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Taylor KA, Schwartz SW, Alman AC, Goode AP, Dagne GA, Sebastião YV, Foulis PR. Nightmare disorder and low back pain in veterans: cross-sectional association and effect over time. Sleep Adv 2022; 3:zpac030. [PMID: 36387301 PMCID: PMC9648406 DOI: 10.1093/sleepadvances/zpac030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 07/29/2022] [Indexed: 12/15/2022]
Abstract
Low back pain (LBP) disproportionately impacts US military veterans compared with nonveterans. Although the effect of psychological conditions on LBP is regularly studied, there is little published to date investigating nightmare disorder (NMD) and LBP. The purpose of this study was to (1) investigate whether an association exists between NMD and LBP and (2) estimate the effect of NMD diagnosis on time to LBP. We used a retrospective cohort design with oversampling of those with NMD from the Veterans Health Administration (n = 15 983). We used logistic regression to assess for a cross-sectional association between NMD and LBP and survival analysis to estimate the effect of NMD on time to LBP, up to 60-month follow-up, conditioning on age, sex, race, index year, Charlson Comorbidity Index, depression, anxiety, insomnia, combat exposure, and prisoner of war history to address confounding. Odds ratios (with 95% confidence intervals [CIs]) indicated a cross-sectional association of 1.35 (1.13 to 1.60) and 1.21 (1.02 to 1.42) for NMD and LBP within 6 months and 12 months pre- or post-NMD diagnosis, respectively. Hazard ratios (HRs) indicated the effect of NMD on time to LBP that was time-dependent-HR (with 95% CIs) 1.27 (1.02 to 1.59), 1.23 (1.03 to 1.48), 1.19 (1.01 to 1.40), and 1.10 (0.94 to 1.29) in the first 3, 6, 9, and 12 months post-diagnosis, respectively-approximating the null (1.00) at >12 months. The estimated effect of NMD on LBP suggests that improved screening for NMD among veterans may help clinicians and researchers predict (or intervene to reduce) risk of future back pain.
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Affiliation(s)
- Kenneth A Taylor
- Corresponding author. Kenneth A. Taylor, Duke Clinical Research Institute, 300 West Morgan Street, Ste 800, Durham, NC 27701, USA.
| | - Skai W Schwartz
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Amy C Alman
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Adam P Goode
- Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA,Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA,Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Getachew A Dagne
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Yuri V Sebastião
- Division of Global Women’s Health, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Philip R Foulis
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA,Pathology and Laboratory Medicine, James A. Haley Veterans’ Hospital, Tampa, FL, USA
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Syler LB, Stobaugh CL, Foulis PR, Carlton GT, DeLand LA, Borkowski AA. Cervical Cancer Screening in South Florida Veteran Population, 2014 to 2020: Cytology and High-Risk Human Papillomavirus Correlation and Epidemiology. Cureus 2021; 13:e17247. [PMID: 34540473 PMCID: PMC8445854 DOI: 10.7759/cureus.17247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/16/2021] [Indexed: 01/09/2023] Open
Abstract
Objective This project aims to use our robust women's health patient data to analyze the correlation between cytology and high-risk human papillomavirus (Hr-HPV) testing, study the performance of Hr-HPV testing for detecting cytology lesions, and examine epidemiologic measures of human papillomavirus (HPV) infections in the women's veteran population. Methods We collected patient data from 2014 to 2020 from our computerized patient record system. We performed HPV assays using the cobas® 4800 system (Roche Diagnostics, Basel, Switzerland). The cobas HPV assay detects HPV 16, HPV 18, and 12 other HPV types (31, 33, 35, 39, 45, 51, 56, 58, 59, 66, and 68). We organized cytology results and Hr-HPV assays with Microsoft Access and Microsoft Excel (Microsoft Corporation, Washington, USA) for analysis. Results A total of 9437 cervical specimens were co-tested. High-grade cytology lesions - high-grade intraepithelial lesion (HSIL) or higher and atypical squamous cells, cannot exclude HSIL (ASC-H) - were overwhelmingly positive for Hr-HPV (94.1% and 87.2%, respectively). Low-grade cytology lesions - low-grade squamous intraepithelial lesion ((LSIL) and atypical squamous cells of undetermined significance (ASC-US) - were positive for Hr-HPV in lower percentages (72.6% and 54.9%, respectively). Hr-HPV testing had a sensitivity of 91.3%, a specificity of 93.1%, a positive predictive value of 16.4%, and a negative predictive value of 99.8% for detecting high-grade cytology lesions. Hr-HPV testing had a lower performance for detecting low-grade cytology lesions. Ten cases had high-grade cytology and negative Hr-HPV test. Out of 10 such patients, nine showed no dysplasia (six) or low-grade dysplasia (three) on subsequent biopsy. Overall, 14.4% of tests were positive for Hr-HPV. The highest positive Hr-HPV test rates were in the third and eighth decades of life, 25.1% and 22.0%, respectively. However, the eighth decade consisted of a small sample of only 50 women. In women over 30 years of age with Hr-HPV infections, HPV types 16 and 18 were present in 11.7% and 6.4% of tests, respectively. Other HPV types were present in 82.3% of tests. Conclusions Hr-HPV testing has a high performance in detecting high-grade cytology lesions and a lower performance for detecting low-grade cytology lesions. However, studies show that LSIL rarely progresses to cervical intraepithelial neoplasia grade 3 or higher (CIN3+), suggesting minimal to no impact on cervical cancer screening. We believe our findings are in accordance with recent studies and affirm the guidelines that recommend primary Hr-HPV testing as the preferred screening method. The percentage of positive Hr-HPV tests and rates for age and HPV types 16 and 18 in our women's veteran population suggest similar HPV prevalence to that of the general US population.
