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Sheehan OC, Bayliss EA, Green AR, Drace ML, Norton J, Reeve E, Shetterly SS, Gleason Kathy S, Weffald LA, Maciejewski ML, Kraus C, Maiyani M, Wolff J, Boyd CM. 263 INFORMING INTERVENTION DESIGN IN COGNITIVELY IMPAIRED POPULATIONS: LESSONS LEARNED FROM THE OPTIMIZE DEPRESCRIBING INTERVENTION. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.231] [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: 11/13/2022] Open
Abstract
Abstract
Background
Polypharmacy is common in older adults with cognitive impairment and multiple chronic conditions increasing their risks of adverse drug events, hospitalization, further cognitive decline and death and leading to higher health care costs. Deprescribing, the process of reducing or stopping potentially inappropriate medications may improve outcomes. The OPTIMIZE trial examined whether educating and activating patients, family and clinicians about deprescribing reduces number of medications for older adults with cognitive impairment and multiple chronic conditions. Acceptability and challenges of intervention delivery in this vulnerable population are not well understood.
Methods
We explored mechanisms of intervention effectiveness through post hoc qualitative interviews and surveys with 15 patients, 7 family caregivers, and 28 clinicians. We assessed accessibility and delivery of materials as well as the ability of the materials to facilitate conversations and influence decisions around deprescribing.
Results
Acceptance of the intervention was affected by contextual factors including cognition and prior knowledge of deprescribing. Positive effects of the intervention included patients scheduling specific appointments to discuss deprescribing and providers being prompted to consider deprescribing. Recollection of intervention materials by patients was inconsistent but highest shortly after intervention delivery. Short clinic visit times remained the largest clinician barrier to deprescribing.
Conclusion
Our work identifies key learnings in intervention roll out which can guide future scaling of our intervention and other pragmatic deprescribing intervention studies in patients with cognitive impairment. We highlight the critical roles of both timing and repetition in intervention delivery to cognitively impaired populations as well as the barrier to deprescribing posed by short clinic consultation time. Our success in activating deprescribing conversations in this population highlights the need to incentivize medical professionals and health systems to incorporate deprescribing into routine clinical practice and expand proven interventions to other vulnerable populations.
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Affiliation(s)
- OC Sheehan
- Connolly Hospital RCSI Hospital Group, , Dublin, Ireland
- Johns Hopkins University School of Medicine , Baltimore, USA
| | - EA Bayliss
- Institute for Health Research, Kaiser Permanente , Colorado, USA
| | - AR Green
- Johns Hopkins University School of Medicine , Baltimore, USA
| | - ML Drace
- Institute for Health Research, Kaiser Permanente , Colorado, USA
| | - J Norton
- Johns Hopkins University School of Medicine , Baltimore, USA
| | - E Reeve
- University of South Australia , Adelaide, Australia
| | - SS Shetterly
- Institute for Health Research, Kaiser Permanente , Colorado, USA
| | - S Gleason Kathy
- Institute for Health Research, Kaiser Permanente , Colorado, USA
| | - LA Weffald
- Institute for Health Research, Kaiser Permanente , Colorado, USA
| | | | - C Kraus
- Institute for Health Research, Kaiser Permanente , Colorado, USA
| | - M Maiyani
- Institute for Health Research, Kaiser Permanente , Colorado, USA
| | - J Wolff
- Johns Hopkins University School of Public Health , Baltimore, USA
| | - CM Boyd
- Johns Hopkins University School of Medicine , Baltimore, USA
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Bayliss EA, Shetterly SM, Drace ML, Norton J, Green AR, Reeve E, Weffald LA, Wright L, Maciejewski ML, Sheehan OC, Wolff JL, Gleason KS, Kraus C, Maiyani M, Du Vall M, Boyd CM. The OPTIMIZE patient- and family-centered, primary care-based deprescribing intervention for older adults with dementia or mild cognitive impairment and multiple chronic conditions: study protocol for a pragmatic cluster randomized controlled trial. Trials 2020; 21:542. [PMID: 32552857 PMCID: PMC7301527 DOI: 10.1186/s13063-020-04482-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 02/24/2020] [Accepted: 06/06/2020] [Indexed: 12/03/2022] Open
Abstract
