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Kao A. Deconstructing disparity. AMA J Ethics 2001; 3:virtualmentor.2001.3.6.fred1-0106. [PMID: 23273025 DOI: 10.1001/virtualmentor.2001.3.6.fred1-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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177
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Kao A. Doctor saving time. AMA J Ethics 2001; 3:virtualmentor.2001.3.5.fred1-0105. [PMID: 23273002 DOI: 10.1001/virtualmentor.2001.3.5.fred1-0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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178
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Kao A. Balls, Strikes, and VIPs. AMA J Ethics 2001; 3:virtualmentor.2001.3.5.dykn1-0105. [PMID: 23273008 DOI: 10.1001/virtualmentor.2001.3.5.dykn1-0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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179
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Kao A. Origami and paper airplanes. AMA J Ethics 2001; 3:virtualmentor.2001.3.4.dykn1-0104. [PMID: 23272959 DOI: 10.1001/virtualmentor.2001.3.4.dykn1-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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180
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Kao A. Lighten up. AMA J Ethics 2001; 3:virtualmentor.2001.3.4.fred1-0104. [PMID: 23272953 DOI: 10.1001/virtualmentor.2001.3.4.fred1-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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181
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Kao A. Back to the future. AMA J Ethics 2001; 3:virtualmentor.2001.3.3.imhl1-0103. [PMID: 23272932 DOI: 10.1001/virtualmentor.2001.3.3.imhl1-0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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182
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Rosenstein NE, Emery KW, Werner SB, Kao A, Johnson R, Rogers D, Vugia D, Reingold A, Talbot R, Plikaytis BD, Perkins BA, Hajjeh RA. Risk factors for severe pulmonary and disseminated coccidioidomycosis: Kern County, California, 1995-1996. Clin Infect Dis 2001; 32:708-715. [PMID: 11229838 DOI: 10.1580/10806032(2001)012[0216:aocl]2.0.co;2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2000] [Revised: 07/26/2000] [Indexed: 05/23/2023] Open
Abstract
Surveillance for coccidioidomycosis (CM) and a case-control study for risk factors among adults were conducted in Kern County, California. From January 1995 through December 1996, 905 cases of CM were identified, for an annual incidence of 86 cases per 100,000 population. A total of 380 adults were enrolled in the case-control study: 77 had severe pulmonary disease, 33 had disseminated disease, and 270 control patients had mild disease. Independent risk factors for severe pulmonary disease included diabetes, recent history of cigarette smoking, income of < $15,000 per year, and older age. Oral antifungal therapy before hospitalization was associated with a reduced risk of CM pneumonia. Risk factors for disseminated disease were black race, income of < $15,000 per year, and pregnancy. Early treatment of CM with oral antifungal agents may prevent severe pulmonary disease in groups considered to be at high risk, such as elderly individuals, persons with diabetes, and smokers. Persons at risk for severe CM may benefit from vaccination once an effective CM vaccine is available.
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183
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Parsi K, Kao A. Cases in law and ethics. Responsibility of a "virtual" consultant. THE VIRTUAL MENTOR : VM 2001:E3. [PMID: 15612134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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184
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Kao A. The digital divide. AMA J Ethics 2001; 3:virtualmentor.2001.3.3.dykn1-0103. [PMID: 23272929 DOI: 10.1001/virtualmentor.2001.3.3.dykn1-0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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185
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Rosenstein NE, Emery KW, Werner SB, Kao A, Johnson R, Rogers D, Vugia D, Reingold A, Talbot R, Plikaytis BD, Perkins BA, Hajjeh RA. Risk factors for severe pulmonary and disseminated coccidioidomycosis: Kern County, California, 1995-1996. Clin Infect Dis 2001; 32:708-15. [PMID: 11229838 DOI: 10.1086/319203] [Citation(s) in RCA: 135] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2000] [Revised: 07/26/2000] [Indexed: 11/04/2022] Open
Abstract
Surveillance for coccidioidomycosis (CM) and a case-control study for risk factors among adults were conducted in Kern County, California. From January 1995 through December 1996, 905 cases of CM were identified, for an annual incidence of 86 cases per 100,000 population. A total of 380 adults were enrolled in the case-control study: 77 had severe pulmonary disease, 33 had disseminated disease, and 270 control patients had mild disease. Independent risk factors for severe pulmonary disease included diabetes, recent history of cigarette smoking, income of < $15,000 per year, and older age. Oral antifungal therapy before hospitalization was associated with a reduced risk of CM pneumonia. Risk factors for disseminated disease were black race, income of < $15,000 per year, and pregnancy. Early treatment of CM with oral antifungal agents may prevent severe pulmonary disease in groups considered to be at high risk, such as elderly individuals, persons with diabetes, and smokers. Persons at risk for severe CM may benefit from vaccination once an effective CM vaccine is available.