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Affiliation(s)
- Lee B Syler
- Pathology, University of South Florida, Tampa, USA
| | - Corinne L Stobaugh
- Pathology and Laboratory Medicine, James A. Haley Veterans' Hospital, Tampa, USA
| | - Philip R Foulis
- Pathology and Laboratory Medicine, James A. Haley Veterans' Hospital, Tampa, USA
| | - George T Carlton
- Pathology and Laboratory Medicine, James A. Haley Veterans' Hospital, Tampa, USA
| | | | - Andrew A Borkowski
- Pathology and Laboratory Medicine, James A. Haley Veterans' Hospital, Tampa, USA
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Taylor KA, Schwartz SW, Sebastião YV, Anderson WM, Foulis PR. 0667 Positive Airway Pressure Non-Adherence Interacts With Post-Traumatic Stress Disorder to Increase Risk of Back Pain. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.663] [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
Introduction
Altered sleep, as is associated with obstructive sleep apnea (OSA), may increase the risk of back pain (BP). However, little to no evidence regarding the effect of OSA on musculoskeletal pain is currently available, let alone the effect of positive airway pressure (PAP) treatment non-adherence. The purpose of this analysis is to investigate the effect of PAP non-adherence on future BP diagnosis.
Methods
A sample of 1,662 veterans who had a sleep study between January 2003 and October 2006 and receiving PAP treatment for OSA were used for analysis. Measures at baseline included demographic and OSA symptom severity data. Up to 3 weeks of PAP adherence data were collected and patient chart data was collected through May 2010 to determine outcomes. Time was calculated from PAP treatment start to BP diagnosis or censoring, which occurred at date of death or last recorded encounter. Survival analysis was conducted to obtain the hazard ratios (HR) for the effect of PAP non-adherence on BP diagnosis and to investigate whether post-traumatic stress disorder (PTSD) is an effect modifier of this relationship.
Results
PAP treatment non-adherence significantly increased the risk of BP diagnosis (HR 1.88 [95% CI: 1.08, 3.27]) among veterans with PTSD, while non-adherence among veterans without PTSD was not a statistically significant risk factor. Relative excess risk due to interaction (RERI) was 0.97 (95% CI: -0.07, 2.02; p-value=0.068). These estimates are independent of age, sex, race, body mass index, apnea severity (based on Apnea-Hypopnea Index), PTSD diagnosis, income level, and marital status.
Conclusion
PAP treatment non-adherence among veterans with PTSD appears to result in a significant increase in risk of future BP diagnosis. The interaction between PAP non-adherence and PTSD appears to be borderline synergistic. Therefore, improving PAP adherence among veterans with PTSD may decrease risk of future BP diagnosis.
Support
This material is the result of work supported with resources and the use of facilities at the James A. Haley Veterans’ Hospital.
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Affiliation(s)
- K A Taylor
- University of South Florida, Tampa, FL
- Gannon University, Ruskin, FL
| | | | | | - W M Anderson
- University of South Florida, Tampa, FL
- James A. Haley Veterans’ Hospital, Tampa, FL
| | - P R Foulis
- James A. Haley Veterans’ Hospital, Tampa, FL
- University of South Florida, Tampa, FL
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Patel RK, Schwartz SW, Sebastiao YV, Andrews A, Foulis PR, Anderson WM. 0816 Sleep Correlates Of Nightmares Among Veterans. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.812] [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
Introduction
There is an increased prevalence of Nightmare disorder (ND) among patients with obstructive sleep apnea (OSA). A further investigation of objectively measured sleep parameters among patients with and without ND could inform on potential comorbidities. We hypothesize ND correlates with Epworth sleepiness scale (ESS), apnea hypopnea index (AHI), Trough 02% (Sp02 nadir), and periodic limb movement (PLM) index.
Methods
Data presented herein are interim results from an IRB approved study to determine correlates and sequelae of nightmares. A cohort of all patients with ND visiting James A Haley Veterans Hospital between 2007 and 2011 was defined along with a random cohort of control patients. Demographic and outpatient visit data between January 2006 and April 2016 was pulled from VISTA for both the ND and control cohorts, and patients who had undergone a sleep study were identified. To date, sleep summary data has been individually extracted for 111 ND patients and 835 control patients. Logistic regression (SAS 9.4) was used to compare ESS, AHI, Sp02 nadir, and PLM Index.
