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GST Primary GST Primary Best Strategies for Health Care Quality Im... Best Strategies for Health Care Quality Improvement - Diabetes Quality Improvement Strategies for Antibio... Kathryn McDonald, Stanford-UCSF Evidence-b... Systematic review assessing the effect of ... Quality Improvement Strategies for Antibiotics Management Kathryn McDonald, Stanford-UCSF Evidence-based Practice Center, 117 Encina Commons, Stanford, CA 94305-6019, Kathy.mcdonald@stanford.edu Systematic review assessing the effect of quality improvement strategies on appropriate prescribing of antibiotics and appropriate choice of antibiotics. Adherence Adherence Assistive Devices Assistive Devices Childhood Burn Hanson MacMillan Childhood Burn Hanson MacMillan CLSA_9 CLSA_9 Cyberabuse Cyberabuse Cognitive Behavioural Therapy for Violent ... This review included randomized trials abo... Cognitive Behavioural Therapy for Violent Men who Batter Their Partners This review included randomized trials about the effects of cognitive behavioral therapy on domestic violence. The intervention included programs based on the Duluth Model. The violence had to be committed by a male toward his female partner. The violence also had to be physical. The primary outcomes were new arrests and convictions, and new reports of violence. CABG vs PCI CABG vs PCI Quality Improvement Strategies for Prevent... Quality Improvement Strategies for Preventing Nosocomial Infections (Created 17-Feb-06) Quality Improvement Strategies for Asthma ... Quality Improvement Strategies for Asthma Control Erectile Dysfunction (Created 30-Jan-06) Erectile Dysfunction (Created 30-Jan-06) Inequality - Smoking Cessation to Reduce S... This review was the first part of a projec... Inequality - Smoking Cessation to Reduce Socio-Economic Differences This review was the first part of a project about inequality. It included randomized trials about the effect of smoking cessation interventions on reducing socio-economic differences. The studies had to report data either on persons with low socio-economic groups status or, preferably, on both low and high socio-economic groups. Diet and Physical Activity to Reduce Socio... This review was the second part in a proje... Diet and Physical Activity to Reduce Socio-Economic Differences This review was the second part in a project about inequality. It included randomized trials about the effect of interventions on reducing socio-economic differences in diet and physical activity. The studies had to report data either on persons with low socio-economic groups status or, preferably, on both low and high socio-economic groups. Workfare The data in SRS are not identical to the d... Workfare The data in SRS are not identical to the data in the published report. We used SRS only for an updated search. The review included randomized trials about the effect of welfare-to-work programs. Participants were welfare recipients. There were basically two types of programs. The educational type tried to build knowledge and skills in order to help the welfare recipients acquire jobs that could support them economically. The "work first" approach was more aimed at getting the participants quickly into a job. Exercise interventions for the management ... The objective of this systematic review wa... Exercise interventions for the management of frailty The objective of this systematic review was to examine the effectiveness of current exercise interventions on the management of frailty. A comprehensive search of Medline, Embase, Psycinfo, Cinahl, Scopus, Ageline, Eric, and SportDiscus databases was conducted and produced 1808 citations. So far we have completed 2 levels of “title and abstract” screening and we ended up with 262 articles. We have just started the full text screening. Eligibility criteria included original studies whose participants were identified as frail or prefrail with specific criteria and in which structured physical activity was included as at least one component of the intervention. Create a free account, build a dictionary with saved terms to re-use later! Public Domestic Violence - Using Cognitive Behavior Therapy Smoking Cessation to Reduce Socio-Economic Differences Diet and Physical Activity to Reduce Socio-Economic Differences Workfare Exercise Interventions for the Management of Frailty Search     Simple Advanced Refine (5 coded questions)  Any of these:   Exact Phrase: All of these: None of these: Author: Periodical: Projects: No restrictions   Libraries: Public   Select SRS Projects Show Saved Terms Select Library Show articles that do not have abstracts  Humans or Animals Humans Animals Ages All Infant: birth-23 months All Child: 0-18 years All Adult: 19+ years Newborn: birth-1 month Infant: 1-23 months Preschool Child: 2-5 years Child: 6-12 years Adolescent: 13-18 years Adult: 19-44 years Middle Aged: 45-64 years Middle Aged + Aged: 45+ years Aged: 65+ years 80 and over: 80+ years Undetermined Type of Article Clinical Trial Editorial Letter Meta-Analysis Practice Guideline Randomized Controlled Trial Review Addresses Bibliography Biography Case Reports Classical Article Clinical Conference Clinical Trial, Phase I Clinical Trial, Phase II Clinical Trial, Phase III Clinical Trial, Phase IV Comment Comparative Study Consensus Development Conference Consensus Development Conference, NIH Controlled Clinical Trial Corrected and Republished Article Dictionary Directory Duplicate Publication English Abstract Evaluation Studies Festschrift Government Publications Guideline Historical Article Interview In Vitro Journal Article Lectures Legal Cases Legislation Multicenter Study News Newspaper Article Overall Patient Education Handout Periodical Index Published Erratum Retracted Publication Research Support, N.I.H., Extramural Research Support, N.I.H., Intramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S. 