty reported to the US Food and Drug Administration from 2012 to 2016". J Shoulder Elbow Surg 2020; 29:e322-e323. [PMID: 32713474 DOI: 10.1016/j.jse.2020.03.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 02/01/2023]
Affiliation(s)
| | - Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | | | - Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
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XING YL, Chen MA, SUN Y, Neradilek MB, WU XT, ZHANG D, HUANG W, CUI Y, YANG QQ, LI HW, ZHAO XQ. Atherosclerosis, its risk factors, and cognitive impairment in older adults. J Geriatr Cardiol 2020; 17:434-440. [PMID: 32863826 PMCID: PMC7416070 DOI: 10.11909/j.issn.1671-5411.2020.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVE To examine the association of atherosclerotic cardiovascular disease (ASCVD) and its risk factors with cognitive impairment in older adults. METHODS Six hundred and fourteen subjects, aged ≥ 65 years, from one center (2016-2018) underwent clinical, laboratory assessments and the Montreal Cognitive Assessment (MoCA). Using regression analysis, the relationship between ASCVD and its risk factors was evaluated in subjects with and without cognitive impairment (MoCA score < 26). RESULTS Older age (β = -1.3 per 5 years, 95% CI: -1.7 to -0.9, P < 0.001), history of stroke (β = -1.6, 95% CI: -3.0 to -0.3, P = 0.01), and myocardial infarction (MI; β = -2.2, 95% CI: -3.6 to -0.8, P = 0.003) were independently associated with lower MoCA scores, whereas more education (β = 1.5 per 3 years, 95% CI: 1.1 to 1.9, P < 0.001), higher body mass index (BMI; β = 0.5 per 3 kg/m2, 95% CI: 0.0 to 1.0, P = 0.04), higher estimated glomerular filtration rate (eGFR; β = 0.8 per 15 U, 95% CI: 0.1 to 1.4, P = 0.03), left ventricular ejection fraction (LVEF; β = 0.4 per 5%, 95% CI: 0 to 0.8, P = 0.04) and statin use (β = 1.3, 95% CI: 0.3 to 2.3, P = 0.01) were associated with a higher MoCA score. Cognitive impairment was independently associated with older age (OR = 1.51 per 5 yrs, 95% CI: 1.28 to 1.79, P < 0.001), less education (OR = 0.55 per 3 years, 95% CI: 0.45 to 0.68, P < 0.001), lower BMI (OR = 0.78 per 3 kg/m2, 95% CI: 0.62 to 0.98, P = 0.03) and higher levels of high sensitivity c-reactive protein (hsCRP; OR = 1.08 per 1 mg/L, 95% CI: 1.02 to 1.15, P = 0.01). CONCLUSIONS Beyond age, cognitive impairment was associated with prior MI/stroke, higher hsCRP, statin use, less education, lower eGFR, BMI and LVEF.
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Affiliation(s)
- Yun-Li XING
- Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Michael A Chen
- Division of Cardiology, University of Washington, Seattle, WA, USA
- Michael A Chen, MD, PhD, Division of Cardiology, University of Washington, 325 9 Avenue, Box 359748, Seattle, WA 98104, USA. E-mail:
| | - Ying SUN
- Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | | | - Xi-Ting WU
- Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Dai ZHANG
- Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wei HUANG
- Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yining CUI
- Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qi-Qi YANG
- Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hong-Wei LI
- Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xue-Qiao ZHAO
- Division of Cardiology, University of Washington, Seattle, WA, USA
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9
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Ersek M, Neradilek MB, Herr K, Hilgeman MM, Nash P, Polissar N, Nelson FX. Psychometric Evaluation of a Pain Intensity Measure for Persons with Dementia. Pain Med 2020; 20:1093-1104. [PMID: 30204895 DOI: 10.1093/pm/pny166] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The goal of this study was to conduct initial psychometric analyses of a seven-item pain intensity measure for persons with dementia (PIMD) that was developed using items from existing pain observational measures. DESIGN AND METHODS We evaluated validity by examining associations with an expert clinician's pain intensity rating (ECPIR) and an established pain observation tool (Mobilization Observation Behaviour Intensity Dementia [MOBID]). We also examined correlations between the PIMD and known correlates of pain: depression, sleep disturbances, agitation, painful diagnoses, and caregiver pain reports. We examined the differences between PIMD scores for "at rest" and "during movement" observations. We assessed reliability by calculating Cronbach's alpha and estimating inter-rater reliability using intraclass correlations (ICCs). Finally, we examined whether six additional "recent changes in behavior" items improved the PIMD's ability to predict expert clinicians' pain ratings. SETTING Sixteen nursing homes located in Alabama, Georgia, Pennsylvania, and New Jersey. PARTICIPANTS One hundred ninety residents with moderate to severe cognitive impairment, mean age of 84 years, 49.5% female, and 70% white. RESULTS PIMD during movement scores were highly correlated with the ECPIR and overall MOBID scores. As expected, there were large differences between at rest and during movement PIMD scores. Associations of PIMD with known correlates of pain were generally low and statistically nonsignificant. Internal consistency was supported with a Cronbach alpha of 0.72 and an inter-rater ICC of 0.82 for during movement PIMD scores. CONCLUSIONS Initial evaluation of the PIMD supports its validity and reliability. Additional testing is needed to evaluate the tool's sensitivity to changes in pain intensity.
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Affiliation(s)
- Mary Ersek
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.,University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | | | - Keela Herr
- University of Iowa College of Nursing, Iowa City, Iowa
| | - Michelle M Hilgeman
- Tuscaloosa VA Medical Center, Tuscaloosa, Alabama.,Department of Psychology, Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa, Alabama.,Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Nayak Polissar
- The Mountain-Whisper-Light Statistics, Seattle, Washington
| | - Francis X Nelson
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
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Somerson JS, Comley MC, Mansi A, Neradilek MB, Matsen FA. Industry payments to authors of Journal of Shoulder and Elbow Surgery shoulder arthroplasty manuscripts are accurately disclosed by most authors and are not significantly associated with better reported treatment outcomes. J Shoulder Elbow Surg 2020; 29:667-673. [PMID: 31899091 DOI: 10.1016/j.jse.2019.09.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 07/24/2019] [Revised: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Author transparency in disclosing potential conflicts of interest when reporting outcomes for shoulder arthroplasty implants is important. Using the Centers for Medicare & Medicaid Services Open Payments Program (OPP) database, we analyzed articles in the Journal of Shoulder and Elbow Surgery to evaluate (1) discrepancies between the stated conflicts of interest and associated payments recorded in the database, (2) the magnitude and types of payments received, and (3) possible relationships between industry financial support and positive study outcomes. METHODS Articles reporting clinical outcomes of shoulder arthroplasty from 2016 and 2017 were reviewed. Articles identifying a specific shoulder arthroplasty implant and having at least 1 author based in the United States were included. Payment types, amounts, and sources were extracted from disclosure statements in the manuscript and considered relevant if they were received from the implant manufacturer. Published disclosure statements were compared against the OPP database. Study outcomes demonstrating a clinical benefit were considered "positive." Payments to authors reporting positive outcomes were compared with those reporting nonpositive outcomes. RESULTS Implant manufacturers provided $16,051,261 to authors of shoulder arthroplasty publications over a 2-year period. Approximately half of senior authors (46%) received royalty payments, more than 90% of which ($14,910,873; 93%) were reported in disclosure statements. Although authors of articles with positive outcomes received greater payments than those reporting nonpositive outcomes, these differences were not statistically significant. CONCLUSION The majority of author disclosure statements accurately reflected the OPP data. Payments were not significantly associated with positive outcomes reported for the specific implant.
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Affiliation(s)
- Jeremy S Somerson
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA.
| | - Matthew C Comley
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
| | - Ahmed Mansi
- School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | | | - Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
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Ersek M, Nash PV, Hilgeman MM, Neradilek MB, Herr KA, Block PR, Collins AN. Pain Patterns and Treatment Among Nursing Home Residents With Moderate-Severe Cognitive Impairment. J Am Geriatr Soc 2019; 68:794-802. [PMID: 31868921 DOI: 10.1111/jgs.16293] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 09/04/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To examine the frequency and severity of pain and use of pain therapies among long-term care residents with moderate to severe dementia and to explore the factors associated with increased pain severity. DESIGN Prospective individual data were collected over 1 to 3 days for each participant. SETTING Sixteen long-term care facilities in Alabama, Georgia, Pennsylvania, and New Jersey. PARTICIPANTS Residents with moderate to severe cognitive impairment residing in a long-term care facility for at least 7 days were enrolled (N = 205). Residents were 47% female, predominantly white (69%), and 84 years old, on average (SD = 10 years). MEASUREMENTS A comprehensive pain assessment protocol was used to evaluate pain severity and characteristics through medical record review, interviews with nursing home staff, physical examinations, as well as pain observation tools (Mobilization-Observation-Behavior-Intensity-Dementia Pain Scale and Pain Intensity Measure for Persons With Dementia). Known correlates were also assessed (agitation, depression, and sleep). RESULTS Experts' pain evaluations indicated that residents' usual pain was mild (mean = 1.6/10), and most experienced only intermittent pain (70%). However, 45% of residents experienced moderate to severe worst pain. Of residents, 90% received a pain therapy, with acetaminophen (87%) and opioids (32%) commonly utilized. Only 3% had a nondrug therapy documented in the medical record. The only resident characteristic that was significantly associated with pain severity was receipt of an opioid in the past week. CONCLUSION Using a comprehensive pain assessment protocol, we found that most nursing home residents with moderate to severe dementia had mild usual, intermittent pain and the vast majority received at least one pain therapy in the previous week. Although these findings reflect improvements in pain management compared with older studies, there is still room for improvement in that 45% of the sample experienced moderate to severe pain at some point in the previous week. J Am Geriatr Soc 68:794-802, 2020.