Results
Mean age for ND was significantly lower at 49.7 ± 14, compared to 58.4 ± 12 for controls. Other demographic measures were similar including gender, race, and marital status. PLM index was significantly lower in ND compared to controls, however this relationship disappeared after adjusting for age. There were neither significant differences between other polysomnographic (PSG) variables, specifically AHI and Sp02 nadir, nor did OSA severity significantly different between ND and controls.
Conclusion
Among veterans undergoing a PSG, there were no significant differences between measured sleep parameters. Our results contradict our hypothesis that ND correlates with ESS, AHI, Sp02 nadir, and PLM index.
Support
This material is the result of work supported with resources and the use of facilities at the James A. Haley Veterans’ Hospital.
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Affiliation(s)
- R K Patel
- University of South Florida, Tampa, FL
- James A. Haley Veterans Hospital, Tampa, FL
| | | | | | - A Andrews
- University of South Florida, Tampa, FL
- James A. Haley Veterans Hospital, Tampa, FL
| | - P R Foulis
- University of South Florida, Tampa, FL
- James A. Haley Veterans Hospital, Tampa, FL
| | - W M Anderson
- University of South Florida, Tampa, FL
- James A. Haley Veterans Hospital, Tampa, FL
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Donaldson K, Buchanich JM, Grigson PS, Deneke E, Donaldson K, Vrana KE, Sacks DB, Kuehn GJ, Cardamone D, Pesce A, Smiley S, Nickley J, Krock K, Thomas R, Wilkerson ML, Farag HA, Challa SR, Tice AM, Wolk DM, Prichard J, Grant ML, Regmi S, Kerbacher B, Quinton LE, Farag HA, Tice AM, Wolk DM, Olson J, Haynes A, Yu E, McCully KS, Assi J, Wong M, Zarrin-Khameh N, Nifong TP, Hawker CD, Carlton GT, Rivera JM, Foulis PR, Zuraw A, Morlote D, Peker D, Reddy V, Harada S, Crutchfield C, Zander D, Barbhuiya MA, Pederson EC, Straub ML, Scott SC, Neibauer TL, Salter WF, Creer MH, Zhu Y, Bornhorst JA, Theobald JP, Algeciras-Schimnich A, Cao L, Knox J, Hardy R, Texas HJ, McGuire MF, Hunter RL, Brown RE, Hicks J, Hicks J, Cai Z, Brown RE, Ali Y, Cheng KC, Katz SR, Ding Y, Vanselow DJ, Yakovlev MA, Lin AY, Clark DP, Vargas P, Xin X, Copper JE, Canfield VA, Ang KC, Wang Y, Xiao X, De Carlo F, van Rossum DB, La Rivière PJ, Newell J, Hossler C, Roche M, Warrick J, Phaeton R, Kesterson J, Donaldson K, Myers C, Barrios R, Mintz P, Robyak K, Hamilton C, McGhee P, Pederson C, Straub M, Scott S, Neibauer T, Salter W, Creer M, Zhu Y, Hamilton C, Robyak K, McGhee P, Pederson C, Straub M, Scott S, Neibauer T, Salter W, Creer M, Zhu Y, Singh N, Morlote D, Vnencak-Jones C, Yemelyanova A, Harada S, Shah M, Moghadamtousi SZ, Lan C, Duose D, Hu P, Esquenazi Y, Luthra R, Ballester LY, Koenig AN, Liu CG, Zhang J, Kalia A, Al-Habib A, Van Arsdall M, Dhingra S, Patel K, Tatevian N. Abstracts of Presentations at the Association of Clinical Scientists 139 th Meeting Hershey, PA, May 15-18, 2019. Ann Clin Lab Sci 2019; 49:403-416. [PMID: 31308044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Robert E Brown
- UT Health McGovern Medical School at Houston, Houston, TX
| | | | | | | | | | | | - Keith C Cheng
- Department of Pathology, Penn State College of Medicine
| | | | - Yifu Ding
- Department of Pathology, Penn State College of Medicine
| | | | | | - Alex Y Lin
- Department of Pathology, Penn State College of Medicine
| | | | | | - Xuying Xin
- Department of Pathology, Penn State College of Medicine
| | - Jean E Copper
- Department of Pathology, Penn State College of Medicine
| | | | - Khai C Ang
- Department of Pathology, Penn State College of Medicine
| | - Yuxin Wang
- Omnivision Technologies, Santa Clara, CA
| | - Xianghui Xiao
- Advanced Photon Source, Argonne National Laboratory, University of Chicago
- Brookhaven National Laboratory, University of Chicago
| | - Francesco De Carlo
- Advanced Photon Source, Argonne National Laboratory, University of Chicago
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mauli Shah
- Graduate Program in Diagnostic Genetics, School of Health Professions, UT MD Anderson Cancer Center, Houston, TX
| | | | - Chieh Lan
- Department of Translational Molecular Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dzifa Duose
- Department of Translational Molecular Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Peter Hu
- Graduate Program in Diagnostic Genetics, School of Health Professions, UT MD Anderson Cancer Center, Houston, TX
| | - Yoshua Esquenazi
- Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX
| | - Rajyalakshmi Luthra
- Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Leomar Y Ballester
- Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX
| | | | | | | | | | - Ali Al-Habib
- The University of Texas Health Science Center, Houston, TX
| | | | | | | | - Nina Tatevian
- The University of Texas Health Science Center, Houston, TX
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Schwartz SW, Ghimire-Aryal P, Scheer D, Taylor K, Anderson WM, Rosas J, Foulis PR. 0515 Interaction Of Apnea Severity And Comorbidity With CPAP Adherence. Sleep 2019. [DOI: 10.1093/sleep/zsz067.513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Skai W Schwartz
- Epidemiology and Biostatistics, University of South Florida, Tampa, FL, USA
| | | | - Darren Scheer
- Epidemiology and Biostatistics, University of South Florida, Tampa, FL, USA
| | - Kenneth Taylor
- Epidemiology and Biostatistics, University of South Florida, Tampa, FL, USA
| | - W M Anderson
- James A Haley Veteran's Hospital, Tampa, FL, USA