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Retraction of Publication Scientific Integrity Review Support of Research Technical Report Twin Study Validation Studies Not a Primary Study or Review Unknown Primary Study Case Series Case Control Cohort Study Observational Study Qualitative Research CBA or ITS Registry Double Blind Controlled before after study Quasi-randomized trial Simple before after study Cluster-RCT Non-Randomized Study Report Book Book chapter Dissertation Conference procedings Secondary Research Not RCT Language English French German Italian Japanese Russian Spanish Afrikaans Albanian Unknown Arabic Armenian Azerbaijani Bosnian Bulgarian Catalan Chinese Croatian Czech Danish Dutch Esperanto Estonian Finnish Georgian Greek, Modern Hebrew Hindi Hungarian Icelandic Indonesian Kinyarwanda Korean Latin Latvian Lithuanian Macedonian Malay Malayalam Maori Multiple Languages Norwegian Persian Polish Portuguese Pushto Romanian Sanskrit Scottish gaelic Serbian Slovak Slovenian Swedish Thai Turkish Ukrainian Vietnamese Not English Not French Patient Demograhics Welfare recipients Unknown Not on welfare Mean Age Percent high school diploma Percent GED or high school diploma Mean number of years of education Results(1-25 of 13,007) Sort By: Publication Date Relevance Took: 0.472 seconds to search 17,750,454  Action: Copy Results to new Clipboard Build Search Link Page 1 of 521 1 2 3 4 > Last >> (13007 articles found) Comparison of in-hospital mortality for acute myocardial infarction in Switzerland with admission during routine duty hours versus admission during out of hours (insight into the AMIS plus registry). Feb 15, 2008 Alexandre Berger,Jean-Christophe Stauffer,Dragana Radovanovic,Philip Urban,Osmund Bertel,Paul Erne,AMIS Plus Investigators To improve long-term survival, prompt revascularization of the infarct-related artery should be done in patients with acute myocardial infarction (AMI); therefore, a large proportion of these patients would be hospitalized during out of hours. The clinical effects of out-of-hours AMI management wer... ( view more )e already questioned, with conflicting results. The purpose of this investigation was to compare the in-hospital outcome of patients admitted for AMI during out of hours and working hours. All patients with AMI included in the AMIS Plus Registry from January 1, 1997, to March 30, 2006, were analyzed. The working-hours group included patients admitted from 7 a.m. to 7 p.m. on weekdays, and the out-of-hours group included patients admitted from 7 p.m. to 7 a.m. on weekdays or weekends. Major cardiac events were defined as cardiovascular death, reinfarction, and stroke. The study primary end points were in-hospital death and major adverse cardiac event (MACE) rates. A total of 12,480 patients met the inclusion criteria, with 52% admitted during normal working hours, and 48%, during out of hours. Patients admitted during weekdays included more women (28.1% vs 26%; p = 0.009), older patients (65.5 +/- 13 vs 64.1 +/- 13 years; p = 0.0011), less current smokers (40.1% vs 43.5%; p <0.001), and less patients with a history of ischemic heart disease (31.5% vs 34.5%; p = 0.001). A significantly higher proportion of patients admitted during out of hours had Killip's class III and IV. No differences in terms of in-hospital survival rates between the 2 groups (91.5% vs 91.2%; p = 0.633) or MACE-free survival rates (both 88.5%; p = 1.000) were noted. In conclusion, the outcome of patients with AMI admitted out of hours was the same compared with those with a weekday admission. Of predictors for in-hospital outcome, timing of admission had no significant influence on mortality and/or MACE incidence. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Double-blind, randomized trial of an anti-CD18 antibody in conjunction with recombinant tissue plasminogen activator for acute myocardial infarction: limitation of myocardial infarction following thrombolysis in acute myocardial infarction (LIMIT AMI) study. Dec 4, 2001 K W Baran,M Nguyen,G R McKendall,C T Lambrew,G Dykstra,S T Palmeri,R J Gibbons,S Borzak,B E Sobel,S G Gourlay,A C Rundle,C M Gibson,H V Barron,Limitation of Myocardial Infarction Following Thrombolysis in Acute Myocardial Infarction (LIMIT AMI) Study Group BACKGROUND: Inhibition of leukocyte adhesion can reduce myocardial infarct size in animals. This study was designed to define the safety and efficacy of a recombinant, humanized, monoclonal antibody to the CD18 subunit of the beta2 integrin adhesion receptors (rhuMAb CD18), in reducing infarct size... ( view more ) in patients treated with a thrombolytic agent. METHODS AND RESULTS: The Limitation of Myocardial Infarction following Thrombolysis in Acute Myocardial Infarction Study (LIMIT AMI) was a randomized, double-blind, placebo-controlled, multicenter study conducted in 60 centers in the United States and Canada. A total of 394 subjects who presented within 12 hours of symptom onset with ECG findings (ST-segment elevation) consistent with AMI were treated with recombinant tissue plasminogen activator and were also given an intravenous bolus of 0.5 or 2.0 mg/kg rhuMAb CD18 or placebo. Coronary angiography was performed at 90 minutes, 12-lead ECGs were obtained at baseline, 90, and 180 minutes, and resting sestamibi scans were performed at >/=120 hours. Adjunctive angioplasty and use of glycoprotein IIb/IIIa antiplatelet agents at the time of angiography were discretionary. There were no treatment effects on coronary blood flow, infarct size, or the rate of ECG ST-segment elevation resolution, despite the expected induction of peripheral leukocytosis. A slight trend toward an increase in bacterial infections was observed with rhuMAb CD18 (P=0.33). CONCLUSIONS: RhuMAb CD18 was well tolerated but not effective in modifying cardiac end points. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Gender differences in management and outcomes in patients with acute coronary syndromes: results on 20,290 patients from the AMIS Plus Registry. Nov 2007 Dragana Radovanovic,Paul Erne,Philip Urban,Osmund Bertel,Hans Rickli,Jean-Michel Gaspoz,AMIS Plus Investigators BACKGROUND: Gender differences in management and outcomes have been reported in acute coronary syndrome (ACS). OBJECTIVES: To assess such gender differences in a Swiss national registry. METHODS: 20 290 patients with ACS enrolled in the AMIS Plus Registry from January 1997 to March 2006 by 68 hospi... ( view more )tals were included in a prospective observational study. Data on patients' characteristics, diagnoses, procedures, complications and outcomes were recorded. Odds ratios (ORs) of in-hospital mortality were calculated using logistic regression models. RESULTS: 5633 (28%) patients were female and 14 657 (72%) male. Female patients were older than men (mean (SD) age 70.9 (12.1) vs 63.4 (12.9) years; p<0.001), had more comorbidities and came to hospital later. They underwent percutaneous coronary intervention (PCI) less frequently (OR = 0.65; 95% CI 0.61 to 0.69) and their unadjusted in-hospital mortality was higher overall (10.7% vs 6.3%; p<0.001) and in those who underwent PCI (3.0% vs 4.2%; p = 0.018). Mortality differences between women and men disappeared after adjustments for other predictors (adjusted OR (aOR) for women vs men: 1.09; 95% CI 0.95 to 1.25), except in women aged 51-60 years (aOR = 1.78; 95% CI 1.04 to 3.04). However, even after adjustments, female gender remained significantly associated with a lower probability of undergoing PCI (OR = 0.70; 95% CI 0.64 to 0.76). CONCLUSIONS: The analysis showed gender differences in baseline characteristics and in the rate of PCI in patients admitted for ACS in Swiss hospitals between 1997 and 2006. Reasons for the significant underuse of PCI in women, and a slightly higher in-hospital mortality in the 51-60 year age group, need to be investigated further. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Present-at-admission diagnoses improved mortality risk adjustment among acute myocardial infarction patients. Feb 2007 George J Stukenborg,Douglas P Wagner,Frank E Harrell,M Norman Oliver,Steven W Heim,Amy L Price,Caroline Kim Han,Andrew M D Wolf,Alfred F Connors OBJECTIVE: Hospital mortality outcomes for acute myocardial infarction (AMI) patients are a focus of quality improvement programs conducted by government agencies. AMI mortality risk-adjustment models using administrative data typically adjust for baseline differences in mortality risk with a limit... ( view more )ed set of common and definite comorbidities. In this study, we present an AMI mortality risk-adjustment model that adjusts for comorbid disease and for AMI severity using information from secondary diagnoses reported as present at admission for California hospital patients. STUDY DESIGN AND SETTING: AMI patients were selected from California hospital administrative data for 1996 through 1999 according to criteria used by the California Hospital Outcomes Project Report on Heart Attack Outcomes, a state-mandated public report that compares hospital mortality outcomes. We compared results for the new model to two mortality risk-adjustment models used to assess hospital AMI mortality outcomes by the state of California, and to two other models used in prior research. RESULTS: The model using present-at-admission diagnoses obtained substantially better discrimination between predicted survival and inpatient death than the other models we considered. CONCLUSION: AMI mortality risk-adjustment methods can be meaningfully improved using present-at-admission diagnoses to identify comorbid disease and conditions related closely to AMI. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Geographical variation in the incidence of acute myocardial infarction in eastern Finland--a Bayesian perspective. 2003 Maarit Viik-Kajander,Elena Moltchanova,Veikko Salomaa,Jaakko Tuomilehto,Matti Ketonen,Pertti Palomäki,Heikki Miettinen,Kalevi Pyörälä,Marjatta Karvonen,FINMONICA AMI Register Study Group BACKGROUND: Large geographical variation in the incidence and mortality of cardiovascular disease (CHD) has been repeatedly reported in Finland with persistent difference between east and west. We undertook this study to estimate the geographical distribution of Acute Myocardial Infarction (AMI) in... ( view more )cidence in the high-risk province of North Karelia and in the province of Kuopio. METHODS: Data on men aged 25-64 years with first event of acute myocardial infarction (AMI) were obtained from the FINMONICA AMI register, which recorded detailed information of AMI events during the period 1983 to 1992. The geographical pattern of AMI incidence was studied in two five-year periods 1983 to 1987 and 1988 to 1992 separately in 10 km x 10 km grid cells employing the Geographical Information System (GIS) and a Bayesian hierarchical approach. RESULTS: In both periods Bayesian modeling revealed a geographical pattern of AMI incidence and high risk (probability that incidence exceeds the observed mean incidence) in the remote rural areas. CONCLUSIONS: Detection of high-risk areas in both provinces showed that underlying environmental and/or genetic risk factors of AMI are not evenly distributed within the province but enriched in certain geographical non-administratively defined locations in eastern Finland. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Independent prognostic importance of a restrictive left ventricular filling pattern after myocardial infarction: an individual patient meta-analysis: Meta-Analysis Research Group in Echocardiography acute myocardial infarction. May 20, 2008 Meta-Analysis Research Group in Echocardiography (MeRGE) AMI Collaborators ,J E Møller,G A Whalley,F L Dini,R N Doughty,G D Gamble,A L Klein,M Quintana,C M Yu BACKGROUND: Restrictive mitral filling pattern (RFP), the most severe form of diastolic dysfunction, is a predictor of outcome after acute myocardial infarction (AMI). Low power has precluded a definite conclusion on the independent importance of RFP, especially when overall systolic function is pr... ( view more )eserved. We undertook an individual patient meta-analysis to determine whether RFP is predictive of mortality independently of LV ejection fraction (LVEF), end-systolic volume index, and Killip class in patients after AMI. METHODS AND RESULTS: Twelve prospective studies (3396 patients) assessing the relationship between prognosis and Doppler echocardiographic LV filling pattern in patients after AMI were included. Individual patient data from each study were extracted and collated into a single database for analysis. RFP was associated with higher all-cause mortality (hazard ratio, 2.67; 95% CI, 2.23 to 3.20; P<0.001) and remained an independent predictor in multivariate analysis with age, gender, and LVEF. The overall prevalence of RFP was 20% but was highest (36%) in the quartile of patients with lowest LVEF (<39%) and lowest (9%) in patients with the highest LVEF (>53%; P<0.0001). RFP remained significant within each quartile of LVEF, and no interaction was found for RFP and LVEF (P=0.42). RFP also predicted mortality in patients with above- and below-median end-systolic volume index (1575 patients) and in different Killip classes (1746 patients). Importantly, when diabetes, current medication, and prior AMI were included in the model, RFP remained an independent predictor of outcome. CONCLUSIONS: Restrictive filling is an important independent predictor of mortality after AMI regardless of LVEF, end-systolic volume index, and Killip class. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Smoking and mortality following acute myocardial infarction: results from the National Registry of Myocardial Infarction 2 (NRMI 2). Feb 2002 Steven G Gourlay,Amy C Rundle,Hal V Barron BACKGROUND: Current smokers have lower mortality following acute myocardial infarction (AMI) than non-smokers. This is often referred to as the "smokers' paradox". Our study explored possible explanations of this phenomenon. METHODS: From the 510,044 cases of AMI in the NRMI 2 from 1 June 1994, thr... ( view more )ough 30 April 1997, 297,458 cases without hospital transfer were analyzed. Characteristics and treatments of tobacco smokers and non-smokers were compared before and after age-standardization. Multivariate logistic models investigated possible associations with in-hospital mortality using clinically relevant variables and interaction terms. RESULTS: Twenty-four per cent of AMI cases were current smokers. Smokers were 14 years younger than non-smokers (mean age 58 vs. 72 years, p<0.001) and had lower in-hospital mortality (8.0% vs. 16.4%, p<0.001). After age-standardization, smokers were more likely than non-smokers to suffer a Q-wave type of infarction, and were less likely to have a prior history of diabetes, hypertension, AMI, angina, cardiac failure, and coronary interventions. The unadjusted odds ratio (OR) for smoking and mortality was 0.44 (95% confidence interval, CI 0.43-0.45). After adjustment for age the OR was 0.81 (95% CI 0.78-0.83). Additional adjustment for previous medical history/cardiovascular risk factors changed the OR to 0.86 (95% CI 0.83-0.89). Adjustment for additional covariates and interaction terms had little effect. CONCLUSIONS: Smokers with AMI were on average 14 years younger than non-smokers, explaining most of the apparent association of smoking with differences in presentation and treatment, and lower in-hospital mortality. The residual association of smoking and better prognosis, the "smoker's paradox", was not fully explained by measured covariates. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Acute occlusive mesenteric ischemia: surgical management and outcomes. Jan 2003 Matthew S Edwards,Gregory S Cherr,Timothy E Craven,Amy W Olsen,George W Plonk,Randolph L Geary,John L Ligush,Kimberley J Hansen Acute mesenteric ischemia secondary to arterial occlusion (AMI) remains a highly lethal condition. To examine recent trends in management and associated outcomes, we examined our institutional experience over a recent 10-year period. All patients treated for AMI between January 1990 and January 200... ( view more )0 were identified (76 patients, 77 cases) and their medical records examined. At presentation, 64% demonstrated peritonitis and 30% exhibited hypotension. The interval from symptom onset to treatment exceeded 24 h in 63% of cases. Etiology was mesenteric thrombosis in 44 patients (58%) and embolism in 32 patients (42%). Thirty-five patients (46%) had prior conditions placing them at high risk for the development of AMI including chronic mesenteric ischemia (n = 26) and inadequately anticoagulated chronic atrial fibrillation (n = 9). Surgical management consisted of exploration alone in 16 patients, bowel resection alone in 18 patients, and revascularization in 43 patients, including 28 who required concomitant bowel resection. Overall, intestinal necrosis was present in 81% of cases. Perioperative mortality was 62% and long-term parenteral nutrition (TPN) was required in 31% of survivors. Peritonitis (odds ratio [OR] 9.4, 95% confidence interval [CI] 1.6, 54.0; p = 0.012 and bowel necrosis (OR 10.4, CI 1.9, 56.3; p = 0.007) at presentation were independent predictors of death or survival dependent upon TPN. We conclude that AMI remains a highly lethal condition due in large part to advanced presentation and inadequate recognition and treatment of patients at high risk. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Mortality among patients in VA hospitals in the first 2 years following ACGME resident duty hour reform. Sep 5, 2007 Kevin G Volpp,Amy K Rosen,Paul R Rosenbaum,Patrick S Romano,Orit Even-Shoshan,Anne Canamucio,Lisa Bellini,Tiffany Behringer,Jeffrey H Silber CONTEXT: Limitations in duty hours for physicians-in-training in the United States were established by the Accreditation Council for Graduate Medical Education (ACGME) and implemented on July 1, 2003. The association of these changes with mortality among hospitalized patients has not been well esta... ( view more )blished. OBJECTIVE: To determine whether the change in duty hour regulations was associated with relative changes in mortality in hospitals of different teaching intensity within the US Veterans Affairs (VA) system. DESIGN, SETTING, AND PATIENTS: An observational study of all unique patients (N = 318 636) admitted to acute-care VA hospitals (N = 131) using interrupted time series analysis with data from July 1, 2000, to June 30, 2005. All patients had principal diagnoses of acute myocardial infarction (AMI), congestive heart failure, gastrointestinal bleeding, or stroke or a diagnosis related group classification of general, orthopedic, or vascular surgery. Logistic regression was used to examine the change in mortality for patients in more vs less teaching-intensive hospitals before (academic years 2000-2003) and after (academic years 2003-2005) duty hour reform, adjusting for patient comorbidities, common time trends, and hospital site. MAIN OUTCOME MEASURE: All-location mortality within 30 days of hospital admission. RESULTS: In postreform year 1, no significant relative changes in mortality were observed for either medical or surgical patients. In postreform year 2, the odds of mortality decreased significantly in more teaching-intensive hospitals for medical patients only. Comparing a hospital having a resident-to-bed ratio of 1 with a hospital having a resident-to-bed ratio of 0, the odds of mortality were reduced for patients with AMI (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.33-0.71), for the 4 medical conditions together (OR, 0.74; 95% CI, 0.61-0.89), and for the 3 medical conditions excluding AMI (OR, 0.79; 95% CI, 0.63-0.98). Compared with hospitals in the 25th percentile of teaching intensity, there was an absolute improvement in mortality from prereform year 1 to postreform year 2 of 0.70 percentage points (11.1% relative decrease) and 0.88 percentage points (13.9% relative decrease) in hospitals in the 75th and 90th percentile of teaching intensity, respectively, for the combined medical conditions. CONCLUSIONS: The ACGME duty hour reform was associated with significant relative improvement in mortality for patients with 4 common medical conditions in more teaching-intensive VA hospitals in postreform year 2. No associations were identified for surgical patients. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Gender and age differences in chief complaints of acute myocardial infarction (Worcester Heart Attack Study). Mar 1, 2004 Kerry A Milner,Viola Vaccarino,Amy L Arnold,Marjorie Funk,Robert J Goldberg We examined gender and age differences for chief symptom complaints in a population-based sample of 881 women (43%) and 1,192 men (57%) hospitalized for acute myocardial infarction (AMI). Women, in particular older women, were less likely than men to have a chief complaint of chest pain associated ... ( view more )with AMI. Overall, a large proportion of women and men whose AMI was ultimately diagnosed did not present with chest pain as their chief complaint. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles The Veterans Aging Cohort Study: observational studies of alcohol use, abuse, and outcomes among human immunodeficiency virus-infected veterans. Feb 2004 Joseph Conigliaro,Tamra Madenwald,Kendall Bryant,Scott Braithwaite,Adam Gordon,Shawn L Fultz,Stephen Maisto,Jeffrey Samet,Kevin Kraemer,Robert Cook,Nancy Day,Diedra Roach,Susan Richey,Amy Justice This article represents the proceedings of a symposium at the 2003 annual meeting of the Research Society on Alcoholism in Fort Lauderdale, FL. The organizers/chairs were Joseph Conigliaro and Amy Justice. The presentations were (1) Introduction, by Joseph Conigliaro and Tamra Madenwald; (2) Alcoho... ( view more )l and HIV/AIDS: the importance of integrative and translational research, by Kendall Bryant; (3) Alcohol use and abuse among patients with HIV infection, by Joseph Conigliaro and Stephan Maisto; (4) Severity of comorbid alcohol use/abuse in HIV infection, by Amy Justice and Jeffrey Samet; (5) Estimating the impact of alcohol use on long-term HIV outcomes, by Scott Braithwaite and Amy Justice; (6) Homelessness, drug & alcohol use among HIV+ veterans, by Adam Gordon and Robert Cook; and (7) Hepatitis C & alcohol in the VACS 3 study, by Shawn Fultz and Kevin Kraemer. The symposium concluded with a discussion led and facilitated by Diedra Roach. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Parameters of red blood cell aggregation as correlates of the inflammatory state. May 2001 R B Ami,G Barshtein,D Zeltser,Y Goldberg,I Shapira,A Roth,G Keren,H Miller,V Prochorov,A Eldor,S Berliner,S Yedgar To identify clinically relevant parameters of red blood cell (RBC) aggregation, we examined correlations of aggregation parameters with C-reactive protein and fibrinogen in unstable angina (UA), acute myocardial infarction (AMI), and bacterial infection (BI). Aggregation parameters were derived fro... ( view more )m the distribution of RBC population into aggregate sizes (cells per aggregate) and changing of the distribution by flow-derived shear stress. Increased aggregation was observed in the following order: UA, AMI, and BI. The best correlation was obtained by integration of large aggregate fraction as a function of shear stress. To differentiate plasmatic from cellular factors in RBC aggregation, we determined the aggregation in the presence and absence of plasma and formulated a "plasma factor" (PF) ranging from 0 to 1. In AMI the enhanced aggregation was entirely due to PF (PF = 1), whereas in UA and BI it was due to both plasmatic and cellular factors (0 < or = PF < or = 1). It is proposed that clinically relevant parameters of RBC aggregation should express both RBC aggregate size distribution and aggregate resistance to disaggregation and distinguish between plasmatic and cellular factors. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Higher doses of lenalidomide are associated with unacceptable toxicity including life-threatening tumor flare in patients with chronic lymphocytic leukemia. May 20, 2008 Leslie A Andritsos,Amy J Johnson,Gerard Lozanski,William Blum,Cheryl Kefauver,Farrukh Awan,Lisa L Smith,Rosa Lapalombella,Sarah E May,Chelsey A Raymond,Da-Sheng Wang,Robert D Knight,Amy S Ruppert,Amy Lehman,David Jarjoura,Ching-Shih Chen,John C Byrd PURPOSE: Lenalidomide is a novel therapeutic agent with uncertain mechanism of action that is clinically active in myelodysplastic syndrome (MDS) and multiple myeloma (MM). Application of high (MM) and low (MDS) doses of lenalidomide has been reported to have clinical activity in CLL. Herein, we hi... ( view more )ghlight life-threatening tumor flare when higher doses of lenalidomide are administered to patients with CLL and provide a potential mechanism for its occurrence. PATIENTS AND METHODS: Four patients with relapsed CLL were treated with lenalidomide (25 mg/d for 21 days of a 28-day cycle). Serious adverse events including tumor flare and tumor lysis are summarized. In vitro studies examining drug-induced apoptosis and activation of CLL cells were also performed. RESULTS: Four consecutive patients were treated with lenalidomide; all had serious adverse events. Tumor flare was observed in three patients and was characterized by dramatic and painful lymph node enlargement resulting in hospitalization of two patients, with one fatal outcome. Another patient developed sepsis and renal failure. In vitro studies demonstrated lenalidomide-induced B-cell activation (upregulation of CD40 and CD86) corresponding to degree of tumor flare, possibly explaining the tumor flare observation. CONCLUSION: Lenalidomide administered at 25 mg/d in relapsed CLL is associated with unacceptable toxicity; the rapid onset and adverse clinical effects of tumor flare represent a significant limitation of lenalidomide use in CLL at this dose. Drug-associated B-cell activation may contribute to this adverse event. Future studies with lenalidomide in CLL should focus on understanding this toxicity, investigating patients at risk, and investigating alternative safer dosing schedules. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Trends in reperfusion therapy of ST segment elevation myocardial infarction in Switzerland: six year results from a nationwide registry. Jul 2005 A-A Fassa,P Urban,D Radovanovic,N Duvoisin,J-M Gaspoz,J-C Stauffer,P Erne,AMIS Plus Investigators OBJECTIVE: To document the trends in reperfusion therapy for ST segment elevation myocardial infarction (STEMI) in Switzerland. DESIGN: National prospective multicentre registry, AMIS Plus (acute myocardial infarction and unstable angina in Switzerland), of patients admitted with acute coronary syn... ( view more )dromes. SETTING: 54 hospitals of varying size and capability in Switzerland. PATIENTS: 7098 of 11 845 AMIS Plus patients who presented with ST segment elevation or left bundle branch block on the ECG at admission. MAIN OUTCOME MEASURES: In-hospital mortality and its predictors at admission by multivariate analysis. RESULTS: The proportion of patients treated by primary percutaneous coronary intervention (PCI) progressively increased from 1997 to 2002, while the proportion with thrombolysis or no reperfusion decreased (from 8.0% to 43.1%, from 47.2% to 25.6%, and from 44.8% to 31.4%, respectively). Overall in-hospital mortality decreased over the study period from 12.2% to 6.7% (p < 0.001). Main in-hospital mortality predictors by multivariate analysis were primary PCI (odds ratio (OR) 0.52, 95% confidence interval (CI) 0.33 to 0.81), thrombolysis (OR 0.63, 95% CI 0.47 to 0.83), and Killip class III (OR 3.61, 95% CI 2.49 to 5.24) and class IV (OR 5.97, 95% CI 3.51 to 10.17) at admission. When adjusted for the year, multivariate analysis did not show PCI to be significantly superior to thrombolysis for in-hospital mortality (OR 1.2 for PCI better, 95% CI 0.8 to 1.9, p = 0.42). CONCLUSION: Primary PCI has become the preferred mode of reperfusion for STEMI since 2002 in Switzerland, whereas use of intravenous thrombolysis has decreased from 1997 to 2002. Furthermore, there was a major reduction of in-hospital mortality over the same period. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Lessons learned from dirty diapers. 2002 Sep-Oct Amy L Gaudet This essay by Amy Gaudet is the winning entry in the annual Humanism in Medicine Essay Contest at LSU School of Medicine in New Orleans. Amy is a second year student and writes about everyday humanism in the context of everyday problems involving two patients and their families--one she had never m... ( view more )et and a second much closer to home. The essay contest was initiated in the spring of 2001 by the students in the School of Medicine to inspire fellow students to embrace the humanism displayed around them and to incorporate the humanistic spirit into their daily lives. The top five finalists are recognized at our White Coat Ceremony in July every year. The winning author receives a prize and presents his or her essay at the ceremony, as the keynote speaker. What is humanism? Simply, as described by our students, it is a concern with the needs, well-being, and interests of people. In our profession, humanism can take on many shapes, among them--displaying compassion, empathy, and utmost respect in the delivery of healthcare, serving as a role model by displaying professional behavior and ethical composure, showing sensitivity to diverse ethnic or religious backgrounds, effectively communicating complex medical diagnoses and treatments to patients and in turn, possessing excellent listening skills, caring for a patient's emotional and psychological well-being, possessing a work ethic that earns trust and confidence from all colleagues and patients, and being willing to help others, but also willing to seek help when necessary. These are values that we share as a profession and that we should reflect on as we do our work, day in and day out, in an environment that makes following them more and more difficult and for that reason more and more important. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Characterization of ischemic events and use of prescription antiplatelet and anticoagulant agents after stroke or transient ischemic attack. 2005 Jul-Aug Carol Zaher,Stella Schloss,Dorothy George,Amy White Poret,Hemal Shah Stroke patients are at risk for subsequent ischemic events; yet preventive therapy is often underused. An analysis was performed to determine the rate of secondary ischemic events and use of prescription antiplatelets or anticoagulants after ischemic stroke or transient ischemic attack (TIA). Patie... ( view more )nts age 25 years or older with a medical claim for stroke or TIA between July 1, 1998 and September 30, 1999 were identified from a managed care database. Patients sustaining a stroke or TIA within 6 months before the index event were excluded. Patients were categorized as hospitalized stroke, nonhospitalized stroke, or TIA and were followed for 24 months for a secondary stroke, TIA, or acute myocardial infarction (AMI). Use of prescription antiplatelet or anticoagulant agents was determined for each subgroup. Over 2 years, subsequent stroke occurred in 5.8% of patients, TIA occurred in 3.8%, and AMI occurred in 4.9%. Death occurred in 32.3% during follow-up. Hospitalized stroke patients were the subgroup at highest risk, with a 7.6% stroke rate and a 45.4% death rate within 2 years. Prescription antiplatelet or warfarin therapy was given in 45.7% of hospitalized stroke cases, 29.5% of nonhospitalized stroke cases, and 39.2% of TIA cases. Against the background of current treatment, patients who suffer a stroke or TIA are at high risk of death and a subsequent stroke within 2 years. These outcomes highlight the importance of effective secondary stroke prevention efforts for those suffering acute stroke, whether or not they are hospitalized. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Post myocardial infarction treatment in the older adult. 2002 Jan-Feb Amy Chorzempa,Patricia Tabloski Treatments for acute myocardial infarctions (AMIs) have advanced over the past few decades. Although AMIs are considered medical emergencies, continuing research has provided protocols and guidelines that significantly decrease mortality and reinfarction rates. Beta-blockers and aspirin are conside... ( view more )red standard treatment for post-AMI patients; however, studies involving the elderly reveal that this population is less likely to receive beta-blocker and aspirin therapy. This article discusses current recommendations and treatments for post-AMI elderly patients. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Quality of life valuations of mammography screening. Jun 2008 Amy E Bonomi,Denise M Boudreau,Paul A Fishman,Evette Ludman,Amy Mohelnitzky,Elizabeth A Cannon,Deb Seger Objective To obtain quality-of-life (QOL) valuations associated with mammography screening and breast cancer treatment that are suitable for use in cost-effectiveness analyses. Methods Subjects comprised 131 women (age range 50-79 years) randomly sampled from a breast cancer screening program. In a... ( view more )n in-person or telephone interview, women rated the QOL impact of 14 clinical scenarios (ranging from mammography to end-of-life care for breast cancer) using a visual analogue scale anchored by death (0) and perfect health/quality of life (100). Results Women rated the scenarios describing true negative results, false positive results, and routine screening mammography at 80 or above on a scale of 0-100, suggesting that they perceive these states as being close to perfect health. They rated adjuvant chemotherapy (39.7; range 10-90), palliation/end-of-life care (35.8; range 0-100), and recurrence at 1 year (33.0; range 0-95) the lowest, suggesting that these health states are perceived as compromised. Women rated receiving news of a breast cancer diagnosis (true positive) (45.7; range 5-100) and receiving delayed news of a breast cancer diagnosis (false negative) (48.5; range 5-100) as being comparable to undergoing mastectomy (48.3; range 10-100) and radiation therapy (46.2; range 5-100) for breast cancer. Conclusions These data can be used to update cost analyses of mammography screening that wish to take into account the QOL impact of screening. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Nuclear factor-kappaB activation in airway epithelium induces inflammation and hyperresponsiveness. May 1, 2008 Cristen Pantano,Jennifer L Ather,John F Alcorn,Matthew E Poynter,Amy L Brown,Amy S Guala,Stacie L Beuschel,Gilman B Allen,Laurie A Whittaker,Mieke Bevelander,Charles G Irvin,Yvonne M W Janssen-Heininger RATIONALE: Nuclear factor (NF)-kappaB is a prominent proinflammatory transcription factor that plays a critical role in allergic airway disease. Previous studies demonstrated that inhibition of NF-kappaB in airway epithelium causes attenuation of allergic inflammation. OBJECTIVES: We sought to dete... ( view more )rmine if selective activation of NF-kappaB within the airway epithelium in the absence of other agonists is sufficient to cause allergic airway disease. METHODS: A transgenic mouse expressing a doxycycline (Dox)-inducible, constitutively active (CA) version of inhibitor of kappaB (IkappaB) kinase-beta (IKKbeta) under transcriptional control of the rat CC10 promoter, was generated. MEASUREMENTS AND MAIN RESULTS: After administration of Dox, expression of the CA-IKKbeta transgene induced the nuclear translocation of RelA in airway epithelium. IKKbeta-triggered activation of NF-kappaB led to an increased content of neutrophils and lymphocytes, and concomitant production of proinflammatory mediators, responses that were not observed in transgenic mice not receiving Dox, or in transgene-negative littermate control animals fed Dox. Unexpectedly, expression of the IKKbeta transgene in airway epithelium was sufficient to cause airway hyperresponsiveness and smooth muscle thickening in absence of an antigen sensitization and challenge regimen, the presence of eosinophils, or the induction of mucus metaplasia. CONCLUSIONS: These findings demonstrate that selective activation NF-kappaB in airway epithelium is sufficient to induce airway hyperresponsiveness and smooth muscle thickening, which are both critical features of allergic airway disease. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Methotrexate (MTX) pathway gene polymorphisms and their effects on MTX toxicity in Caucasian and African American patients with rheumatoid arthritis. Apr 2008 Prabha Ranganathan,Robert Culverhouse,Sharon Marsh,Ami Mody,Tiffany J Scott-Horton,Richard Brasington,Amy Joseph,Virginia Reddy,Seth Eisen,Howard L McLeod OBJECTIVE: Research has examined the association of folate-dependent gene polymorphisms with methotrexate (MTX) toxicity in racially homogenous patients with rheumatoid arthritis (RA). We examined the influence of MTX transporter gene polymorphisms on MTX toxicity in 2 racial groups of patients wit... ( view more )h RA. METHODS: Using a retrospective cross-validation approach, the association of polymorphisms in 6 genes in the MTX cellular pathway with MTX toxicity was examined in training and validation cohorts. The genes analyzed were ATP-binding cassette transporter B1 (ABCB1), C1 (ABCC1), C2 (ABCC2), folylpolyglutamyl synthase (FPGS), methylenetetrahydrofolate reductase (MTHFR), and thymidylate synthase (TYMS). Both cohorts included Caucasian Americans and African Americans. Statistical analyses consisted of Fisher exact tests, multivariable logistic regression models, and survival analyses. RESULTS: Four of 25 variants displayed significant associations with MTX toxicity in the training cohort. The intronic single-nucleotide polymorphism (SNP) ABCC2 IVS 23+56 T --> C was associated with alopecia in Caucasians (p = 0.035). ABCB1 1236 C --> T was associated with overall toxicity (p = 0.013); ABCC2 1249 G --> A with gastrointestinal toxicity (p = 0.009); and ABCC2 1058 G --> A with hepatotoxicity (p = 0.04) in African Americans. These 4 SNP and the MTHFR 677 C --> T variant were assessed in the validation cohort. Of these, only the MTHFR 677 C --> T SNP was associated with alopecia, and only in African Americans (p = 0.032). The ABCC2 IVS 23+56 T --> C genotype influenced toxicity-related time to discontinuation or dose decrease in the Caucasian validation cohort (p < 0.0001). CONCUSION: In addition to SNP in folate-dependent genes, MTX transporter gene SNP may be important markers of MTX toxicity in RA. Such pharmacogenetic associations are race-specific. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles A macadamia nut-rich diet reduces total and LDL-cholesterol in mildly hypercholesterolemic men and women. Apr 2008 Amy E Griel,Yumei Cao,Deborah D Bagshaw,Amy M Cifelli,Bruce Holub,Penny M Kris-Etherton Epidemiologic studies and clinical trials have demonstrated that the unique fatty acid profile of nuts beneficially affects serum lipids/lipoproteins, reducing cardiovascular disease (CVD) risk. Nuts are low in SFA and high in PUFA and monounsaturated fatty acids (MUFA). Macadamia nuts are a rich s... ( view more )ource of MUFA. A randomized, crossover, controlled feeding study (5-wk diet periods) compared a Macadamia nut-rich diet [42.5 g (1.5 ounces)/8.79 MJ (2100 kcal)] [MAC; 33% total fat (7% SFA, 18% MUFA, 5% PUFA)] vs. an average American diet [AAD; 33% total fat (13% SFA, 11% MUFA, 5% PUFA)] on the lipid/lipoprotein profile of mildly hypercholesterolemic (n = 25; 15 female, 10 male) subjects. Serum concentrations of total cholesterol (TC) and LDL cholesterol (LDL-C) following the MAC (4.94 +/- 0.17 mmol/L, 3.14 +/- 0.14 mmol/L) were lower than the AAD (5.45 +/- 0.17 mmol/L, 3.44 +/- 0.14 mmol/L; P < 0.05). The serum non-HDL cholesterol (HDL-C) concentration and the ratios of TC:HDL-C and LDL-C:HDL-C were reduced following consumption of the MAC diet (3.83 +/- 0.17, 4.60 +/- 0.24, and 2.91 +/- 0.17, respectively) compared with the AAD (4.26 +/- 0.17, 4.89 +/- 0.24, and 3.09 +/- 0.18, respectively; P < 0.05). There was no change in serum triglyceride concentration. Thus, macadamia nuts can be included in a heart-healthy dietary pattern that reduces lipid/lipoprotein CVD risk factors. Nuts as an isocaloric substitute for high SFA foods increase the proportion of unsaturated fatty acids and decrease SFA, thereby lowering CVD risk. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles The effectiveness of 4% intracuff lidocaine in reducing coughing during emergence from general anesthesia in smokers undergoing procedures lasting less than 1.5 hours. Apr 2008 Laura E Wetzel,Amy L Ancona,Andrew S Cooper,Amy J Kortman,Gayle B Loniewski,Lynn L Lebeck Coughing commonly occurs in patients emerging from general endotracheal anesthesia and is prominent in smokers due to underlying airway irritation. Clinical techniques used to mitigate emergence coughing include intravenous narcotics, intravenous or topical lidocaine, and deep extubation. Reduction... ( view more ) of coughing by instilling lidocaine into the endotracheal tube cuff has been shown to be effective in long cases. Research has not confirmed efficacy of this technique in short cases. Does administration of intracuff lidocaine decrease coughing during emergence of smokers in short cases requiring general endotracheal anesthesia? This study was a randomized, double blind, posttest-only design that included 38 patients. Investigators recruited the subjects, obtained consent, and provided a syringe containing 5 mL of 4% lidocaine or 5 mL of saline to the anesthesia provider. At time of intubation, the provider injected the contents of the syringe into the endotracheal tube cuff. The control group received 5 mL of saline, and the experimental group received 5 mL of 4% lidocaine. On emergence, the anesthesia provider counted and recorded the number of coughs before awake extubation. This study did not show a correlation between use of intracuff lidocaine and a decrease in emergence coughing in procedures lasting less than 1.5 hours in patients who smoke. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Flavopiridol causes early mitochondrial damage in chronic lymphocytic leukemia cells with impaired oxygen consumption and mobilization of intracellular calcium. Mar 15, 2008 Syed-Rehan A Hussain,David M Lucas,Amy J Johnson,Thomas S Lin,Alan P Bakaletz,Vinh X Dang,Serge Viatchenko-Karpinski,Amy S Ruppert,John C Byrd,Periannan Kuppusamy,Elliott D Crouser,Michael R Grever Effective administration of flavopiridol in advanced-stage chronic lymphocytic leukemia (CLL) is often associated with early biochemical evidence of tumor cell lysis. Previous work using other cell types showed that flavopiridol impacts mitochondria, and in CLL cells flavopiridol down-regulates the... ( view more ) mitochondrial protein Mcl-1. We therefore investigated mitochondrial structure and function in flavopiridol-treated CLL patient cells and in the lymphoblastic cell line 697 using concentrations and times at which tumor lysis is observed in treated patients. Mitochondrial membrane depolarization was detected in flavopiridol-treated CLL cells by 6 hours, well before the onset of cell death. Flavopiridol-induced mitochondrial depolarization was not blocked by caspase inhibitors or by the calcium chelator EGTA, but was reduced by Bcl-2 overexpression. Intracellular calcium mobilization was noted at early time points using fluorescence microscopy. Furthermore, electron paramagnetic resonance oximetry showed a gradual but significant reduction in cellular oxygen consumption rate by 6 hours, corresponding with ultrastructural mitochondrial damage detected by electron microscopy. These observations suggest that in CLL and 697 cells, flavopiridol mediates its cytotoxic effects via induction of the mitochondrial permeability transition and changes in intracellular calcium. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Use of selective serotonin reuptake inhibitors by pediatricians: comparing attitudes of primary care pediatricians and child and adolescent psychiatrists. Mar 2008 Amy Heneghan,Andrew S Garner,Amy Storfer-Isser,Karl Kortepeter,Ruth E K Stein,Sarah McCue Horwitz To compare attitudes regarding a pediatrician's role in prescribing selective serotonin reuptake inhibitors for children and adolescents, surveys were mailed to 338 primary care pediatricians and 75 child and adolescent psychiatrists; half responded. Child and adolescent psychiatrists were signific... ( view more )antly more likely than primary care pediatricians to agree that selective serotonin reuptake inhibitors are safe and effective when used for children and adolescents. Primary care pediatricians were significantly more likely than child and adolescent psychiatrists to agree that black box warnings have changed their prescribing practices. Both had similar beliefs about whether antidepressants should be prescribed only by psychiatrists and whether pediatricians should initiate selective serotonin reuptake inhibitor therapy, without or after consulting a psychiatrist. These data suggest that among child and adolescent psychiatrists and primary care pediatricians, agreement about the pediatrician's role in using selective serotonin reuptake inhibitors therapy is lacking. Strategies that enhance communication and endorse support for defined roles of primary care pediatricians and child and adolescent psychiatrists will ensure that children with mental health needs are treated safely and appropriately. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Validating an index of adolescent sexual behavior using psychosocial theory and social trait correlates. Mar 2008 Michael Hennessy,Amy Bleakley,Martin Fishbein,Amy Jordan Using a web-based survey of adolescents 14-16 years of age, a hierarchical index of heterosexual behavior was developed with excellent psychometric properties. The easiest sexual behavior to perform was "deep kissing" and the most difficult was "receiving anal sex" for females and "giving anal sex"... ( view more ) for males. The index was validated with data that show increased sexual activity with being older and of minority status, with social traits such as physical development, having a romantic partner, and sensation seeking, and with psychosocial variables known to be associated with sexual behavior such as attitudes, norms, self-efficacy and intentions. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Page 1 of 521 1 2 3 4 > Last >> (13007 articles found)

      
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