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Affiliation(s)
- Mary Ersek
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Administration (VA) Medical Center, Philadelphia, Pennsylvania.,Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.,Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Princess V Nash
- Tuscaloosa Veterans Administration (VA) Medical Center, Tuscaloosa, Alabama
| | - Michelle M Hilgeman
- Tuscaloosa Veterans Administration (VA) Medical Center, Tuscaloosa, Alabama.,Department of Psychology and the Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa, Alabama.,Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Moni B Neradilek
- The Mountain-Whisper-Light Statistical Consulting, Seattle, Washington
| | - Keela A Herr
- The University of Iowa College of Nursing, Iowa City, Iowa
| | - Phoebe R Block
- Tuscaloosa Veterans Administration (VA) Medical Center, Tuscaloosa, Alabama.,Department of Psychology and the Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa, Alabama
| | - Amber N Collins
- Tuscaloosa Veterans Administration (VA) Medical Center, Tuscaloosa, Alabama
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12
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Somerson JS, Petersen JP, Neradilek MB, Cizik AM, Gee AO. Complications and Outcomes After Medial Ulnar Collateral Ligament Reconstruction: A Meta-Regression and Systematic Review. JBJS Rev 2019; 6:e4. [PMID: 29738408 DOI: 10.2106/jbjs.rvw.17.00138] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Evidence is limited regarding the complications and outcomes after medial ulnar collateral ligament (UCL) reconstruction. The published data regarding this procedure are composed predominantly of small Level-III and IV retrospective studies for which meta-analysis is not generally useful. Meta-regression is an alternative technique to identify variables across multiple publications that have an effect on published outcomes and complication rates. METHODS We performed a systematic search of published literature for outcomes after UCL reconstruction. A random effects meta-regression model was constructed to identify the association of study characteristics with outcome proportions. Sensitivity analyses were performed to assess the impact of influential studies on the results. RESULTS Fourteen studies (median sample size, 26 patients; range, 10 to 743 patients) were included in the systematic review and meta-regression. These studies included a total of 1,177 patients with a reported Conway outcome rating (a measure of a patient's return to play). The majority of patients (mean, 83.2%) achieved an excellent Conway rating. Studies involving the docking technique were more likely to have a higher percentage of patients with an excellent outcome (14% risk difference compared with the figure-of-8 technique, p = 0.002) and lower reported rates of ulnar neurapraxia (Spearman correlation = -0.83). A lower reported rate of ulnar neurapraxia was strongly associated with the likelihood of an excellent (p = 0.01) or good or excellent (p = 0.001) Conway outcome rating. CONCLUSIONS Despite substantial heterogeneity among study outcomes, studies that involved a docking technique and that had lower reported rates of ulnar neurapraxia were associated with greater percentages of excellent or good-to-excellent reported Conway outcome ratings. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jeremy S Somerson
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch at Galveston, Galveston, Texas
| | - John P Petersen
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | | | - Amy M Cizik
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Albert O Gee
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
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Denard PJ, Hsu JE, Whitson A, Neradilek MB, Matsen FA. Radiographic outcomes of impaction-grafted standard-length humeral components in total shoulder and ream-and-run arthroplasty: is stress shielding an issue? J Shoulder Elbow Surg 2019; 28:2181-2190. [PMID: 31272887 DOI: 10.1016/j.jse.2019.03.016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate humeral stress shielding in shoulder arthroplasties performed with a smooth, standard-length humeral stem fixed with impaction autografting. METHODS Two-year outcomes were evaluated for 48 ream-and-run arthroplasties and 78 total shoulder arthroplasties (TSAs) performed at a single institution. Postoperative radiographs were analyzed for adaptive changes, calcar osteolysis, and component shift or subsidence. Radiographic outcomes were analyzed for associations with patient demographic characteristics, humeral stem filling ratios, and glenoid loosening; clinical outcomes were assessed using the Simple Shoulder Test. RESULTS At 2 years after surgery, the ream-and-run procedures showed partial calcar osteolysis in 9 cases (19%). The TSAs showed partial calcar osteolysis in 19 cases (24%) and complete calcar osteolysis in 2 (3%). Humeral component subsidence or component shift was observed in 3 ream-and-run procedures (6%) and in 8 TSAs (10%). These radiographic findings were not significantly associated with patient demographic characteristics, canal-filling ratios, or clinical outcomes. CONCLUSION When inserted with impaction autografting, a smooth, standard-length humeral stem offers a secure bone-preserving approach for humeral component fixation in shoulder arthroplasty. These results with a conventional prosthesis can serve as a basis for comparison for new component designs and fixation methods.
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Affiliation(s)
- Patrick J Denard
- Southern Oregon Orthopedics, Medford, OR, USA; Department of Orthopaedics & Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Anastasia Whitson
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Moni B Neradilek
- The Mountain-Whisper-Light Statistical Consulting, Seattle, WA, USA
| | - Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.
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Nair BG, Neradilek MB, Newman SF, Horibe M. Association between acute phase perioperative glucose parameters and postoperative outcomes in diabetic and non-diabetic patients undergoing non-cardiac surgery. Am J Surg 2019; 218:302-310. [DOI: 10.1016/j.amjsurg.2018.10.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 10/03/2018] [Accepted: 10/12/2018] [Indexed: 01/31/2023]
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Saxena RC, Whipple ME, Neradilek MB, Solomon S, Fong CT, Nair BG, Lang JD. Does Attending Surgeon Presence at the Preinduction Briefing Improve Operating Room Efficiency? Otolaryngol Head Neck Surg 2019; 161:787-795. [PMID: 31335269 DOI: 10.1177/0194599819864319] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine if attending surgeon presence at the preinduction briefing is associated with a shorter time to incision. STUDY DESIGN Retrospective cohort study and survey. SETTING Tertiary academic medical center. SUBJECTS AND METHODS A retrospective cohort study was conducted of 22,857 operations by 141 attending surgeons across 12 specialties between August 3, 2016, and June 21, 2018. The independent variable was attending surgeon presence at the preinduction briefing. Linear regression models compared time from room entry to incision overall, by service line, and by surgeon. We hypothesized a shorter time to incision when the attending surgeon was present and a larger effect for cases with complex surgical equipment or positioning. A survey was administered to evaluate attending surgeons' perceptions of the briefing, with a response rate of 68% (64 of 94 attending surgeons). RESULTS Cases for which the attending surgeon was present at the preinduction briefing had a statistically significant yet operationally minor reduction in mean time to incision when compared with cases when the attending surgeon was absent. After covariate adjustment, the mean time to incision was associated with an efficiency gain of 1.8 ± 0.5 minutes (mean ± SD; P < .001). There were no statistically significant differences in the subgroups of complex surgical equipment and complex positioning or in secondary analysis comparing service lines. The surgeon was the strongest confounding variable. Survey results demonstrated mild support: 55% of attending surgeons highly prioritized attending the preinduction briefing. CONCLUSION Attending surgeon presence at the preinduction briefing has only a minor effect on efficiency as measured by time to incision.
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Affiliation(s)
- Rajeev C Saxena
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Mark E Whipple
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | | | - Stuart Solomon
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Christine T Fong
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Bala G Nair
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - John D Lang
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
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Shah AC, Nair B, Lang C, Ma K, Neradilek MB, Zucker FH, Lang JD. Safe on Saturday: Elective abdominal and perineal surgeries can be performed on Saturday without increased risk of poor post-operative outcome. Am J Surg 2019; 218:462-466. [PMID: 31288926 DOI: 10.1016/j.amjsurg.2019.06.026] [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] [Received: 06/25/2018] [Revised: 02/12/2019] [Accepted: 06/29/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The "weekend effect," whereby surgeries performed during weekend haven been associated with poorer postoperative outcomes. We explored whether Saturday elective procedures at our hospital were associated with poorer post-operative outcomes when compared with weekday surgeries. METHODS A retrospective cohort study of patients undergoing elective surgery on the abdomen or perineum from 2008 to 2015 was performed. Procedures were classified by day (Group 1: Monday, Tuesday, Wednesday; Group 2: Saturday). Multivariate regression analyses were performed to determine group differences in procedure duration, length-of-stay (LOS) and complications. RESULTS In adjusted analyses, there were no statistically significant differences between Group 1 (n = 816) and Group 2 (n = 269) procedures in terms of procedure duration (Group 2 - Group 1 = 13.6 min, p = .19), LOS (Group 2 - Group 1 = 1.9 days, p = .14) and complications (OR 0.58, p = .46). CONCLUSION Saturday elective procedures were not associated with poorer outcomes.
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Affiliation(s)
- Aalap C Shah
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
| | - Bala Nair
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
| | - Courtney Lang
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
| | - Kevin Ma
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
| | | | - Frank H Zucker
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
| | - John D Lang
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
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Matsen FA, Whitson A, Jackins SE, Neradilek MB, Warme WJ, Hsu JE. Ream and run and total shoulder: patient and shoulder characteristics in five hundred forty-four concurrent cases. International Orthopaedics (SICOT) 2019; 43:2105-2115. [DOI: 10.1007/s00264-019-04352-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 05/28/2019] [Indexed: 01/28/2023]
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Matsen FA, Somerson JS, Hsu JE, Lippitt SB, Russ SM, Neradilek MB. Clinical effectiveness and safety of the extended humeral head arthroplasty for selected patients with rotator cuff tear arthropathy. J Shoulder Elbow Surg 2019; 28:483-495. [PMID: 30392935 DOI: 10.1016/j.jse.2018.08.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 03/27/2018] [Accepted: 08/02/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cuff tear arthropathy is commonly managed with a reverse total shoulder arthroplasty (RTSA). A humeral hemiarthroplasty with an extended humeral head may provide a less invasive alternative for selected patients with cuff tear arthropathy if the shoulder has preserved active elevation. Because evidence regarding this procedure is limited, we investigated its safety and efficacy in treating selected patients with cuff tear arthropathy. METHODS We analyzed the preoperative characteristics, surgical findings, and clinical outcomes for patients selected for extended head hemiarthroplasty. RESULTS For 42 patients with 2-year follow-up, there were no complications or revisions. The Simple Shoulder Test score improved from a median of 3.0 to 8.0 (P < .001). The median percentage of maximal possible improvement was 50% (P < .001). The percentage of patients able to perform each of the functions of the Simple Shoulder Test was significantly improved; for example, the ability to sleep comfortably increased from 19% to 71%, and the ability to place a coin on the shelf at shoulder level increased from 38% to 86% (P < .001). CONCLUSIONS There are circumstances in which RTSA is clearly the preferred procedure for cuff tear arthropathy, including pseudoparalysis, anterosuperior escape, and glenohumeral instability; however, in shoulders with preserved active motion and stability of the humeral head provided by an intact coracoacromial arch, the extended head humeral arthroplasty can enable selected patients to realize improved comfort and function without the potential risks of RTSA. Extended humeral head hemiarthroplasty can provide a safe and effective alternative for the management of selected patients with rotator cuff tear arthropathy and preserved active motion.
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Affiliation(s)
- Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.
| | - Jeremy S Somerson
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
| | - Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Steven B Lippitt
- Department of Orthopedic Surgery, Akron Medical Center, Akron, OH, USA
| | - Stacy M Russ
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
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Somerson JS, Hsu JE, Neradilek MB, Matsen FA. Analysis of 4063 complications of shoulder arthroplasty reported to the US Food and Drug Administration from 2012 to 2016. J Shoulder Elbow Surg 2018; 27:1978-1986. [PMID: 29759905 DOI: 10.1016/j.jse.2018.03.025] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/19/2018] [Accepted: 03/25/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Most of the literature on shoulder arthroplasty failure comes from high-volume centers. These reports tend to exclude the experience of community orthopedic surgeons, who perform most of the shoulder joint replacements. METHODS We analyzed the failure reports mandated by the US Food and Drug Administration for all hospitals. Each reported event from 2012 to 2016 was characterized by implant, failure mode, and year of surgery. RESULTS For the 1673 anatomic arthroplasties, the most common failure modes were glenoid component failure (20.4%), rotator cuff/subscapularis tear (15.4%), pain/stiffness (12.9%), dislocation/instability (11.8%), infection (9%), and humeral component loosening (5.1%). For the 2390 reverse arthroplasties, the most common failure modes were dislocation/instability (32%), infection (13.8%), glenosphere-baseplate dissociation (12.2%), failed/loosened baseplate (10.4%), humeral component dissociation/tray fracture (5.5%), difficulty inserting the baseplate (4.8%), and difficulty inserting the glenosphere (4.2%). Although the percentage distribution among the different failure modes was relatively consistent over the years of this study, the percentage distribution of these failure modes differed substantially among different implant manufacturers. CONCLUSIONS The Food and Drug Administration database reveals modes of shoulder arthroplasty failure that are not emphasized in the published literature, such as rotator cuff tear, infection, and postoperative pain/stiffness for anatomic total shoulder arthroplasty and implant dissociation and baseplate failure for reverse shoulder arthroplasty. Knowledge of these failure modes may help inform surgical technique and implant design in ways that will lower the risk of implant failure in the future.