| | - Julie Rosas
- James A Haley Veteran's Hospital, Tampa, FL, USA
| | - P R Foulis
- James A Haley Veteran's Hospital, Tampa, FL, USA
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Ghimire-Aryal P, Schwartz SW, Sebastião YV, Anderson WM, Scheer D, Foulis PR. 0850 The Role Of Sleeping Pills In The Development Of Shingles In Veterans. Sleep 2019. [DOI: 10.1093/sleep/zsz067.848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Skai W Schwartz
- Epidemology and Biostatistics, University of South Florida, Tampa, FL, USA
| | | | | | - Darren Scheer
- Epidemology and Biostatistics, University of South Florida, Tampa, FL, USA
| | - P R Foulis
- James A Haley Veteran's Hospital, Tampa, FL, USA
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Strickland-Marmol LB, Muro-Cacho CA, Washington K, Foulis PR. "Ask The Pathologist": An Internet Forum Facilitating Communication Between Cancer Registrars and Pathologists. Arch Pathol Lab Med 2018; 142:1275-1283. [PMID: 29846103 DOI: 10.5858/arpa.2017-0424-oa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Cancer registrars should work closely with pathologists to ensure compliance with reporting standards. Many registrars, however, have little contact with pathologists, resulting in a lack of "real-time" interaction that is essential for their professional activities and development. OBJECTIVE.— To facilitate registrars' case management, as cancer biology becomes more complex, we developed the ATP (Ask the Pathologist) forum as a place to ask pathology-related questions about neoplasms, such as terminology, biology, histologic classification, extent of disease, molecular markers, and prognostic factors. DESIGN.— Questions posted are reviewed by the ATP multidisciplinary oversight committee, which consists of 3 pathologists, 4 cancer registrars, 1 internal medicine physician, the pathology resident member of the College of American Pathologists Cancer Committee, and 2 medical technologists. The oversight committee may answer the question. Alternatively, the committee may forward the question to a content expert pathologist, determine that the question is better suited for another reference Web site, or both. RESULTS.— Since September 2013, when the ATP forum became available, users have posted 284 questions, of which 48 (17%) related to gastrointestinal tumors, 43 (15%) to breast tumors, and 37 (13%) to general pathology. The average turnaround time, from question posted to response, is 11.1 days. CONCLUSIONS.— The ATP forum has had a positive impact in the daily activities of cancer registrars. Of 440 registrars surveyed, more than 90% considered that questions were answered satisfactorily, and one-third reported that ATP answers affected how they managed a given case.
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Affiliation(s)
- Leah B Strickland-Marmol
- From the Pathology and Laboratory Medicine Service, James A. Haley Veterans' Hospital and the University of South Florida, Tampa (Drs Strickland-Marmol, Muro-Cacho, and Foulis); and the Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Washington)
| | - Carlos A Muro-Cacho
- From the Pathology and Laboratory Medicine Service, James A. Haley Veterans' Hospital and the University of South Florida, Tampa (Drs Strickland-Marmol, Muro-Cacho, and Foulis); and the Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Washington)
| | - Kay Washington
- From the Pathology and Laboratory Medicine Service, James A. Haley Veterans' Hospital and the University of South Florida, Tampa (Drs Strickland-Marmol, Muro-Cacho, and Foulis); and the Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Washington)
| | - Philip R Foulis
- From the Pathology and Laboratory Medicine Service, James A. Haley Veterans' Hospital and the University of South Florida, Tampa (Drs Strickland-Marmol, Muro-Cacho, and Foulis); and the Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Washington)
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Patel RK, Schwartz SW, Sebastião YV, Andrews A, Foulis PR, Anderson WM. 0932 Sleep Correlates of Nightmares Among Veterans. Sleep 2018. [DOI: 10.1093/sleep/zsy061.931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R K Patel
- University of South Florida, Tampa, FL
- James A Haley Veterans Hospital, Tampa, FL
| | - S W Schwartz
- University of South Florida, Tampa, FL
- James A Haley Veterans Hospital, Tampa, FL
| | | | - A Andrews
- University of South Florida, Tampa, FL
- James A Haley Veterans Hospital, Tampa, FL
| | - P R Foulis
- University of South Florida, Tampa, FL
- James A Haley Veterans Hospital, Tampa, FL
| | - W M Anderson
- University of South Florida, Tampa, FL
- James A Haley Veterans Hospital, Tampa, FL
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10
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Ghimire-Aryal P, Schwartz S, Sebastião YV, Anderson WM, Foulis PR. 0914 Association Between Obstructive Sleep Apnea, Nightmare Disorder and Incident Herpes Zoster. Sleep 2018. [DOI: 10.1093/sleep/zsy061.913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | | | - P R Foulis
- James A. Haley Veterans Hospital, Tampa, FL
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Abstract