Background Most individuals with dementia or mild cognitive impairment (MCI) have multiple chronic conditions (MCC). The combination leads to multiple medications and complex medication regimens and is associated with increased risk for significant treatment burden, adverse drug events, cognitive changes, hospitalization, and mortality. Optimizing medications through deprescribing (the process of reducing or stopping the use of inappropriate medications or medications unlikely to be beneficial) may improve outcomes for MCC patients with dementia or MCI. Methods With input from patients, family members, and clinicians, we developed and piloted a patient-centered, pragmatic intervention (OPTIMIZE) to educate and activate patients, family members, and primary care clinicians about deprescribing as part of optimal medication management for older adults with dementia or MCI and MCC. The clinic-based intervention targets patients on 5 or more medications, their family members, and their primary care clinicians using a pragmatic, cluster-randomized design at Kaiser Permanente Colorado. The intervention has two components: a patient/ family component focused on education and activation about the potential value of deprescribing, and a clinician component focused on increasing clinician awareness about options and processes for deprescribing. Primary outcomes are total number of chronic medications and total number of potentially inappropriate medications (PIMs). We estimate that approximately 2400 patients across 9 clinics will receive the intervention. A comparable number of patients from 9 other clinics will serve as wait-list controls. We have > 80% power to detect an average decrease of − 0.70 (< 1 medication). Secondary outcomes include the number of PIM starts, dose reductions for selected PIMs (benzodiazepines, opiates, and antipsychotics), rates of adverse drug events (falls, hemorrhagic events, and hypoglycemic events), ability to perform activities of daily living, and skilled nursing facility, hospital, and emergency department admissions. Discussion The OPTIMIZE trial will examine whether a primary care-based, patient- and family-centered intervention educating patients, family members, and clinicians about deprescribing reduces numbers of chronic medications and PIMs for older adults with dementia or MCI and MCC. Trial registration NCT03984396. Registered on 13 June 2019
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Affiliation(s)
- E A Bayliss
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA. .,Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
| | - S M Shetterly
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - M L Drace
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - J Norton
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A R Green
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - E Reeve
- Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia.,Geriatric Medicine Research, Faculty of Medicine, and College of Pharmacy, Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada
| | - L A Weffald
- Department of Clinical Pharmacy, Kaiser Permanente Colorado, Aurora, CO, USA
| | - L Wright
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - M L Maciejewski
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, Veterans Affairs Medical Center, Durham, NC, USA.,Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA
| | - O C Sheehan
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J L Wolff
- School of Public Health, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - K S Gleason
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - C Kraus
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - M Maiyani
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - M Du Vall
- Department of Clinical Pharmacy, Kaiser Permanente Colorado, Aurora, CO, USA
| | - C M Boyd
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Bayliss EA, Tabano HA, Gill TM, Anzuoni K, Tai-Seale M, Allore HG, Ganz DA, Dublin S, Gruber-Baldini AL, Adams AL, Mazor KM. Data Management for Applications of Patient Reported Outcomes. EGEMS (Wash DC) 2018; 6:5. [PMID: 29881763 PMCID: PMC5983068 DOI: 10.5334/egems.201] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 02/01/2018] [Indexed: 11/20/2022]
Abstract
CONTEXT Patient reported outcomes (PROs) are one means of systematically gathering meaningful subjective information for patient care, population health, and patient centered outcomes research. However, optimal data management for effective PRO applications is unclear. CASE DESCRIPTION Delivery systems associated with the Health Care Systems Research Network (HCSRN) have implemented PRO data collection as part of the Medicare annual Health Risk Assessment (HRA). A questionnaire assessed data content, collection, storage, and extractability in HCSRN delivery systems. FINDINGS Responses were received from 15 (83.3 percent) of 18 sites. The proportion of Medicare beneficiaries completing an HRA ranged from less than 10 to 42 percent. Most sites collected core HRA elements and 10 collected information on additional domains such as social support. Measures for core domains varied across sites. Data were collected at and prior to visits. Modes included paper, clinician entry, patient portals, and interactive voice response. Data were stored in the electronic health record (EHR) in scanned documents, free text, and discrete fields, and in summary databases. MAJOR THEMES PRO implementation requires effectively collecting, storing, extracting, and applying patient-reported data. Standardizing PRO measures and storing data in extractable formats can facilitate multi-site uses for PRO data, while access to individual PROs in the EHR may be sufficient for use at the point of care. CONCLUSION Collecting comparable PRO data elements, storing data in extractable fields, and collecting data from a higher proportion of eligible respondents represents an optimal approach to support multi-site applications of PRO information.