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Affiliation(s)
- Jeremy S Somerson
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX, USA
| | - Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | | | - Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.
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Haas M, Bronfort G, Evans R, Schulz C, Vavrek D, Takaki L, Hanson L, Leininger B, Neradilek MB. Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial. Spine J 2018; 18:1741-1754. [PMID: 29481979 PMCID: PMC6107442 DOI: 10.1016/j.spinee.2018.02.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 11/21/2017] [Revised: 01/30/2018] [Accepted: 02/16/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The optimal number of visits for the care of cervicogenic headache (CGH) with spinal manipulative therapy (SMT) is unknown. PURPOSE The present study aimed to identify the dose-response relationship between visits for SMT and chronic CGH outcomes and to evaluate the efficacy of SMT by comparison with a light-massage control. STUDY DESIGN/SETTING This is a two-site, open-label randomized controlled trial. PATIENT SAMPLE Participants were 256 adults with chronic CGH. OUTCOME MEASURES The primary outcome was days with CGH in the previous 4 weeks evaluated at the 12- and 24-week primary end points. Secondary outcomes included CGH days at remaining end points, pain intensity, disability, perceived improvement, medication use, and patient satisfaction. METHODS Participants were randomized to four dose levels of chiropractic SMT: 0, 6, 12, or 18 sessions. They were treated three times per week for 6 weeks and received a focused light-massage control at sessions when SMT was not assigned. Linear dose effects and comparisons with the no-manipulation control group were evaluated at 6, 12, 24, 39, and 52 weeks. The present study was funded by the National Center for Complementary and Integrative Health (R01AT006330) and is registered at ClinicalTrials.gov (NCT01530321). The authors declare no conflicts of interest. RESULTS A linear dose-response was observed for all follow-ups, a reduction of approximately 1 CGH day/4 weeks per additional 6 SMT visits (p<.05); a maximal effective dose could not be determined. Cervicogenic headache days/4 weeks were reduced from about 16 to 8 for the highest and most effective dose of 18 SMT visits. Mean differences in CGH days/4 weeks between 18 SMT visits and control were -3.3 (p=.004) and -2.9 (p=.017) at the primary end points, and were similar in magnitude at the remaining end points (p<.05). Differences between other SMT doses and control were smaller in magnitude (p>.05). Cervicogenic headache intensity showed no important improvement nor differed by dose. Other secondary outcomes were generally supportive of the primary outcome. CONCLUSIONS There was a linear dose-response relationship between SMT visits and days with CGH. For the highest and most effective dose of 18 SMT visits, CGH days were reduced by half and about 3 more days per month than for the light-massage control.
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Affiliation(s)
- Mitchell Haas
- Integrative Health & Wellbeing Research Program, Earl E. Bakken Center for Spirituality & Healing, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, USA.
| | - Gert Bronfort
- Integrative Health & Wellbeing Research Program, Earl E.
Bakken Center for Spirituality & Healing, University of Minnesota, 420
Delaware Street SE, Minneapolis, MN, USA, 55455
| | - Roni Evans
- Integrative Health & Wellbeing Research Program, Earl E.
Bakken Center for Spirituality & Healing, University of Minnesota, 420
Delaware Street SE, Minneapolis, MN, USA, 55455
| | - Craig Schulz
- Integrative Health & Wellbeing Research Program, Earl E.
Bakken Center for Spirituality & Healing, University of Minnesota, 420
Delaware Street SE, Minneapolis, MN, USA, 55455
| | - Darcy Vavrek
- Illumina, Inc, 5200 Illumina Way, San Diego, CA, USA, 92122
| | - Leslie Takaki
- University of Western States, 2900 NE 132 nd Avenue,
Portland, Oregon, USA, 97230
| | - Linda Hanson
- Integrative Health & Wellbeing Research Program, Earl E.
Bakken Center for Spirituality & Healing, University of Minnesota, 420
Delaware Street SE, Minneapolis, MN, USA, 55455
| | - Brent Leininger
- Integrative Health & Wellbeing Research Program, Earl E.
Bakken Center for Spirituality & Healing, University of Minnesota, 420
Delaware Street SE, Minneapolis, MN, USA, 55455
| | - Moni B. Neradilek
- The Mountain-Whisper-Light Statistics, 1827 23rd Ave. East, Seattle,
WA, USA, 98112
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Hsu JE, Neradilek MB, Russ SM, Matsen FA. Preoperative skin cultures are predictive of Propionibacterium load in deep cultures obtained at revision shoulder arthroplasty. J Shoulder Elbow Surg 2018; 27:765-770. [PMID: 29544667 DOI: 10.1016/j.jse.2018.01.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 11/15/2017] [Revised: 01/11/2018] [Accepted: 01/22/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Propionibacterium-specific cultures are commonly positive in revised shoulders without obvious signs of infection. To help identify patients at risk for these "stealth" presentations of positive Propionibacterium cultures, we assessed the value of a preoperative skin culture in predicting the results of deep cultures obtained at the time of revision shoulder arthroplasty in patients without clinical evidence of infection. METHODS The study enrolled 60 patients undergoing revision for a prior shoulder arthroplasty without clinical evidence of infection. A preoperative culture of the skin surface was taken before skin preparation. At surgery, multiple (mean 5.9 ± standard deviation 1.6) deep tissue and explant cultures were harvested from the shoulder. Each culture was semiquantitatively reported as the specimen Propionibacterium value (SpPV). All SpPVs from the deep specimens from each patient were summed as the total shoulder Propionibacterium score (ShPS). The averaged ShPS was the total ShPS divided by the number of deep specimens harvested. RESULTS A multivariate analysis demonstrated that the preoperative skin SpPV was predictive of the Propionibacterium load in the revised shoulders as indicated by the total ShPS (P = .004) and averaged ShPS (P = .003). CONCLUSIONS In this series of patients, a preoperative culture of the unprepared skin was strongly predictive of the Propionibacterium load in revised shoulder arthroplasties without clinical evidence of infection. This result suggests that the results of skin cultures taken before revision surgery may help inform operative management with respect to the need for prosthesis exchange and extended postoperative antibiotic treatment.
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Affiliation(s)
- Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | | | - Stacy M Russ
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.
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MacNiven I, Hsu JE, Neradilek MB, Matsen FA. Preoperative Skin-Surface Cultures Can Help to Predict the Presence of Propionibacterium in Shoulder Arthroplasty Wounds. JB JS Open Access 2018; 3:e0052. [PMID: 30229238 PMCID: PMC6132903 DOI: 10.2106/jbjs.oa.17.00052] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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] [Indexed: 01/09/2023] Open
Abstract
Background: Propionibacterium species are commonly cultured from specimens harvested at the time of revision shoulder arthroplasty. These bacteria reside in normal sebaceous glands, out of reach of surgical skin preparation. The arthroplasty incision transects these structures, which allows Propionibacterium to inoculate the wound and to potentially lead to the formation of a biofilm on the inserted implant. To help identify patients who are at increased risk for wound inoculation, we investigated whether preoperative cultures of the specimens from the unprepared skin surface were predictive of the results of intraoperative cultures of dermal wound-edge specimens obtained immediately after incision of the surgically prepared skin. Methods: Sixty-six patients (mean age, 66.1 ± 9.4 years [range, 37 to 82 years]; 73% male) undergoing primary shoulder arthroplasty had preoperative cultures of the unprepared skin surface and intraoperative cultures of the freshly incised dermis using special culture swabs. For the first 50 patients, a control swab was opened to air during the same time that the dermal specimen was obtained. The results for female and male patients were characterized as the Specimen Propionibacterium Value (SpPV). We then determined the degree to which the results of cultures of the skin surface specimens were predictive of the results of culture of the dermal specimens. Results: The skin-surface SpPV was ≥1 in 3 (17%) of the 18 female patients and 34 (71%) of the 48 male patients (p < 0.001). The dermal SpPV was ≥1 in 0 (0%) of the 18 female patients and 19 (40%) of the 48 male patients (p < 0.001). None of the control samples had an SpPV of ≥1. The predictive characteristics of a skin-surface SpPV of ≥1 for a dermal SpPV of ≥1 were as follows: sensitivity, 1.00 (95% confidence interval [CI], 0.82 to 1.00); specificity, 0.62 (95% CI, 0.46 to 0.75); positive predictive value, 0.51 (95% CI, 0.34 to 0.68); and negative predictive value, 1.00 (95% CI, 0.88 to 1.00). Conclusions: A preoperative culture of the unprepared skin surface can help to predict whether the freshly incised dermal edge is likely to be positive for Propionibacterium. This test may help to identify patients who may merit more aggressive topical and systemic antibiotic prophylaxis. Clinical Relevance: This study shows that surgeons have the opportunity to use preoperative skin cultures to determine the likelihood that the shoulder arthroplasty wound will be culture-positive for Propionibacterium.