SummaryThere has been growing interest in studying the biological effects of certain drugs and their potential to reduce the risk of various cancers. One study reported a decrease in the incidence of urogenital cancers in a trial with patients who received warfarin for treatment of venous thromboembolism, but a limitation to this study of urogenital cancers was the very small number of bladder cancer cases that developed following warfarin therapy. The objective of the present study is to measure the association between warfarin use and bladder cancer. A total of 330 cases with bladder cancer were identified at the James A. Haley Veterans’ Administration (VA) Hospital in Tampa, Florida, using a combination of computerized pathology records and inpatient and outpatient diagnoses. Controls were randomly selected from the VA computerized administrative database and 1293 controls were included for analysis. Unconditional logistic regression analysis was performed to assess the risk of bladder cancer after adjusting for age, gender, and cigarette smoking. Among warfarin users, although there was a 27% elevation in risk, it did not differ significantly from nonusers (OR = 1.27, 95% CI = 0.85, 1.89). No durationresponse relationship was observed between anticoagulant use and risk of bladder cancer. The results suggest that warfarin does not protect against bladder cancer, at least in male smokers, the highest risk population for bladder cancer.
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Affiliation(s)
- William A Blumentals
- Procter & Gamble Pharmaceuticals, HCRC - Box 2207, 8700 Mason-Montgomery Road, Mason, OH 45040-9462, USA.
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Strickland-Marmol LB, Muro-Cacho CA, Barnett SD, Banas MR, Foulis PR. College of American Pathologists Cancer Protocols: Optimizing Format for Accuracy and Efficiency. Arch Pathol Lab Med 2017; 140:578-87. [PMID: 27232350 DOI: 10.5858/arpa.2015-0237-oa] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT -The data in College of American Pathologists cancer protocols have to be presented effectively to health care providers. There is no consensus on the format of those protocols, resulting in various designs among pathologists. Cancer protocols are independently created by site-specific experts, so there is inconsistent wording and repetition of data. This lack of standardization can be confusing and may lead to interpretation errors. OBJECTIVE -To define a synopsis format that is effective in delivering essential pathologic information and to evaluate the aesthetic appeal and the impact of varying format styles on the speed and accuracy of data extraction. DESIGN -We queried individuals from several health care backgrounds using varying formats of the fallopian tube protocol of the College of American Pathologists without content modification to investigate their aesthetic appeal, accuracy, efficiency, and readability/complexity. Descriptive statistics, an item difficulty index, and 3 tests of readability were used. RESULTS -Columned formats were aesthetically more appealing than justified formats (P < .001) and were associated with greater accuracy and efficiency. Incorrect assumptions were made about items not included in the protocol. Uniform wording and short sentences were associated with better performance by participants. CONCLUSIONS -Based on these data, we propose standardized protocol formats for cancer resections of the fallopian tube and the more-familiar colon, employing headers, short phrases, and uniform terminology. This template can be easily and minimally modified for other sites, standardizing format and verbiage and increasing user accuracy and efficiency. Principles of human factors engineering should be considered in the display of patient data.
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Affiliation(s)
- Leah B Strickland-Marmol
- From the Departments of Pathology and Laboratory Medicine (Drs Strickland-Marmol, Muro-Cacho, and Foulis), Systems Redesign (Mr Banas), and the Health Services Research & Development Center of Innovation on Disability and Rehabilitation Research (Dr Barnett), James A. Haley Veterans' Hospital, Tampa, Florida
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13
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Schwartz SW, Sebastião Y, Rosas J, Iannacone MR, Foulis PR, Anderson WM. Racial disparity in adherence to positive airway pressure among US veterans. Sleep Breath 2016; 20:947-55. [PMID: 26810493 DOI: 10.1007/s11325-016-1316-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 01/09/2016] [Accepted: 01/12/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Despite advances in continuous positive airway pressure (CPAP) technology, compliance with CPAP therapy remains suboptimal. Studies conducted since the advent of objective CPAP recording have noted that African Americans (AA) may use CPAP less than Whites. We sought to confirm this finding among a large sample of veterans and examine effect modifiers of the differential usage. METHODS A retrospective cohort of 233 AA and 1939 White Veterans Administration (VA) patients who had a sleep study between January 2003 and October 2006 and received CPAP therapy by the end of 2007. CPAP compliance was summarized at 2 weeks and 6 months post CPAP receipt. RESULTS AAs were significantly less adherent than Whites even when controlling for age, gender, marital status, median household income for zip code, BMI, comorbidities, and obstructive sleep apnea (OSA) severity. AAs with severe OSA were 3 times more likely to use CPAP than AAs with mild/moderate OSA (p ≤ 0.001); a much smaller but still statistically significant difference was seen for Whites. CONCLUSIONS CPAP compliance is considerably lower in AAs than in Whites, though severity of OSA modifies this association. These findings are not readily explained by differences in demographics or comorbidity.