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Affiliation(s)
- E. A. Bayliss
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, US
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, US
| | - H. A. Tabano
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, US
| | - T. M. Gill
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, US
| | - K. Anzuoni
- Meyers Primary Care Institute, a joint endeavor of the University of Massachusetts Medical School, Reliant Medical Group and Fallon Health, Worcester, MA, US
| | - M. Tai-Seale
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, US
| | - H. G. Allore
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, US
| | - D. A. Ganz
- Division of Geriatrics, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, US
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, US
| | - S. Dublin
- Kaiser Permanente Washington Health Research Institute, Seattle WA, US
| | - A. L. Gruber-Baldini
- Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, US
| | - A. L. Adams
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, US
| | - K. M. Mazor
- Meyers Primary Care Institute, a joint endeavor of the University of Massachusetts Medical School, Reliant Medical Group and Fallon Health, Worcester, MA, US
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Townsend NT, Everhart RM, Bayliss EA, Jaiswal K. Abstract P6-02-02: Increased interval cancers after the 2009 U.S. preventive services task force guidelines: A single-center, retrospective analysis. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-02-02] [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: 11/16/2022]
Abstract
Abstract
Background: In late 2009, the U.S. Preventive Services Task Force (USPSTF) increased the recommended time between screening mammography from one year to two years. We examined the effect of USPSTF recommendations in an integrated safety-net system whose patients often have intermittent access to care. The purpose of this study was to determine if changes in screening guidelines were associated with stage migration or changes in rate of interval cancers.
Methods: We conducted a retrospective cohort analysis of breast cancer patients diagnosed between 2005-2013 at one safety-net hospital. We abstracted stage at diagnosis, time intervals between screening and diagnostic imaging, as well as BIRADS classification from clinical and administrative billing data. We divided patients into two cohorts: Those diagnosed with breast cancer "pre-2010" (2005 – 2010) and "post-2010" (2011-2013). We compared stage of diagnosis between cohorts using Chi-Square tests. In a subset of patients for whom we had prior screening imaging information, we determined the rate of interval cancers. Interval cancers were defined as patients whose diagnosis occurred within 14 months (pre-2010) or within 26 months (post-2010) of normal screening mammography. Logistic regression was used to determine the unadjusted odds of interval cancer as a function of being post-2010 versus pre-2010.
Results: There were 521 unique, breast cancer patients between 2005-2013,
Distribution of Breast Cancer by Stage Stage 0Stage IStage IIStage IIIStage IVTotal2005-200941816142242492010-20134679824421272
249 in the 'pre-2010' cohort, and 272 in the 'post-2010' cohort. In the 2005-2009 cohort, 32.5% and 24.5% of patients were stage I and Stage II respectively. In 2010-2013, 29.0% and 30% were stage I and stage II, respectively. The difference in stage at diagnosis was not statistically significant (p=0.62). In a subset of 178 patients with available screening imaging data, we determined the rate of interval cancers. Pre-2010, 7.4% (8/108) of patients had an interval cancer. Post-2010, 20% (14/70) patients had an interval cancer. Patients diagnosed post-2010 had three times the odds of having an interval cancer compared to pre-2010 patients (OR = 3.13, 95% CI 1.24-7.91, p=0.01).
Discussion: The USPSTF 2009 recommendation is associated with a statistically significant increase in interval cancers in a safety-net population, but we cannot conclude that this contributes to stage migration in this limited population. Investigation of larger groups is needed to further assess how USPSTF guidelines affect outcomes in underserved populations.
Citation Format: Townsend NT, Everhart RM, Bayliss EA, Jaiswal K. Increased interval cancers after the 2009 U.S. preventive services task force guidelines: A single-center, retrospective analysis. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-02-02.