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Affiliation(s)
- Ian MacNiven
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | | | - Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
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Sun J, Zhao XQ, Balu N, Neradilek MB, Isquith DA, Yamada K, Cantón G, Crouse JR, Anderson TJ, Huston J, O'Brien K, Hippe DS, Polissar NL, Yuan C, Hatsukami TS. Carotid Plaque Lipid Content and Fibrous Cap Status Predict Systemic CV Outcomes: The MRI Substudy in AIM-HIGH. JACC Cardiovasc Imaging 2017; 10:241-249. [PMID: 28279371 DOI: 10.1016/j.jcmg.2016.06.017] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [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: 05/16/2016] [Accepted: 06/09/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to investigate whether and what carotid plaque characteristics predict systemic cardiovascular outcomes in patients with clinically established atherosclerotic disease. BACKGROUND Advancements in atherosclerosis imaging have allowed assessment of various plaque characteristics, some of which are more directly linked to the pathogenesis of acute cardiovascular events compared to plaque burden. METHODS As part of the event-driven clinical trial AIM-HIGH (Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact on Global Health Outcomes), subjects with clinically established atherosclerotic disease underwent multicontrast carotid magnetic resonance imaging (MRI) to detect plaque tissue composition and high-risk features. Prospective associations between MRI measurements and the AIM-HIGH primary endpoint (fatal and nonfatal myocardial infarction, ischemic stroke, hospitalization for acute coronary syndrome, and symptom-driven revascularization) were analyzed using Cox proportional hazards survival models. RESULTS Of the 232 subjects recruited, 214 (92.2%) with diagnostic image quality constituted the study population (82% male, mean age 61 ± 9 years, 94% statin use). During median follow-up of 35.1 months, 18 subjects (8.4%) reached the AIM-HIGH endpoint. High lipid content (hazard ratio [HR] per 1 SD increase in percent lipid core volume: 1.57; p = 0.002) and thin/ruptured fibrous cap (HR: 4.31; p = 0.003) in carotid plaques were strongly associated with the AIM-HIGH endpoint. Intraplaque hemorrhage had a low prevalence (8%) and was marginally associated with the AIM-HIGH endpoint (HR: 3.00; p = 0.053). High calcification content (HR per 1 SD increase in percent calcification volume: 0.66; p = 0.20), plaque burden metrics, and clinical risk factors were not significantly associated with the AIM-HIGH endpoint. The associations between carotid plaque characteristics and the AIM-HIGH endpoint changed little after adjusting for clinical risk factors, plaque burden, or AIM-HIGH randomized treatment assignment. CONCLUSIONS Among patients with clinically established atherosclerotic disease, carotid plaque lipid content and fibrous cap status were strongly associated with systemic cardiovascular outcomes. Markers of carotid plaque vulnerability may serve as novel surrogate markers for systemic atherothrombotic risk.
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Affiliation(s)
- Jie Sun
- Department of Radiology, University of Washington, Seattle, Washington
| | - Xue-Qiao Zhao
- Department of Medicine, University of Washington, Seattle, Washington
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington
| | | | - Daniel A Isquith
- Department of Medicine, University of Washington, Seattle, Washington
| | - Kiyofumi Yamada
- Department of Radiology, University of Washington, Seattle, Washington
| | - Gádor Cantón
- Department of Mechanical Engineering, University of Washington, Seattle, Washington
| | - John R Crouse
- Department of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Todd J Anderson
- Libin Cardiovascular Institute of Alberta and Cumming School of Medicine, Calgary, Alberta, Canada
| | - John Huston
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Kevin O'Brien
- Department of Medicine, University of Washington, Seattle, Washington
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, Washington
| | | | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, Washington
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Somerson JS, Neradilek MB, Service BC, Hsu JE, Russ SM, Matsen FA. Clinical and Radiographic Outcomes of the Ream-and-Run Procedure for Primary Glenohumeral Arthritis. J Bone Joint Surg Am 2017; 99:1291-1304. [PMID: 28763415 DOI: 10.2106/jbjs.16.01201] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 02/01/2023]
Abstract
BACKGROUND The ream-and-run procedure can provide improvement in shoulder function and comfort for selected patients with primary glenohumeral arthritis who wish to avoid a prosthetic glenoid component. The purpose of this study was to evaluate factors associated with medialization of the humeral head after this procedure as well as the relationship of medialization to the clinical outcome. METHODS We collected patient, shoulder, and procedure characteristics along with Simple Shoulder Test (SST) scores before surgery and at the time of follow-up. Medialization was determined by comparing the position of the humeral head prosthesis in relation to the scapula on postoperative baseline radiographs made within 6 weeks after surgery with that on comparable follow-up radiographs made ≥18 months after surgery. RESULTS Two-year clinical outcomes were available for 101 patients (95% were male). Comparable radiographs at postoperative baseline and follow-up evaluations were available for 50 shoulders. For all patients, the mean SST score (and standard deviation) increased from 4.9 ± 2.8 preoperatively to 10.3 ± 2.4 at the latest follow-up (p < 0.001). Significant clinical improvement was observed for glenoid types A2 and B2. Shoulders with a type-A2 glenoid morphology, with larger preoperative scapular body-glenoid angles, and with lower preoperative SST scores, were associated with the greatest clinical improvement. Clinical outcome was not significantly associated with the amount of medialization. CONCLUSIONS The ream-and-run procedure can be an effective treatment for advanced primary glenohumeral osteoarthritis in active patients. Further study will be necessary to determine whether medialization affects the clinical outcome with follow-up of >2 years. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jeremy S Somerson
- 1The University of Texas Medical Branch, Galveston, Texas 2The Mountain-Whisper-Light Statistics, Seattle, Washington 3Orthopaedic Surgery and Sports Medicine, Orlando Health, Orlando, Florida 4Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
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Yragui NL, Demsky CA, Hammer LB, Van Dyck S, Neradilek MB. Linking Workplace Aggression to Employee Well-Being and Work: The Moderating Role of Family-Supportive Supervisor Behaviors (FSSB). J Bus Psychol 2017; 32:179-196. [PMID: 29563665 PMCID: PMC5858561 DOI: 10.1007/s10869-016-9443-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE The present study examined the moderating effects of family-supportive supervisor behaviors (FSSB) on the relationship between two types of workplace aggression (i.e., patient-initiated physical aggression and coworker-initiated psychological aggression) and employee well-being and work outcomes. METHODOLOGY Data were obtained from a field sample of 417 healthcare workers in two psychiatric hospitals. Hypotheses were tested using moderated multiple regression analyses. FINDINGS Psychiatric care providers' perceptions of FSSB moderated the relationship between patient-initiated physical aggression and physical symptoms, exhaustion and cynicism. In addition, FSSB moderated the relationship between coworker-initiated psychological aggression and physical symptoms and turnover intentions. IMPLICATIONS Based on our findings, family-supportive supervision is a plausible boundary condition for the relationship between workplace aggression and well-being and work outcomes. This study suggests that, in addition to directly addressing aggression prevention and reduction, family-supportive supervision is a trainable resource that healthcare organizations should facilitate to improve employee work and well-being in settings with high workplace aggression. ORIGINALITY This is the first study to examine the role of FSSB in influencing the relationship between two forms of workplace aggression: patient-initiated physical and coworker- initiated psychological aggression and employee outcomes.
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Affiliation(s)
- Nanette L Yragui
- Washington State Department of Labor & Industries, SHARP Program, 243 Israel Rd SE, Bldg 3, Olympia, WA 98501, USA
| | - Caitlin A Demsky
- Department of Psychology, Portland State University, Portland, OR, USA
| | - Leslie B Hammer
- Department of Psychology, Portland State University, Portland, OR, USA
| | - Sarah Van Dyck
- Department of Psychology, Portland State University, Portland, OR, USA
| | - Moni B Neradilek
- The Mountain-Whisper-Light Statistical Consulting, Seattle, WA, USA
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Elliott LS, Henderson JC, Neradilek MB, Moyer NA, Ashcraft KC, Thirumaran RK. Clinical impact of pharmacogenetic profiling with a clinical decision support tool in polypharmacy home health patients: A prospective pilot randomized controlled trial. PLoS One 2017; 12:e0170905. [PMID: 28151991 PMCID: PMC5289536 DOI: 10.1371/journal.pone.0170905] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 01/09/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In polypharmacy patients under home health management, pharmacogenetic testing coupled with guidance from a clinical decision support tool (CDST) on reducing drug, gene, and cumulative interaction risk may provide valuable insights in prescription drug treatment, reducing re-hospitalization and emergency department (ED) visits. We assessed the clinical impact of pharmacogenetic profiling integrating binary and cumulative drug and gene interaction warnings on home health polypharmacy patients. METHODS AND FINDINGS This prospective, open-label, randomized controlled trial was conducted at one hospital-based home health agency between February 2015 and February 2016. Recruitment came from patient referrals to home health at hospital discharge. Eligible patients were aged 50 years and older and taking or initiating treatment with medications with potential or significant drug-gene-based interactions. Subjects (n = 110) were randomized to pharmacogenetic profiling (n = 57). The study pharmacist reviewed drug-drug, drug-gene, and cumulative drug and/or gene interactions using the YouScript® CDST to provide drug therapy recommendations to clinicians. The control group (n = 53) received treatment as usual including pharmacist guided medication management using a standard drug information resource. The primary outcome measure was the number of re-hospitalizations and ED visits at 30 and 60 days after discharge from the hospital. The mean number of re-hospitalizations per patient in the tested vs. untested group was 0.25 vs. 0.38 at 30 days (relative risk (RR), 0.65; 95% confidence interval (CI), 0.32-1.28; P = 0.21) and 0.33 vs. 0.70 at 60 days following enrollment (RR, 0.48; 95% CI, 0.27-0.82; P = 0.007). The mean number of ED visits per patient in the tested vs. untested group was 0.25 vs. 0.40 at 30 days (RR, 0.62; 95% CI, 0.31-1.21; P = 0.16) and 0.39 vs. 0.66 at 60 days (RR, 0.58; 95% CI, 0.34-0.99; P = 0.045). Differences in composite outcomes at 60 days (exploratory endpoints) were also found. Of the total 124 drug therapy recommendations passed on to clinicians, 96 (77%) were followed. These findings should be verified with additional prospective confirmatory studies involving real-world applications in larger populations to broaden acceptance in routine clinical practice. CONCLUSIONS Pharmacogenetic testing of polypharmacy patients aged 50 and older, supported by an appropriate CDST, considerably reduced re-hospitalizations and ED visits at 60 days following enrollment resulting in potential health resource utilization savings and improved healthcare. TRIAL REGISTRATION ClinicalTrials.gov NCT02378220.