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Affiliation(s)
- Skai W Schwartz
- Department of Epidemiology and Biostatistics, College of Public Health MDC-56, University of South Florida, Tampa, FL, 33612, USA.
| | - Yuri Sebastião
- Department of Epidemiology and Biostatistics, College of Public Health MDC-56, University of South Florida, Tampa, FL, 33612, USA
| | - Julie Rosas
- Medical Service, James A. Haley VA Hospital, Tampa, FL, USA
| | - Michelle R Iannacone
- Department of Epidemiology and Biostatistics, College of Public Health MDC-56, University of South Florida, Tampa, FL, 33612, USA
| | - Philip R Foulis
- Laboratory Service, James A. Haley VA Hospital, Tampa, FL, USA
- Department of Pathology and Cell Biology, University of South Florida, Tampa, FL, USA
| | - W McDowell Anderson
- Medical Service, James A. Haley VA Hospital, Tampa, FL, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, University of South Florida, Tampa, FL, USA
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Luther SL, McCart JA, Berndt DJ, Hahm B, Finch D, Jarman J, Foulis PR, Lapcevic WA, Campbell RR, Shorr RI, Valencia KM, Powell-Cope G. Improving identification of fall-related injuries in ambulatory care using statistical text mining. Am J Public Health 2015; 105:1168-73. [PMID: 25880936 DOI: 10.2105/ajph.2014.302440] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We determined whether statistical text mining (STM) can identify fall-related injuries in electronic health record (EHR) documents and the impact on STM models of training on documents from a single or multiple facilities. METHODS We obtained fiscal year 2007 records for Veterans Health Administration (VHA) ambulatory care clinics in the southeastern United States and Puerto Rico, resulting in a total of 26 010 documents for 1652 veterans treated for fall-related injury and 1341 matched controls. We used the results of an STM model to predict fall-related injuries at the visit and patient levels and compared them with a reference standard based on chart review. RESULTS STM models based on training data from a single facility resulted in accuracy of 87.5% and 87.1%, F-measure of 87.0% and 90.9%, sensitivity of 92.1% and 94.1%, and specificity of 83.6% and 77.8% at the visit and patient levels, respectively. Results from training data from multiple facilities were almost identical. CONCLUSIONS STM has the potential to improve identification of fall-related injuries in the VHA, providing a model for wider application in the evolving national EHR system.
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Affiliation(s)
- Stephen L Luther
- Stephen L. Luther, James A. McCart, Bridget Hahm, Dezon Finch, Philip R. Foulis, William A. Lapcevic, Robert R. Campbell, and Gail Powell-Cope are with the HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, Tampa, FL. Donald J. Berndt is with the University of South Florida College of Business Administration, Tampa. Jay Jarman is with the East Tennessee State University Department of Computing, Johnson City. Ronald I. Shorr is with the North Florida/South Georgia Veterans Health System, Gainesville, FL. Keryl Motta Valencia is with the VA Caribbean Healthcare System, San Juan, PR
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15
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Simpson RW, Berman MA, Foulis PR, Divaris DXG, Birdsong GG, Mirza J, Moldwin R, Spencer S, Srigley JR, Fitzgibbons PL. Cancer biomarkers: the role of structured data reporting. Arch Pathol Lab Med 2014; 139:587-93. [PMID: 25275812 DOI: 10.5858/arpa.2014-0082-ra] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT The College of American Pathologists has been producing cancer protocols since 1986 to aid pathologists in the diagnosis and reporting of cancer cases. Many pathologists use the included cancer case summaries as templates for dictation/data entry into the final pathology report. These summaries are now available in a computer-readable format with structured data elements for interoperability, packaged as "electronic cancer checklists." Most major vendors of anatomic pathology reporting software support this model. OBJECTIVES To outline the development and advantages of structured electronic cancer reporting using the electronic cancer checklist model, and to describe its extension to cancer biomarkers and other aspects of cancer reporting. DATA SOURCES Peer-reviewed literature and internal records of the College of American Pathologists. CONCLUSIONS Accurate and usable cancer biomarker data reporting will increasingly depend on initial capture of this information as structured data. This process will support the standardization of data elements and biomarker terminology, enabling the meaningful use of these datasets by pathologists, clinicians, tumor registries, and patients.