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186
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Kao A. Let there be light. AMA J Ethics 2001; 3:virtualmentor.2001.3.3.fred1-0103. [PMID: 23272923 DOI: 10.1001/virtualmentor.2001.3.3.fred1-0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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187
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Parsi K, Kao A. Responsibility of a "virtual" consultant. AMA J Ethics 2001; 3:virtualmentor.2001.3.3.hlaw1-0103. [PMID: 23272927 DOI: 10.1001/virtualmentor.2001.3.3.hlaw1-0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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188
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Kao A. The almost unknown poet, emily dickinson. AMA J Ethics 2001; 3:virtualmentor.2001.3.2.fred1-0102. [PMID: 23272810 DOI: 10.1001/virtualmentor.2001.3.2.fred1-0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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189
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Kao A. Edmund pellegrino, MD, exemplary role model. AMA J Ethics 2001; 3:virtualmentor.2001.3.1.prol1-0101. [PMID: 23272685 DOI: 10.1001/virtualmentor.2001.3.1.prol1-0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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190
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Kao A. Politics, policy, and medicine. AMA J Ethics 2001; 3:virtualmentor.2001.3.1.dykn1-0101. [PMID: 23272680 DOI: 10.1001/virtualmentor.2001.3.1.dykn1-0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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191
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Kao A. Gifts and gift giving. AMA J Ethics 2000; 2:virtualmentor.2000.2.12.fred1-0012. [PMID: 23270841 DOI: 10.1001/virtualmentor.2000.2.12.fred1-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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192
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DeNofrio D, Loh E, Kao A, Korecka M, Pickering FW, Craig KA, Shaw LM. Mycophenolic acid concentrations are associated with cardiac allograft rejection. J Heart Lung Transplant 2000; 19:1071-6. [PMID: 11077224 DOI: 10.1016/s1053-2498(00)00191-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Mycophenolate mofetil (MMF) therapy decreases the incidence of allograft rejection following solid-organ transplantation. Current dosing strategies of MMF are not routinely adjusted based on mycophenolic acid (MPA) area under the concentration-time curve (AUC), MPA trough, or free MPA (fMPA) AUC values. METHODS To determine the clinical significance of MPA concentrations following orthotopic heart transplantation (OHT), we measured pre-dose MPA trough, MPA free fraction, an estimated MPA AUC using an abbreviated sampling schedule, and fMPA AUC in 38 consecutive patients. We measured MPA concentrations using a validated high-performance liquid chromatography method and graded endomyocardial biopsies based on the International Society for Heart and Lung Transplantation (ISHLT) grading system. RESULTS The MPA values for the study group were as follows: MPA trough of 1.2 +/- 0.6 microg/ml; MPA free fraction of 1.9 +/- 0.4%; MPA AUC of 44.5 +/- 16. 1 microg/hour/ml; and fMPA AUC of 0.83 +/- 0.30 microg/hour/ml. We compared patients with Grade 0 (n = 22), Grade 1 (n = 13), or Grade 2/3 (n = 3). The MPA AUC values were lower in patients with Grade 2/3 than in patients with Grade 0 (26.1 +/- 6.6 vs 42.8 +/- 14.0 microg/hour/ml, p < 0.08) or Grade 1 rejection (26.1 +/- 6.6 vs 51.7 +/- 17.5 microg/hour/ml, p < 0.05). The fMPA AUC values were lower in patients with Grade 2/3 than with patients with Grade 0 (0.49 +/- 0.11 vs 0.81 +/- 0.25 microg/hour/ml, p < 0.05) or Grade 1 (0.49 +/- 0.25 vs 0.95 +/- 0.34 microg/hour/ml, p < 0.05) rejection. We noted a trend in MPA trough concentrations between patients with Grade 2/3 vs 0 (0.65 +/- 0.15 vs 1.20 +/- 0.58 microg/ml, p = 0.15) and Grade 1 (0.65 +/- 0.15 vs 1.24 +/- 0.72 microg/ml, p = 0.14) rejection. CONCLUSION These preliminary results suggest that lower MPA AUC and fMPA AUC values are associated with cardiac allograft rejection in heart transplant recipients. Individualizing MMF dosing based on MPA determinations may minimize the risk of rejection following OHT.