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Affiliation(s)
- Lindsay S. Elliott
- Department of Pharmacy Practice, Harding University College of Pharmacy / Unity Health – White County Medical Center, Searcy, Arkansas, United States of America
- * E-mail: (LSE); (RKT)
| | - John C. Henderson
- Unity Health - White County Medical Center, Searcy, Arkansas, United States of America
| | - Moni B. Neradilek
- The Mountain-Whisper-Light Statistics, Seattle, Washington, United States of America
| | - Nicolas A. Moyer
- Clinical Pharmacogenomics Division, Genelex Corporation, Seattle, Washington, United States of America
| | - Kristine C. Ashcraft
- Clinical Pharmacogenomics Division, Genelex Corporation, Seattle, Washington, United States of America
| | - Ranjit K. Thirumaran
- Clinical Pharmacogenomics Division, Genelex Corporation, Seattle, Washington, United States of America
- * E-mail: (LSE); (RKT)
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Plant JD, Neradilek MB. Effectiveness of regionally-specific immunotherapy for the management of canine atopic dermatitis. BMC Vet Res 2017; 13:4. [PMID: 28056956 PMCID: PMC5216569 DOI: 10.1186/s12917-016-0917-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 12/09/2016] [Indexed: 01/08/2023] Open
Abstract
Background Canine atopic dermatitis is a common pruritic skin disease often treated with allergen immunotherapy (AIT). AIT in dogs traditionally begins with attempting to identify clinically relevant environmental allergens. Current allergen testing methodologies and immunotherapy techniques in dogs are not standardized. Immunotherapy with a mixture of allergenic extracts selected based on regional aerobiology rather than intradermal tests or serum IgE assays has been described. The objective of this study was to evaluate the effectiveness of regionally-specific immunotherapy in dogs with atopic dermatitis. The medical records of a veterinary dermatology referral clinic were searched for dogs with atopic dermatitis that began regionally-specific subcutaneous immunotherapy from June, 2010 to May, 2013. An overall assessment of treatment effectiveness (excellent, good, fair, or poor) was assigned based upon changes in pruritus severity, lesion severity, and the reduction in concurrent medication(s) during a follow-up period of at least 270 days. Baseline characteristics that might predict treatment success were analyzed with the Spearman’s correlation and the Kruskal-Wallis tests. Results Of the 286 dogs that began regionally-specific immunotherapy (RESPIT) during a 3 year period, 103 met the inclusion criteria. The overall response to RESPIT was classified as excellent in 19%, good in 38%, fair in 25%, and poor in 18% of dogs. The response classification correlated significantly with a reduction in pruritus severity (r = 0.72, p < 0.001) and lesion severity (r = 0.54, p < 0.001), but not with the dogs’ baseline characteristics. Adverse reactions were reported in 7/286 (2.4%) of treated dogs. Conclusions Under the conditions of this study, RESPIT was safe and effective for the treatment of atopic dermatitis in dogs.
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Affiliation(s)
- Jon D Plant
- SkinVet Clinic, 15800 Upper Boones Ferry Road, Suite 120, Lake Oswego, 97035, OR, USA.
| | - Moni B Neradilek
- The Mountain-Whisper-Light Statistics, 1827 23rd Avenue East, Seattle, 98112, WA, USA
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Lucas RM, Hsu JE, Gee AO, Neradilek MB, Matsen FA. Impaction autografting: bone-preserving, secure fixation of a standard humeral component. J Shoulder Elbow Surg 2016; 25:1787-1794. [PMID: 27262410 DOI: 10.1016/j.jse.2016.03.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 01/21/2016] [Revised: 03/02/2016] [Accepted: 03/13/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND When fixed with bone ingrowth, a tight diaphyseal press fit, or cement, the humeral component of a shoulder arthroplasty may present problems of malposition, stress shielding, or periprosthetic fracture or difficulty with removal at revision arthroplasty. We have avoided the need for these fixation methods by using impaction cancellous autografting of the humeral stem, minimizing contact between the prosthetic stem and the humeral cortex. This study presents the radiographic survivorship of impaction-autografted humeral implants using component subsidence as the primary endpoint. METHODS We reviewed 286 primary anatomic shoulder arthroplasties having an average follow-up of 4.9 ± 2.7 years. Initial postoperative radiographs and minimum 2-year follow-up radiographs were evaluated by 3 observers to assess subsidence. RESULTS Two different implants (Humeral Replacement Prosthesis [HRP] and Global Advantage prosthesis) were used. Of 286 stems, 267 (93.4%) had not subsided. The Global Advantage prosthesis had a subsidence-free survival rate of 98.5% at 5 years. The stiffer-stemmed HRP used early during the study had a higher rate of subsidence compared with the currently used Global Advantage stem (hazard ratio, 5.6; P = .001). Radiolucent lines of 2 mm or greater were less common for the Global Advantage prosthesis than for the HRP in each of 7 zones (P < .001). Total shoulder arthroplasty was associated with a higher rate of subsidence compared with hemiarthroplasty (hazard ratio, 2.6; P = .12). CONCLUSIONS Impaction autografting provides a secure, durable, bone-preserving means of humeral component fixation in anatomic shoulder arthroplasty.
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Affiliation(s)
- Robert M Lucas
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Albert O Gee
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | | | - Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.
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DeLong WB, Polissar NL, Neradilek MB, Laam LA. A Letter to the Editor regarding, "Time to Surgery and Outcomes in Cauda Equina Syndrome: An Analysis of 45 Cases." Critique of Bydon et al. World Neurosurg 2016; 93:479-82. [PMID: 27637700 DOI: 10.1016/j.wneu.2016.02.107] [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] [Received: 02/23/2016] [Accepted: 02/25/2016] [Indexed: 10/21/2022]
Affiliation(s)
- W Bradford DeLong
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA.
| | | | | | - Leslie A Laam
- Health Services Research and Policy, University of Rochester Medical Center, Rochester, New York, USA
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Nair BG, Horibe M, Neradilek MB, Newman SF, Peterson GN. The Effect of Intraoperative Blood Glucose Management on Postoperative Blood Glucose Levels in Noncardiac Surgery Patients. Anesth Analg 2016; 122:893-902. [DOI: 10.1213/ane.0000000000001100] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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O'Brien KD, Hippe DS, Chen H, Neradilek MB, Probstfield JL, Peck S, Isquith DA, Canton G, Yuan C, Polissar NL, Zhao XQ, Kerwin WS. Longer duration of statin therapy is associated with decreased carotid plaque vascularity by magnetic resonance imaging. Atherosclerosis 2016; 245:74-81. [PMID: 26708287 PMCID: PMC8629315 DOI: 10.1016/j.atherosclerosis.2015.11.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 11/06/2015] [Accepted: 11/26/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Plaque neovasculature is a major route for lipoprotein and leukocyte ingress into plaques, and has been identified as a risk factor for carotid plaque disruption. Vp, a variable derived from pharmacokinetic modeling of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), correlates with plaque neovasculature density. Because lipid-lowering therapy has been associated with regression of neovasculature in animal models, we sought to determine clinical correlates of carotid plaque neovasculature (as assessed by Vp) in participants on statin therapy for established cardiovascular disease. METHODS 98 participants from an AIM-HIGH sub-study underwent DCE-MRI of their carotid arteries. Expert readers who were blinded to all clinical variables analyzed the MR images to measure carotid plaque Vp in all participants. Associations between Vp and duration of statin therapy and other clinical risk factors were analyzed. RESULTS Prior duration of statin treatment at enrollment ranged from <1 year (21%) 1-5 years (40%) and >5 years (39%). In univariate analyses, shorter duration of statin therapy (P = 0.01), the presence of metabolic syndrome (P = 0.02), and higher body mass index (P = 0.01) and lipoprotein(a) (P = 0.01) were all significantly associated with higher baseline Vp values. In multivariate analyses, significant associations remained between shorter duration of statin therapy (P = 0.004) and lipoprotein(a) (P = 0.04). CONCLUSIONS These are the first human, in vivo findings suggesting a relationship between duration of statin therapy and regression of carotid plaque neovasculature. Future longitudinal studies are warranted both to confirm this finding and to address whether changes in neovasculature may translate into change in risk for plaque disruption. CLINICALTRIALS. GOV IDENTIFIERS NCT00880178, NCT01178320 and NCT00120289.
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Affiliation(s)
- Kevin D O'Brien
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA.
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Huijun Chen
- Center for Biomedical Imaging Research, Tsinghua University, Beijing, China
| | | | - Jeffrey L Probstfield
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Suzanne Peck
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Daniel A Isquith
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Gador Canton
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, USA
| | | | - Xue-Qiao Zhao
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
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O'Brien KD, Hippe DS, Chen H, Neradilek MB, Probstfield JL, Peck S, Isquith DA, Canton G, Yuan C, Polissar NL, Zhao XQ, Kerwin WS. Summary of clinical and laboratory data of study subjects with and without DCE-MRI plaque measurements in the AIM-HIGH clinical trial. Data Brief 2016; 6:476-81. [PMID: 26977429 PMCID: PMC4773570 DOI: 10.1016/j.dib.2015.12.030] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 12/18/2015] [Accepted: 12/22/2015] [Indexed: 11/25/2022] Open
Abstract
This brief data article summarizes the clinical risk factors and laboratory data of a group of subjects recruited for the AIM-HIGH trial (Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides and Impact on Global Health Outcomes) and an associated magnetic resonance imaging (MRI) substudy. The sample is restricted to those on statin therapy at the time of enrollment and data are presented stratified by whether dynamic contrast enhanced MRI (DCE-MRI) markers of carotid plaque vascularity and inflammation were available or not. The data provided herein are directly related to the article “Longer Duration of Statin Therapy is Associated with Decreased Carotid Plaque Vascularity by Magnetic Resonance Imaging” [2].
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Affiliation(s)
- Kevin D O'Brien
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Huijun Chen
- Center for Biomedical Imaging Research, Tsinghua University, Beijing, China
| | | | - Jeffrey L Probstfield
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Suzanne Peck
- Center for Child Health, Behavior and Development, Seattle Children׳s Research Institute, Seattle, WA, USA
| | - Daniel A Isquith
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Gador Canton
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, USA
| | | | - Xue-Qiao Zhao
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
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Mischley LK, Leverenz JB, Lau RC, Polissar NL, Neradilek MB, Samii A, Standish LJ. A randomized, double-blind phase I/IIa study of intranasal glutathione in Parkinson's disease. Mov Disord 2015; 30:1696-701. [PMID: 26230671 DOI: 10.1002/mds.26351] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/24/2015] [Accepted: 06/29/2015] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Depletion of reduced glutathione is associated with PD and glutathione augmentation has been proposed as a disease-modifying strategy. The aim of this study was to determine the safety and tolerability of intranasal reduced glutathione in individuals with PD. METHODS Thirty individuals with PD were randomized to either placebo (saline), 300 mg/day, or 600 mg/day of intranasal glutathione in three divided daily doses. Follow-up visits included side effect screening of PD symptoms and cognition, blood chemistry, sinus irritation, and hyposmia. Tolerability was measured by frequency and severity of reported adverse events, compliance, and withdrawals from the study. RESULTS After 3 months, there were no substantial differences between groups in the number of adverse events reported or observed among all safety measures assessed. All groups met tolerability criteria. CONCLUSIONS These data support the safety and tolerability of intranasal glutathione in this population. Pharmacokinetic and dose-finding studies are warranted.