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Affiliation(s)
- Ross W Simpson
- From the Department of Pathology, Park Nicollet-Methodist Hospital, St Louis Park, Minnesota (Dr Simpson); the Department of Pathology, Jefferson Regional Medical Center, Jefferson Hills, Pennsylvania (Dr Berman); the University of South Florida Department of Pathology and Cell Biology, James A. Haley Veterans' Hospital, Tampa (Dr Foulis); the Department of Laboratory Medicine, Grand River Hospital, Kitchener, Ontario, Canada (Dr Divaris); the Department of Pathology, Grady Health System/Emory University School of Medicine, Atlanta, Georgia (Dr Birdsong); Capability & Specialty Advancement, College of American Pathologists, Northfield, Illinois (Drs Mirza, Moldwin, and Spencer); the Laboratory Medicine and Genetics Program, Trillium Health Partners, Mississauga, Ontario, Canada (Dr Srigley); and the Department of Pathology, St Jude Medical Center, Fullerton, California (Dr Fitzgibbons)
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16
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Schwartz SW, Rosas J, Iannacone MR, Foulis PR, Anderson WM. Correlates of a prescription for Bilevel positive airway pressure for treatment of obstructive sleep apnea among veterans. J Clin Sleep Med 2013; 9:327-35. [PMID: 23585747 DOI: 10.5664/jcsm.2580] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The acceptance of portable home-based polysomnography together with auto-titrating CPAP has bypassed the need for a laboratory polysomnography. Since bilevel airway pressure (BPAP) is titrated in the sleep lab, patients diagnosed using portable home-based polysomnography may not have the opportunity to receive BPAP. It is unknown whether the patients who would have ordinarily received a BPAP would benefit from it. We determine correlates of receiving BPAP and of being switched from BPAP to CPAP. We examine whether patients with these correlates have better adherence to BPAP versus CPAP. METHODS Retrospective Cohort Study (Correlates at baseline) of 2,513 VA patients with a sleep study between January 2003 and October 2006 and receiving continuous or bilevel positive airway pressure (CPAP [N = 2,251]) or BPAP [N = 262]) by the end of 2007. PAP adherence up to 30 months was assessed. RESULTS Significant correlates of BPAP were older age (p < 0.001), higher BMI and CHF (p < 0.01), COPD (p < 0.001), higher blood CO₂ (p < 0.05), higher AHI and OSA severity (p < 0.001), lower nadir SpO₂ (p < 0.001), and greater sleepiness (ESS) (p < 0.01). Patients on BPAP were more adherent to PAP therapy (p < 0.01), but the association largely disappeared following adjustment for BPAP correlates. There was preliminary evidence that these correlates predict long-term adherence to PAP therapy regardless of mode. CONCLUSIONS We identified baseline factors that can help clinicians decide whether to prescribe an auto-BPAP as first-line therapy and that predict good long-term PAP adherence.
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Affiliation(s)
- Skai W Schwartz
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL 33612, USA.
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Hill OT, Mason TJ, Schwartz SW, Foulis PR. Improving prostate cancer detection in veterans through the development of a clinical decision rule for prostate biopsy. BMC Urol 2013; 13:6. [PMID: 23356551 PMCID: PMC3567946 DOI: 10.1186/1471-2490-13-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 12/28/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We sought to improve prostate cancer (PC) detection through developing a prostate biopsy clinical decision rule (PBCDR), based on an elevated PSA and laboratory biomarkers. This decision rule could be used after initial PC screening, providing the patient and clinician information to consider prior to biopsy. METHODS This case-control study evaluated men from the Tampa, Florida, James A. Haley (JH) Veteran's Administration (VA) (N = 1,378), from January 1, 1998, through April 15, 2005. To assess the PBCDR we did all of the following: 1) Identified biomarkers that are related to PC and have the capability of improving the efficiency of PC screening; 2) Developed statistical models to determine which can best predict the probability of PC; 3) Compared each potential model to PSA alone using Receiver Operator Characteristic (ROC) curves, to evaluate for improved overall effectiveness in PC detection and reduction in (negative) biopsies; and 4) Evaluated dose-response relationships between specified lab biomarkers (surrogates for extra-prostatic disease development) and PC progression. RESULTS The following biomarkers were related to PC: hemoglobin (HGB) (OR = 1.42 95% CI 1.27, 1.59); red blood cell (RBC) count (OR = 2.52 95% CI 1.67, 3.78); PSA (OR = 1.04 95% CI 1.03, 1.05); and, creatinine (OR = 1.55 95% CI 1.12, 2.15). Comparing all PC stages versus non-cancerous conditions, the ROC curve area under the curve (AUC) enlarged (increasing the probability of correctly classifying PC): PSA (alone) 0.59 (95% CI 0.55, 0.61); PBCDR model 0.68 (95% CI 0.65, 0.71), and the positive predictive value (PPV) increased: PSA 44.7%; PBCDR model 61.8%. Comparing PC (stages II, III, IV) vs. other, the ROC AUC increased: PSA (alone) 0.63 (95% CI 0.58, 0.66); PBCDR model 0.72 (95% CI 0.68, 0.75), and the PPV increased: 20.6% (PSA); PBCDR model 55.3%. CONCLUSIONS These results suggest evaluating certain common biomarkers in conjunction with PSA may improve PC prediction prior to biopsy. Moreover, these biomarkers may be more helpful in detecting clinically relevant PC. Follow-up studies should begin with replicating the study on different U.S. VA patients involving multiple practices.