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Affiliation(s)
- NT Townsend
- University of Colorado, Aurora, CO; Denver Health Hospital Authority, Denver, CO; Institute for Health Research, Kaiser Permanente CO, Denver, CO
| | - RM Everhart
- University of Colorado, Aurora, CO; Denver Health Hospital Authority, Denver, CO; Institute for Health Research, Kaiser Permanente CO, Denver, CO
| | - EA Bayliss
- University of Colorado, Aurora, CO; Denver Health Hospital Authority, Denver, CO; Institute for Health Research, Kaiser Permanente CO, Denver, CO
| | - K Jaiswal
- University of Colorado, Aurora, CO; Denver Health Hospital Authority, Denver, CO; Institute for Health Research, Kaiser Permanente CO, Denver, CO
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Jaiswal KR, Furniss A, Doyle R, Gayou N, Bayliss EA. Abstract P6-12-03: Delays in diagnosis and treatment of breast cancer patients: A safety-net population profile. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-12-03] [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: 11/16/2022]
Abstract
Abstract
Background: Timely detection and treatment of breast cancer patients is important in survival and recurrence. Given disparities in breast cancer outcomes based on socioeconomic status, we examined the time to diagnosis and treatment in a safety net hospital.
Methods: We conducted a retrospective review of all breast cancer patients identified by cancer registry records from 7/1/2010 to 6/30/2012 (n=124). We excluded patients with primary stage IV (n=8) and those with recurrent breast cancer within 5 years of primary diagnosis (n=4). We determined intervals between presentation to diagnosis, diagnosis to first treatment, last surgery to chemotherapy start, and last surgery to radiation start. We used logistic regression to calculate unadjusted odds of receiving timely treatment (< median time) versus more delayed treatment (≥ median time) as a function of age, language, ethnicity, insurance, Charlson co-morbidity index, cancer stage, method of first presentation (screening mammography vs. care provider), symptoms at presentation, and type of surgical treatment.
Results: Of 112 patients, the median age was 59. 42.9% were Hispanic, 29.5% were White, and 24.1% were African American. Clinical stage distribution was 20.0% stage 0, 31.8% stage I, 40.9% stage II, and 8% stage III. 83.9% of patients had surgery, of which 51.1% had breast conservation. The median time from presentation to diagnosis, time from diagnosis to first treatment, and time from surgery to chemotherapy start, fell within recommended intervals (Table 1). The time from last surgery to radiation start was greater than recommended intervals. Variables with significantly increased odds of taking longer than the median time include: stage, method of presentation, language, Charlson index, surgical treatment, ethnicity, symptoms at presentation (Table 2).
Conclusion: Acceptable diagnosis and treatment intervals were obtained for disadvantaged patients, except for time to radiation therapy. Room for improvement exists: focused interventions to facilitate access to radiation therapy, aid providers in accessing imaging more quickly, aid non-English speaking and Hispanic patients could lead to improved breast cancer care.
Table 1. Intervals of CareMeasure: Time From...Median (days)25th, 75th % (days)Recommended Intervals (days)Presentation to Diagnosis197, 4360Diagnosis to 1st Treatment3730, 4821-60Presentation to 1st Treatment6247, 83n/aLast Surgery to Chemo Start4831, 5928-90Last Surgery to Radiation Start*6853,7942-56* for patients needing surgery and radiation only
Table 2. Un-adjusted Odds Ratio of Taking Longer than Median TimeIntervalVariableReferenceO.R.p-valuePresentation to DiagnosisStage II or IIIStage 0 or I2.880.008 Method of Presentation: Care ProviderMethod of Presentation: Screening Mammogram4.270.0004Diagnosis to First TreatmentAge< 55Age ≥ 552.180.070 English-speakingNon-English speaking0.220.005 Charlson Index ≥ 3Charlson Index <30.420.040 Symptomatic PresentationAsymptomatic Presentation2.830.040 Breast ConservationMastectomy2.840.020Presentation to First TreatmentHispanicNon-Hispanic2.650.022 Charlson Index ≥ 3Charlson Index <30.520.120 Method of Presentation: Care ProviderMethod of Presentation: Screening Mammogram3.160.008
Citation Format: Jaiswal KR, Furniss A, Doyle R, Gayou N, Bayliss EA. Delays in diagnosis and treatment of breast cancer patients: A safety-net population profile. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-12-03.