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Affiliation(s)
- Laurie K Mischley
- Bastyr University Research Institute, Kenmore, Washington, USA.,Department of Nutritional Sciences, University of Washington, Seattle, Washington, USA
| | - James B Leverenz
- Cleveland Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, Ohio, USA
| | - Richard C Lau
- Bastyr University Research Institute, Kenmore, Washington, USA.,School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon, USA
| | | | | | - Ali Samii
- Department of Neurology, University of Washington; Northwest PADRECC at the Seattle VA Medical Center, Washington, USA
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Nair BG, Grunzweig K, Peterson GN, Horibe M, Neradilek MB, Newman SF, Van Norman G, Schwid HA, Hao W, Hirsch IB, Patchen Dellinger E. Intraoperative blood glucose management: impact of a real-time decision support system on adherence to institutional protocol. J Clin Monit Comput 2015; 30:301-12. [DOI: 10.1007/s10877-015-9718-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 06/05/2015] [Indexed: 11/28/2022]
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Ortiz JR, Neuzil KM, Shay DK, Rue TC, Neradilek MB, Zhou H, Seymour CW, Hooper LG, Cheng PY, Goss CH, Cooke CR. The burden of influenza-associated critical illness hospitalizations. Crit Care Med 2014; 42:2325-32. [PMID: 25148596 DOI: 10.1097/ccm.0000000000000545] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Influenza is the most common vaccine-preventable disease in the United States; however, little is known about the burden of critical illness due to influenza virus infection. Our primary objective was to estimate the proportion of all critical illness hospitalizations that are attributable to seasonal influenza. DESIGN Retrospective cohort study. SETTING Arizona, California, and Washington from January 2003 to March 2009. PATIENTS All adults hospitalized with critical illness, defined by International Classification of Diseases, 9th Edition, Clinical Modification diagnosis and procedure codes for acute respiratory failure, severe sepsis, or in-hospital death. MEASUREMENTS AND MAIN RESULTS We combined the complete hospitalization discharge databases for three U.S. states, regional influenza virus surveillance, and state census data. Using negative binomial regression models, we estimated the incidence rates of adult influenza-associated critical illness hospitalizations and compared them with all-cause event rates. We also compared modeled outcomes to International Classification of Diseases, 9th Edition, Clinical Modification-coded influenza hospitalizations to assess potential underrecognition of severe influenza disease. During the study period, we estimated that 26,760 influenza-associated critical illness hospitalizations (95% CI, 14,541, 47,464) occurred. The population-based incidence estimate for influenza-associated critical illness was 12.0 per 100,000 person-years (95% CI, 6.6, 21.6) or 1.3% of all critical illness hospitalizations (95% CI, 0.7%, 2.3%). During the influenza season, 3.4% of all critical illness hospitalizations (95% CI, 1.9%, 5.8%) were attributable to influenza. There were only 2,612 critical illness hospitalizations with International Classification of Diseases, 9th Edition, Clinical Modification-coded influenza diagnoses, suggesting influenza is either undiagnosed or undercoded in a substantial proportion of critical illness. CONCLUSIONS Extrapolating our data to the 2010 U.S. population, we estimate that about 28,000 adults are hospitalized for influenza-associated critical illness annually. Influenza in many of these critically ill patients may be undiagnosed. Critical care physicians should have a high index of suspicion for influenza in the ICU, particularly when influenza is known to be circulating in their communities.
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Affiliation(s)
- Justin R Ortiz
- 1Department of Medicine, University of Washington, Seattle, WA. 2Department of Global Health, University of Washington, Seattle, WA. 3Vaccine Access and Delivery Global Program, PATH, Seattle, WA. 4Influenza Division, Centers for Disease Control and Prevention, Centers for Disease Prevention and Control, Atlanta, GA. 5Department of Biostatistics, University of Washington, Seattle, WA. 6The Mountain-Whisper-Light Statistics, Seattle, WA. 7Division of Health Informatics and Surveillance (proposed), Centers for Disease Prevention and Control, Atlanta, GA. 8Departments of Critical Care and Emergency Medicine, University of Pittsburgh, Pittsburgh, PA. 9Department of Medicine, University of Michigan, Ann Arbor, MI
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Ortiz JR, Neuzil KM, Cooke CR, Neradilek MB, Goss CH, Shay DK. Influenza pneumonia surveillance among hospitalized adults may underestimate the burden of severe influenza disease. PLoS One 2014; 9:e113903. [PMID: 25423025 PMCID: PMC4244176 DOI: 10.1371/journal.pone.0113903] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 11/02/2014] [Indexed: 01/10/2023] Open
Abstract
Background Studies seeking to estimate the burden of influenza among hospitalized adults often use case definitions that require presence of pneumonia. The goal of this study was to assess the extent to which restricting influenza testing to adults hospitalized with pneumonia could underestimate the total burden of hospitalized influenza disease. Methods We conducted a modelling study using the complete State Inpatient Databases from Arizona, California, and Washington and regional influenza surveillance data acquired from CDC from January 2003 through March 2009. The exposures of interest were positive laboratory tests for influenza A (H1N1), influenza A (H3N2), and influenza B from two contiguous US Federal Regions encompassing the study area. We identified the two outcomes of interest by ICD-9-CM code: respiratory and circulatory hospitalizations, as well as critical illness hospitalizations (acute respiratory failure, severe sepsis, and in-hospital death). We linked the hospitalization datasets with the virus surveillance datasets by geographic region and month of hospitalization. We used negative binomial regression models to estimate the number of influenza-associated events for the outcomes of interest. We sub-categorized these events to include all outcomes with or without pneumonia diagnosis codes. Results We estimated that there were 80,834 (95% CI 29,214–174,033) influenza-associated respiratory and circulatory hospitalizations and 26,760 (95% CI 14,541–47,464) influenza-associated critical illness hospitalizations. When a pneumonia diagnosis was excluded, the estimated number of influenza-associated respiratory and circulatory hospitalizations was 24,816 (95% CI 6,342–92,624). The estimated number of influenza-associated critical illness hospitalizations was 8,213 (95% CI 3,764–20,799). Around 30% of both influenza-associated respiratory and circulatory hospitalizations, as well as influenza-associated critical illness hospitalizations did not have pneumonia diagnosis codes. Conclusions Surveillance studies which only consider hospitalizations that include a diagnosis of pneumonia may underestimate the total burden of influenza hospitalizations.
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Affiliation(s)
- Justin R. Ortiz
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Vaccine Access and Delivery Global Program, PATH, Seattle, Washington, United States of America
- * E-mail:
| | - Kathleen M. Neuzil
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Vaccine Access and Delivery Global Program, PATH, Seattle, Washington, United States of America
| | - Colin R. Cooke
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Moni B. Neradilek
- The Mountain-Whisper-Light Statistics, Seattle, Washington, United States of America
| | - Christopher H. Goss
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - David K. Shay
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Sun J, Zhao XQ, Balu N, Hippe DS, Hatsukami TS, Isquith DA, Yamada K, Neradilek MB, Cantón G, Xue Y, Fleg JL, Desvigne-Nickens P, Klimas MT, Padley RJ, Vassileva MT, Wyman BT, Yuan C. Carotid magnetic resonance imaging for monitoring atherosclerotic plaque progression: a multicenter reproducibility study. Int J Cardiovasc Imaging 2014; 31:95-103. [PMID: 25216871 DOI: 10.1007/s10554-014-0532-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [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: 05/21/2014] [Accepted: 09/04/2014] [Indexed: 11/28/2022]
Abstract
This study sought to determine the multicenter reproducibility of magnetic resonance imaging (MRI) and the compatibility of different scanner platforms in assessing carotid plaque morphology and composition. A standardized multi-contrast MRI protocol was implemented at 16 imaging sites (GE: 8; Philips: 8). Sixty-eight subjects (61 ± 8 years; 52 males) were dispersedly recruited and scanned twice within 2 weeks on the same magnet. Images were reviewed centrally using a streamlined semiautomatic approach. Quantitative volumetric measurements on plaque morphology (lumen, wall, and outer wall) and plaque tissue composition [lipid-rich necrotic core (LRNC), calcification, and fibrous tissue] were obtained. Inter-scan reproducibility was summarized using the within-subject standard deviation, coefficient of variation (CV) and intraclass correlation coefficient (ICC). Good to excellent reproducibility was observed for both morphological (ICC range 0.98-0.99) and compositional (ICC range 0.88-0.96) measurements. Measurement precision was related to the size of structures (CV range 2.5-4.9 % for morphology, 36-44 % for LRNC and calcification). Comparable measurement variability was found between the two platforms on both plaque morphology and tissue composition. In conclusion, good to excellent inter-scan reproducibility of carotid MRI can be achieved in multicenter settings with comparable measurement precision between platforms, which may facilitate future multicenter endeavors that use serial MRI to monitor atherosclerotic plaque progression.
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Affiliation(s)
- Jie Sun
- Department of Radiology, University of Washington, 850 Republican St Brotman 127, Seattle, WA, 98109, USA,
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Chen H, Sun J, Kerwin WS, Balu N, Neradilek MB, Hippe DS, Isquith D, Xue Y, Yamada K, Peck S, Yuan C, O’Brien KD, Zhao XQ. Scan-rescan reproducibility of quantitative assessment of inflammatory carotid atherosclerotic plaque using dynamic contrast-enhanced 3T CMR in a multi-center study. J Cardiovasc Magn Reson 2014; 16:51. [PMID: 25084698 PMCID: PMC4237824 DOI: 10.1186/s12968-014-0051-7] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 06/30/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The aim of this study is to investigate the inter-scan reproducibility of kinetic parameters in atherosclerotic plaque using dynamic contrast-enhanced (DCE) cardiovascular magnetic resonance (CMR) in a multi-center setting at 3T. METHODS Carotid arteries of 51 subjects from 15 sites were scanned twice within two weeks on 3T scanners using a previously described DCE-CMR protocol. Imaging data with protocol compliance and sufficient image quality were analyzed to generate kinetic parameters of vessel wall, expressed as transfer constant (K trans ) and plasma volume (v p ). The inter-scan reproducibility was evaluated using intra-class correlation coefficient (ICC) and coefficient of variation (CV). Power analysis was carried out to provide sample size estimations for future prospective study. RESULTS Ten (19.6%) subjects were found to suffer from protocol violation, and another 6 (11.8%) had poor image quality (n=6) in at least one scan. In the 35 (68.6%) subjects with complete data, the ICCs of K trans and v p were 0.65 and 0.28, respectively. The CVs were 25% and 62%, respectively. The ICC and CV for v p improved to 0.73 and 28% in larger lesions with analyzed area larger than 25 mm2. Power analysis based on the measured CV showed that 50 subjects per arm are sufficient to detect a 20% difference in change of K trans over time between treatment arms with 80% power without consideration of the dropout rate. CONCLUSION The result of this study indicates that quantitative measurement from DCE-CMR is feasible to detect changes with a relatively modest sample size in a prospective multi-center study despite the limitations. The relative high dropout rate suggested the critical needs for intensive operator training, optimized imaging protocol, and strict quality control in future studies.