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Kao A. Health and mental competency of presidents. AMA J Ethics 2000; 2:virtualmentor.2000.2.11.dykn1-0011. [PMID: 23270770 DOI: 10.1001/virtualmentor.2000.2.11.dykn1-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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194
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Kao A. If you build it, they will come. AMA J Ethics 2000; 2:virtualmentor.2000.2.11.fred1-0011. [PMID: 23270765 DOI: 10.1001/virtualmentor.2000.2.11.fred1-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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195
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Cairns L, Blythe D, Kao A, Pappagianis D, Kaufman L, Kobayashi J, Hajjeh R. Outbreak of coccidioidomycosis in Washington state residents returning from Mexico. Clin Infect Dis 2000; 30:61-4. [PMID: 10619734 DOI: 10.1086/313602] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
In July 1996 the Washington State Department of Health (Seattle) was notified of a cluster of a flulike, rash-associated illness in a 126-member church group, many of whom were adolescents. The group had recently returned from Tecate, Mexico, where members had assisted with construction projects at an orphanage. After 1 member was diagnosed with coccidioidomycosis, we initiated a study to identify further cases. We identified 21 serologically confirmed cases of coccidioidomycosis (minimum attack rate, 17%). Twenty cases (95%) occurred in adolescents, and 13 patients (62%) had rash. Sixteen symptomatic patients saw 19 health care providers; 1 health care provider correctly diagnosed coccidioidomycosis. Coccidioides immitis was isolated from soil samples from Tecate by use of the intraperitoneal mouse inoculation method. Trip organizers were unaware of the potential for C. immitis infection. Travelers visiting regions where C. immitis is endemic should be made aware of the risk of acquiring coccidioidomycosis, and health care providers should be familiar with coccidioidomycosis and its diagnosis.
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Menghini VV, Savcenko V, Olson LJ, Tazelaar HD, Dec GW, Kao A, Cooper LT. Combined immunosuppression for the treatment of idiopathic giant cell myocarditis. Mayo Clin Proc 1999; 74:1221-6. [PMID: 10593350 DOI: 10.4065/74.12.1221] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Giant cell myocarditis (GCM) is a rare and frequently fatal disorder with no proven treatment. Case reports and data from a rat model of GCM suggest that immunosuppressive therapy directed against T lymphocytes may have clinical benefit. We describe a 47-year-old man with severe acute heart failure due to GCM in whom the left ventricular ejection fraction normalized and the myocardial inflammatory infiltrate resolved rapidly after treatment with muromonab-CD3, cyclosporine, azathioprine, and corticosteroids. Three previously published cases with less impressive responses to treatment including muromonab-CD3 and a critical review of the published data on immunosuppressive therapy are included in this report. The response to immunosuppressive therapy is highly variable, and direct comparisons between immunosuppressive regimens do not exist. Therefore, despite individual reports of dramatic improvement after immunosuppressive treatment, firm conclusions cannot be made about the benefit of immunosuppression for GCM. The benefits of immunosuppressive therapy must be confirmed in a prospective, randomized trial.
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Levinson W, Gorawara-Bhat R, Dueck R, Egener B, Kao A, Kerr C, Lo B, Perry D, Pollitz K, Reifsteck S, Stein T, Santa J, Kemp-White M. Resolving disagreements in the patient-physician relationship: tools for improving communication in managed care. JAMA 1999; 282:1477-83. [PMID: 10535441 DOI: 10.1001/jama.282.15.1477] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Managed care uses financial incentives and restrictions on tests and procedures to attempt to influence physician decision making and limit costs. Increasingly, the public is questioning whether physicians are truly making decisions based on the patient's best interest or are unduly influenced by economic incentives. These circumstances lead to the potential for disagreements and conflict in the patient-physician relationship. We convened a group of individuals in October 1998, including patient representatives, leaders from health care organizations, practicing physicians, communication experts, and medical ethicists, to articulate the types of disagreements emerging in the patient-physician relationship as a result of managed care. We addressed 3 specific scenarios physicians may encounter, including allocation, illustrated by a patient who is referred to a different ophthalmologist based on a new arrangement in the physician's group; access, illustrated by a patient who wishes to see his own physician for a same-day visit rather than a nurse specialist; and financial incentives, illustrated by a patient who expects to have a test performed and a physician who does not believe the test is necessary but is afraid the patient will think the physician is not ordering the test because of financial incentives. Using these scenarios, we suggest communication strategies that physicians can use to decrease the potential for disagreements. In addition, we propose strategies that health plans or physician groups can use to alleviate or resolve these disagreements.
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Kao A. Sir william osler, MD. AMA J Ethics 1999; 1:virtualmentor.1999.1.1.prol1-9909. [PMID: 23507407 DOI: 10.1001/virtualmentor.1999.1.1.prol1-9909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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199
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Kao A. Sir william osler, MD. THE VIRTUAL MENTOR : VM 1999; 1:virtualmentor.2011.13.6.prol1-9911. [PMID: 23507490 DOI: 10.1001/virtualmentor.2011.13.6.prol1-9911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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200
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Kao A. Call for images of healing and learning. THE VIRTUAL MENTOR : VM 1999; 1:virtualmentor.2011.13.6.imhl1-9911. [PMID: 23507489 DOI: 10.1001/virtualmentor.2011.13.6.imhl1-9911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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