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Affiliation(s)
- KR Jaiswal
- University of Colorado School of Medicine, Denver, CO; Denver Health Medical Center, Denver, CO; Kaiser Permanente Colorado, Denver, CO; University of Colorado School of Medicine, ACCORDS, Denver, CO; Denver Health Medical Center, Health Services Research, Denver, CO
| | - A Furniss
- University of Colorado School of Medicine, Denver, CO; Denver Health Medical Center, Denver, CO; Kaiser Permanente Colorado, Denver, CO; University of Colorado School of Medicine, ACCORDS, Denver, CO; Denver Health Medical Center, Health Services Research, Denver, CO
| | - R Doyle
- University of Colorado School of Medicine, Denver, CO; Denver Health Medical Center, Denver, CO; Kaiser Permanente Colorado, Denver, CO; University of Colorado School of Medicine, ACCORDS, Denver, CO; Denver Health Medical Center, Health Services Research, Denver, CO
| | - N Gayou
- University of Colorado School of Medicine, Denver, CO; Denver Health Medical Center, Denver, CO; Kaiser Permanente Colorado, Denver, CO; University of Colorado School of Medicine, ACCORDS, Denver, CO; Denver Health Medical Center, Health Services Research, Denver, CO
| | - EA Bayliss
- University of Colorado School of Medicine, Denver, CO; Denver Health Medical Center, Denver, CO; Kaiser Permanente Colorado, Denver, CO; University of Colorado School of Medicine, ACCORDS, Denver, CO; Denver Health Medical Center, Health Services Research, Denver, CO
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Bayliss EA, Bosworth HB, Noel PH, Wolff JL, Damush TM, Mciver L. Supporting self-management for patients with complex medical needs: recommendations of a working group. Chronic Illn 2007; 3:167-75. [PMID: 18083671 DOI: 10.1177/1742395307081501] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [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: 11/16/2022]
Abstract
Increasing numbers of persons live with complex chronic medical needs and are at risk for poor health outcomes. These patients require unique self-management support, as they must manage many, often interacting, tasks. As part of a conference on Managing Complexity in Chronic Care sponsored by the Department of Veterans Affairs, a working group was convened to consider self-management issues specific to complex chronic care. In this paper, we assess gaps in current knowledge on self-management support relevant to this population, report on the recommendations of our working group, and discuss directions for future study. We conclude that this population requires specialized, multidimensional self-management support to achieve a range of patient-centred goals. New technologies and models of care delivery may provide opportunities to develop this support. Validation and quantification of these processes will require the development of performance measures that reflect the needs of this population, and research to prove effectiveness.
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Affiliation(s)
- E A Bayliss
- Clinical Research Unit, Kaiser Permanente, PO Box 378066, Denver, CO 80237-8066, USA.
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Bayliss EA, Park MK, Westfall JM, Zamorkski MA. Clinical inquiries. How can I improve patient adherence to prescribed medication? J Fam Pract 2001; 50:303-304. [PMID: 11300979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- E A Bayliss
- University of Colorado, Health Sciences Center, Denver, Colorado, USA
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Abstract
The objective of this study was to determine the concentration of Zinc (Zn), Copper (Cu) and Manganese (Mn) in hepatic tissue from extrahepatic biliary atresia (EHBA). Liver biopsy samples were obtained at time of portoenterostomy from 49 infants ages 1.1 to 20.7 months (median 2.1) with EHBA. Samples were dry ashed and analyzed by flame (Zn) or flameless (Cu and Mn) atomic absorption spectrophotometry. Hepatic Cu concentrations are physiologically elevated at birth and decline rapidly during the first 2 month of life, therefore only samples from 29 infants, ages greater than 8 weeks were considered for Cu. Concentrations (mg/kg dry weight, mean and range) were: Zn 142 (70-507), Cu 204 (19-570), Mn 9.1 (2.8-21.8) vs. literature controls in the same age range: Zn 262 (82-543), Cu 92, Mn 4.3 (3.3-11.5). No correlations were found between serum alkaline phosphatase, AST or total bilirubin and hepatic trace element concentrations, between trace element concentrations and age, or between Cu and Mn. Decreased bile flow with intrahepatic cholestasis may result in hepatic accumulation of Mn as well as Cu. The low hepatic Zn concentrations indicate the need for further study of Zn metabolism in this population.
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Affiliation(s)
- E A Bayliss
- Department of Pediatrics, University of Colorado, Denver 80262, USA
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