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Affiliation(s)
- Huijun Chen
- Department of Biomedical Engineering, Center for Biomedical Imaging Research, School of Medicine, Tsinghua University, Beijing 100084, China
- Department of Radiology, University of Washington, 850 Republican St, Seattle 98109, WA, USA
| | - Jie Sun
- Department of Radiology, University of Washington, 850 Republican St, Seattle 98109, WA, USA
| | - William S Kerwin
- Department of Radiology, University of Washington, 850 Republican St, Seattle 98109, WA, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington, 850 Republican St, Seattle 98109, WA, USA
| | - Moni B Neradilek
- The Mountain-Whisper-Light Statistics, 1827 23rd Ave. East, Seattle 98112, WA, USA
| | - Daniel S Hippe
- Department of Radiology, University of Washington, 850 Republican St, Seattle 98109, WA, USA
| | - Daniel Isquith
- Division of Cardiology, University of Washington School of Medicine, 325 9th Ave, Harborview Medical Center, Seattle 98104, WA, USA
| | - Yunjing Xue
- Department of Radiology, University of Washington, 850 Republican St, Seattle 98109, WA, USA
| | - Kiyofumi Yamada
- Department of Radiology, University of Washington, 850 Republican St, Seattle 98109, WA, USA
| | - Suzanne Peck
- Division of Cardiology, University of Washington School of Medicine, 325 9th Ave, Harborview Medical Center, Seattle 98104, WA, USA
| | - Chun Yuan
- Department of Biomedical Engineering, Center for Biomedical Imaging Research, School of Medicine, Tsinghua University, Beijing 100084, China
- Department of Radiology, University of Washington, 850 Republican St, Seattle 98109, WA, USA
| | - Kevin D O’Brien
- Division of Cardiology, University of Washington School of Medicine, 325 9th Ave, Harborview Medical Center, Seattle 98104, WA, USA
| | - Xue-Qiao Zhao
- Division of Cardiology, University of Washington School of Medicine, 325 9th Ave, Harborview Medical Center, Seattle 98104, WA, USA
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Haas M, Vavrek D, Peterson D, Polissar N, Neradilek MB. Dose-response and efficacy of spinal manipulation for care of chronic low back pain: a randomized controlled trial. Spine J 2014; 14:1106-16. [PMID: 24139233 PMCID: PMC3989479 DOI: 10.1016/j.spinee.2013.07.468] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [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: 11/26/2012] [Revised: 07/17/2013] [Accepted: 07/22/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT There have been no full-scale trials of the optimal number of visits for the care of any condition with spinal manipulation. PURPOSE To identify the dose-response relationship between visits to a chiropractor for spinal manipulation and chronic low back pain (cLBP) outcomes and to determine the efficacy of manipulation by comparison with a light massage control. STUDY DESIGN/SETTING Practice-based randomized controlled trial. PATIENT SAMPLE Four hundred participants with cLBP. OUTCOME MEASURES The primary cLBP outcomes were the 100-point modified Von Korff pain intensity and functional disability scales evaluated at the 12- and 24-week primary end points. Secondary outcomes included days with pain and functional disability, pain unpleasantness, global perceived improvement, medication use, and general health status. METHODS One hundred participants with cLBP were randomized to each of four dose levels of care: 0, 6, 12, or 18 sessions of spinal manipulation from a chiropractor. Participants were treated three times per week for 6 weeks. At sessions when manipulation was not assigned, they received a focused light massage control. Covariate-adjusted linear dose effects and comparisons with the no-manipulation control group were evaluated at 6, 12, 18, 24, 39, and 52 weeks. RESULTS For the primary outcomes, mean pain and disability improvement in the manipulation groups were 20 points by 12 weeks and sustainable to 52 weeks. Linear dose-response effects were small, reaching about two points per six manipulation sessions at 12 and 52 weeks for both variables (p<.025). At 12 weeks, the greatest differences from the no-manipulation control were found for 12 sessions (8.6 pain and 7.6 disability points, p<.025); at 24 weeks, differences were negligible; and at 52 weeks, the greatest group differences were seen for 18 visits (5.9 pain and 8.8 disability points, p<.025). CONCLUSIONS The number of spinal manipulation visits had modest effects on cLBP outcomes above those of 18 hands-on visits to a chiropractor. Overall, 12 visits yielded the most favorable results but was not well distinguished from other dose levels.
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Affiliation(s)
- Mitchell Haas
- Center for Outcomes Studies, University of Western States, 2700 NE 132nd Ave., Portland, OR 97230, USA.
| | - Darcy Vavrek
- Center for Outcomes Studies, University of Western States, 2700 NE 132nd Ave., Portland, OR, USA
| | - David Peterson
- Division of Chiropractic Sciences, University of Western States, 2700 NE 132nd Ave., Portland, OR, USA
| | - Nayak Polissar
- The Mountain-Whisper-Light Statistics, 1827 23rd Ave. East, Seattle, WA, USA
| | - Moni B. Neradilek
- The Mountain-Whisper-Light Statistics, 1827 23rd Ave. East, Seattle, WA, USA
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Udenberg TJ, Griffin CE, Rosenkrantz WS, Ghubash RM, Angus JC, Polissar NL, Neradilek MB. Reproducibility of a quantitative cutaneous cytological technique. Vet Dermatol 2014; 25:435-e67. [DOI: 10.1111/vde.12138] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Tyler J. Udenberg
- Animal Dermatology Clinic; 4834 Lincoln Boulevard Marina Del Rey CA 90292 USA
| | - Craig E. Griffin
- Animal Dermatology Clinic; 5610 Kearny Mesa Road San Diego CA 92111 USA
| | | | - Rudayna M. Ghubash
- Animal Dermatology Clinic; 4834 Lincoln Boulevard Marina Del Rey CA 90292 USA
| | - John C. Angus
- Animal Dermatology Clinic; 150 North San Gabriel Boulevard, Suite 400 Pasadena CA 91107 USA
| | - Nayak L. Polissar
- The Mountain-Whisper-Light Statistics; 1827 23rd Avenue East Seattle WA 98112 USA
| | - Moni B. Neradilek
- The Mountain-Whisper-Light Statistics; 1827 23rd Avenue East Seattle WA 98112 USA
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Haas M, Vavrek D, Neradilek MB, Polissar N. A path analysis of the effects of the doctor-patient encounter and expectancy in an open-label randomized trial of spinal manipulation for the care of low back pain. Altern Ther Health Med 2014; 14:16. [PMID: 24410959 PMCID: PMC3897979 DOI: 10.1186/1472-6882-14-16] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 01/10/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND The doctor-patient encounter (DPE) and associated patient expectations are potential confounders in open-label randomized trials of treatment efficacy. It is therefore important to evaluate the effects of the DPE on study outcomes. METHODS Four hundred participants with chronic low back pain (LBP) were randomized to four dose groups: 0, 6, 12, or 18 sessions of spinal manipulation from a chiropractor. Participants were treated three times per week for six weeks. They received light massage control at visits when manipulation was not scheduled. Treating chiropractors were instructed to have equal enthusiasm for both interventions. A path analysis was conducted to determine the effects of dose, patient expectations of treatment success, and DPE on LBP intensity (100-point scale) at the end of care (6 weeks) and primary endpoint (12 weeks). Direct, indirect, and total standardized effects (βtotal) were computed. Expectations and DPE were evaluated on Likert scales. The DPE was assessed as patient-rated perception of chiropractor enthusiasm, confidence, comfort with care, and time spent. RESULTS The DPE was successfully balanced across groups, as were baseline expectations. The principal finding was that the magnitude of the effects of DPE on LBP at 6 and 12 weeks (|β|total = 0.22 and 0.15, p < .05) were comparable to the effects of dose of manipulation at those times (|β|total = 0.11 and 0.12, p < .05). In addition, baseline expectations had no notable effect on follow-up LBP. Subsequent expectations were affected by LBP, DPE, and dose (p < .05). CONCLUSIONS The DPE can have a relatively important effect on outcomes in open-label randomized trials of treatment efficacy. Therefore, attempts should be made to balance the DPE across treatment groups and report degree of success in study publications. We balanced the DPE across groups with minimal training of treatment providers. TRIAL REGISTRATION ClinicalTrials.gov NCT00376350.
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Wong WM, Korde LA, Roberts TK, Arnett AL, Mart DA, Barnes BS, Neradilek MB, Polissar NL, Amlag JO, Kim JN. Long-term outcomes of post-mastectomy radiation therapy in the setting of neoadjuvant chemotherapy for locally advanced breast cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e12030] [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
e12030 Background: The role of post-mastectomy radiation therapy (PMRT) after neo-adjuvant chemotherapy (NCT) in those with T3N0 disease, younger age, and different tumor subtypes is unclear. Methods: We conducted a single institution, retrospective analysis of patients treated with NCT and mastectomy from 1985-2010. The primary objectives were to (1) assess the association between PMRT and long-term outcomes, and (2) describe outcomes and practice patterns based on tumor subtype, pathologic response, and age at diagnosis. Secondary objectives were to analyze the benefit of PMRT in those with favorable tumor subtypes, cT3N0 disease, and patients younger than 40. Log-rank test and Cox regression was used to test the association of predictors with outcomes. IRB approval was obtained. Results: Of 131 evaluable patients, 115 (88%) received PMRT. Mean±SD age was 48±10 years (range 29-79). Of patients <40 years of age (n=33) 88% received PMRT. At diagnosis, 69.5% were cT3; 53.5% were cN1; 12.3% were cT3N0. Seventy-eight percent of patients received anthracycline-based NCT and 52% received both anthracycline and taxane NCT. Twenty-eight percent of all patients achieved pCR. With a median f/u of 39 months (range 8-177), 30.5% of patients had a recurrence event (6.9% local, 5.3% nodal, 16.8% distant). Ten year OS and DFS for all patients were 56.7% (95% CI, 43.5-73.8) and 66.1% (95% CI, 52.3-83.5), respectively. Those with pCR had a non-significant trend toward better outcome, with 10 year OS=68.0% vs. 54.0% (p=0.7); DFS=70.2% vs. 65.2% (p=1.0). In the Cox regression analysis, pathologic T-stage, triple negative disease, and tumor grade were significantly associated with OS; triple negative disease was also predictive of DFS. Benefit of PMRT was not analyzable in cT3N0 due to small numbers. Conclusions: Most patients had PMRT, with outcomes on par with historical data. Most patients <40 years received PMRT, with no events for the non-PMRT cohort most likely due to selection bias. Unfavorable subgroups were not more likely to receive PMRT, but of those who did, only triple negative was predictive of outcome. A future non-PMRT matched cohort study is necessary to further elucidate the role of PMRT.
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Plant JD, Gortel K, Kovalik M, Polissar NL, Neradilek MB. Development and validation of the Canine Atopic Dermatitis Lesion Index, a scale for the rapid scoring of lesion severity in canine atopic dermatitis. Vet Dermatol 2013; 23:515-e103. [PMID: 23140318 DOI: 10.1111/j.1365-3164.2012.01113.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The third iteration of the Canine Atopic Dermatitis Extent and Severity Index (CADESI-03) is the only tool rigorously validated for canine atopic dermatitis (CAD) lesion scoring. The CADESI-03 requires 248 evaluations, limiting its widespread use. HYPOTHESIS/OBJECTIVES The goal of the study was to develop and validate a practical method of grading CAD lesions that requires scoring only the frequently affected body regions. ANIMALS Fifty-seven privately owned atopic dogs were used in the study. METHODS The Canine Atopic Dermatitis Lesion Index (CADLI) was evaluated in an open, multicentre reliability study. Validity was assessed with expert opinion (content validity) and comparison of CADLI with existing disease severity measures (construct and criterion validity). Reliability was evaluated by analysing repeated observations of each dog. Convenience was assessed in terms of the time required to complete the scale. RESULTS The CADLI scores correlated with overall assessment scores (r = 0.60, P < 0.001, linear mixed model) and pruritus severity scores (r = 0.53, P < 0.001, linear mixed model), establishing construct validity. The CADLI was strongly correlated with CADESI-03 (r = 0.84, P < 0.001, linear mixed model), establishing criterion validity. The CADLI values obtained by two observers correlated very strongly (r = 0.91, P < 0.001), as did the repeat values for the same observer (r = 0.98, P < 0.001). The mean time to complete the CADLI was less than that required for CADESI-03 (1.9 and 12.6 min, respectively), a highly significant difference (P < 0.001). CONCLUSION AND CLINICAL IMPORTANCE The CADLI was found to be an effective measure of CAD lesion severity, strongly correlating with CADESI-03. The convenience of CADLI makes it suitable for use in both clinical research and practice.
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Ersek M, Polissar N, Pen AD, Jablonski A, Herr K, Neradilek MB. Addressing methodological challenges in implementing the nursing home pain management algorithm randomized controlled trial. Clin Trials 2012; 9:634-44. [PMID: 22879574 PMCID: PMC4426859 DOI: 10.1177/1740774512454243] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Unrelieved pain among nursing home (NH) residents is a well-documented problem. Attempts have been made to enhance pain management for older adults, including those in NHs. Several evidence-based clinical guidelines have been published to assist providers in assessing and managing acute and chronic pain in older adults. Despite the proliferation and dissemination of these practice guidelines, research has shown that intensive systems-level implementation strategies are necessary to change clinical practice and patient outcomes within a health-care setting. One promising approach is the embedding of guidelines into explicit protocols and algorithms to enhance decision making. PURPOSE The goal of the article is to describe several issues that arose in the design and conduct of a study that compared the effectiveness of pain management algorithms coupled with a comprehensive adoption program versus the effectiveness of education alone in improving evidence-based pain assessment and management practices, decreasing pain and depressive symptoms, and enhancing mobility among NH residents. METHODS The study used a cluster-randomized controlled trial (RCT) design in which the individual NH was the unit of randomization. The Roger's Diffusion of Innovations theory provided the framework for the intervention. Outcome measures were surrogate-reported usual pain, self-reported usual and worst pain, and self-reported pain-related interference with activities, depression, and mobility. RESULTS The final sample consisted of 485 NH residents from 27 NHs. The investigators were able to use a staggered enrollment strategy to recruit and retain facilities. The adaptive randomization procedures were successful in balancing intervention and control sites on key NH characteristics. Several strategies were successfully implemented to enhance the adoption of the algorithm. LIMITATIONS/LESSONS: The investigators encountered several methodological challenges that were inherent to both the design and implementation of the study. The most problematic issue concerned the measurement of outcomes in persons with moderate to severe cognitive impairment. It was difficult to identify valid, reliable, and sensitive outcome measures that could be applied to all NH residents regardless of the ability to self-report. Another challenge was the inability to incorporate advances in implementation science into the ongoing study CONCLUSIONS Methodological challenges are inevitable in the conduct of an RCT. The need to optimize internal validity by adhering to the study protocol is compromised by the emergent logistical issues that arise during the course of the study.
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Affiliation(s)
- Mary Ersek
- Philadelphia Veterans Affairs Medical Center, Philadelphia, PA 19104-6096, USA.
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Oelschlager BK, Pellegrini CA, Mitsumori LM, Rohrmann CA, Polissar NL, Neradilek MB, Hunter JG, Sheppard BC, Swanstrom LL, Brunt ML, Soper NJ. Reply. J Am Coll Surg 2012. [DOI: 10.1016/j.jamcollsurg.2012.04.002] [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: 10/28/2022]
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Horibe M, Nair BG, Yurina G, Neradilek MB, Rozet I. A novel computerized fading memory algorithm for glycemic control in postoperative surgical patients. Anesth Analg 2012; 115:580-7. [PMID: 22669346 DOI: 10.1213/ane.0b013e318259ee31] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Hyperglycemia is commonly encountered in critically ill patients and is associated with increased mortality and morbidity. To better control blood glucose levels, we previously developed a new computerized fading memory (FM) algorithm. In this study we evaluated the safety and efficacy of this algorithm in surgical intensive care unit (SICU) patients and compared its performance against the existing insulin-infusion algorithm (named VA algorithm) used in our institution. METHODS A computer program was developed to run the FM and VA algorithms. Forty eight patients, who were scheduled to have elective surgery, were randomly assigned to receive insulin infusion on the basis of either the FM or VA algorithm. On SICU admission, an insulin infusion was either continued from the operating room or initiated when the glucose level exceeded the target level of 140 mg/dL. Hourly blood glucose measurements were performed and entered into the computer program, which then prescribed the next insulin dose. The randomly assigned algorithm was applied for the first 8 hours of SICU stay, after which the VA algorithm was used. The number of episodes of hypoglycemia (glucose <60 mg/dL) and excessive hyperglycemia (>300 mg/dL) were noted. Additionally, the time required to bring the glucose level within target range (140 ± 20 mg/dL), the number of glucose measurements within the target range, glycemic variability, and insulin usage were analyzed and compared between the 2 algorithms. RESULTS Patient demographics and starting glucose levels were similar between the groups. With the existing VA algorithm, 1 episode of severe hypoglycemia was observed. Three patients did not reach the target range within 8 hours. With the FM algorithm no hypoglycemia occurred, and all patients achieved the target range within 8 hours. Glycemic variability measured by the SD of mean glucose levels was 28% (95% confidence interval, 14% to 39%) lower for the FM algorithm (P < 0.001). The FM algorithm used 1.1 U/h less insulin than did the VA algorithm (P = 0.043). CONCLUSION The novel computerized FM algorithm for glycemic control, which emulates physiologic biphasic insulin secretion, managed glucose better than the existing algorithm without any episodes of hypoglycemia. The FM algorithm had less glycemic variability and used less insulin when compared to the conventional clinical algorithm.
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Affiliation(s)
- Mayumi Horibe
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA.
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Neradilek MB, Polissar NL, Einstein DR, Glenny RW, Minard KR, Carson JP, Jiao X, Jacob RE, Cox TC, Postlethwait EM, Corley RA. Branch-based model for the diameters of the pulmonary airways: accounting for departures from self-consistency and registration errors. Anat Rec (Hoboken) 2012; 295:1027-44. [PMID: 22528468 DOI: 10.1002/ar.22476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 03/06/2012] [Indexed: 11/08/2022]
Abstract
We examine a previously published branch-based approach for modeling airway diameters that is predicated on the assumption of self-consistency across all levels of the tree. We mathematically formulate this assumption, propose a method to test it and develop a more general model to be used when the assumption is violated. We discuss the effect of measurement error on the estimated models and propose methods that take account of error. The methods are illustrated on data from MRI and CT images of silicone casts of two rats, two normal monkeys, and one ozone-exposed monkey. Our results showed substantial departures from self-consistency in all five subjects. When departures from self-consistency exist, we do not recommend using the self-consistency model, even as an approximation, as we have shown that it may likely lead to an incorrect representation of the diameter geometry. The new variance model can be used instead. Measurement error has an important impact on the estimated morphometry models and needs to be addressed in the analysis.
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Affiliation(s)
- Moni B Neradilek
- The-Mountain-Whisper-Light Statistics, Seattle, Washington, USA.
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Zhao XQ, Dong L, Hatsukami T, Phan BA, Chu B, Moore A, Lane T, Neradilek MB, Polissar N, Monick D, Lee C, Underhill H, Yuan C. MR imaging of carotid plaque composition during lipid-lowering therapy a prospective assessment of effect and time course. JACC Cardiovasc Imaging 2012; 4:977-86. [PMID: 21920335 DOI: 10.1016/j.jcmg.2011.06.013] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 05/26/2011] [Accepted: 06/08/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The purpose of this study was to test the lipid depletion hypothesis and to establish the time course of change in carotid plaque morphology and composition during lipid therapy using high-resolution magnetic resonance imaging (MRI). BACKGROUND Lipid therapy is thought to improve plaque stability and reduce cardiovascular events by targeting the plaque rupture risk features such as large lipid core, thin fibrous cap, and high level of inflammatory infiltrates. However, the plaque stabilizing process during lipid therapy has not been clearly demonstrated in humans and in vivo. METHODS Subjects with coronary or carotid artery disease, apolipoprotein B ≥120 mg/dl, and lipid treatment history <1 year, were randomly assigned to atorvastatin monotherapy or to atorvastatin-based combination therapies with appropriate placebos for 3 years. All subjects underwent high-resolution, multicontrast bilateral carotid MRI scans at baseline and annually for 3 years. All images were analyzed for quantification of wall area and plaque composition blinded to therapy, laboratory results, and clinical course. RESULTS After 3 years of lipid therapy, the 33 subjects with measurable lipid-rich necrotic core (LRNC) at baseline had a significant reduction in plaque lipid content: LRNC volume decreased from 60.4 ± 59.5 mm(3) to 37.4 ± 69.5 mm(3) (p < 0.001) and %LRNC (LRNC area/wall area in the lipid-rich regions) from 14.2 ± 7.0% to 7.4 ± 8.2% (p < 0.001). The time course showed that %LRNC decreased by 3.2 (p < 0.001) in the first year, by 3.0 (p = 0.005) in the second year, and by 0.91 (p = 0.2) in the third year. Changes in LRNC volume followed the same pattern. Percent wall volume (100 × wall/outer wall, a ratio of volumes) in the lipid-rich regions significantly decreased from 52.3 ± 8.5% to 48.6 ± 9.7% (p = 0.002). Slices containing LRNC had significantly more percent wall volume reduction than those without (-4.7% vs. -1.4%, p = 0.02). CONCLUSIONS Intensive lipid therapy significantly depletes carotid plaque lipid. Statistically significant plaque lipid depletion is observed after 1 year of treatment and continues in the second year, and precedes plaque regression. (Using Magnetic Resonance Imaging to Evaluate Carotid Artery Plaque Composition in People Receiving Cholesterol-Lowering Medications [The CPC Study]; NCT00715273).
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Affiliation(s)
- Xue-Qiao Zhao
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA.
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Lebrec H, Cowan L, Lagrou M, Krejsa C, Neradilek MB, Polissar NL, Black L, Bussiere J. An inter-laboratory retrospective analysis of immunotoxicological endpoints in non-human primates: T-cell-dependent antibody responses. J Immunotoxicol 2011; 8:238-50. [DOI: 10.3109/1547691x.2011.587473] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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James DJ, Griffin CE, Polissar NL, Neradilek MB. Comparison of anal sac cytological findings and behaviour in clinically normal dogs and those affected with anal sac disease. Vet Dermatol 2010; 22:80-7. [DOI: 10.1111/j.1365-3164.2010.00916.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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