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Affiliation(s)
- Owen T Hill
- Injury Epidemiology Research Section, Military Performance Division, United States Army Institute of Environmental Medicine, Natick, MA, USA.
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Thomas LB, Foulis PR, Mastorides SM, Djilan YA, Skinner O, Borkowski AA. Hepatitis C genotype analysis: results in a large veteran population with review of the implications for clinical practice. Ann Clin Lab Sci 2012; 42:355-362. [PMID: 23090730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
CONTEXT Hepatitis C virus (HCV) infects up to 1.8% of the US general population, although the rate is significantly higher in military veterans at 5.4-20%. Early detection and accurate diagnosis are critical as chronic HCV infection can lead to liver cirrhosis and hepatocellular carcinoma. Genotype analysis has both therapeutic and prognostic importance in patients with HCV infections. OBJECTIVE We compare two versions of a commonly utilized platform for genotype analysis in HCV infections and review the implications of the results for clinical practice. DESIGN A retrospective review of 9401 genotype results from 2001-2010 were analyzed. All results were obtained from the James A. Haley VA Medical Center, a large referral veterans' healthcare facility. RESULTS Genotype 1 was identified in 80.1% of samples, genotype 2 in 11.1%, genotype 3 in 7.4%, and genotype 4 in 1.2%. Genotypes 5 and 6 were rarely present in our patient population. Improvements in diagnostic methodologies over the study period resulted in shifts in genotype subtyping. Specifically, upgrading from the Versant HCV genotype assay (LIPA) (Siemens, Tarrytown, NY) to the newer version 2.0 assay resulted in an increase in identification of genotype 1a by 18.5%. CONCLUSIONS Improved technologies lead to accurate genotype identification and subtyping, both of which have increasingly important prognostic and therapeutic implications. The clinical importance of these results in patients with HCV infections is reviewed.
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Affiliation(s)
- L Brannon Thomas
- Pathology and Laboratory Medicine, James A. Haley Veterans Hospital, Tampa, FL 33612, USA.
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Neugaard BI, Priest JL, Burch SP, Cantrell CR, Foulis PR. Quality of care for veterans with chronic diseases: performance on quality indicators, medication use and adherence, and health care utilization. Popul Health Manag 2011; 14:99-106. [PMID: 21091367 PMCID: PMC3128447 DOI: 10.1089/pop.2010.0020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study was conducted to assess and benchmark the quality of care, in terms of adherence to nationally recognized treatment guidelines, for veterans with common chronic diseases (ie, asthma, chronic obstructive pulmonary disease [COPD], coronary artery disease [CAD], diabetes, heart failure, hyperlipidemia [HL]) in a Veterans Health Administration (VHA) system. Patients with at least 1 of the target diagnoses in the period between January 2002 and mid-year 2006 were identified using electronic medical records of patients seen at the James A. Haley Veterans' Hospital in Tampa, Florida. The most common diseases identified were HL (34%), CAD (21%), and diabetes (19%). The percentage of patients filling a prescription for any guidelines-sanctioned pharmacotherapy ranged from 28% (heart failure) to 91% (asthma). Persistence to medication ranged from 21% (HL) to 63% (asthma), while compliance ranged from 49% (COPD) to 85% (CAD). Most patients with diabetes (88%) had at least 1 A1c test in a year, but only 47% of patients had A1c values <7%. This study found that quality of care was generally good for conditions such as cardiovascular disease and diabetes, but quality care for conditions that have not been a primary focus of previous VHA quality improvement efforts, such as asthma and COPD, has room for improvement.
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Affiliation(s)
- Britta I Neugaard
- Medical Service, Department of Veterans Affairs Medical Center, Tampa, Florida, USA
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20
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Evans CT, Hershow RC, Chin A, Foulis PR, Burns SP, Weaver FM. Bloodstream infections and setting of onset in persons with spinal cord injury and disorder. Spinal Cord 2009; 47:610-5. [PMID: 19238165 DOI: 10.1038/sc.2009.2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE Health-care-associated (HCA) bloodstream infection (BSI) has been shown to be a distinct epidemiologic category in the general adult population, but few studies have examined specific patient populations. The objective of this study was to assess characteristics associated with BSI that occurred in the hospital (hospital-acquired, HA BSI), from health-care contact outside the hospital (HCA BSI) or in the community (community-acquired, CA BSI) in veterans with spinal cord injury and disorder (SCI&D). SETTING Two United States Department of Veterans Affairs hospitals. METHODS All patients with SCI&D with a positive blood culture admitted to study hospitals over a 7-year period (1 October 1997 to 30 September 2004). Demographics, medical characteristics and causative organisms were collected. RESULTS Four hundred and thirteen episodes of BSI occurred in 226 patients, with a rate of 7.2 BSI episodes per 100 admissions: 267 (64.7%) were HA BSI, 110 (26.6%) were HCA BSI and 36 (8.7%) were CA BSI. Antibiotic resistance was more common in those with HA BSI (65.5%) compared with that in those with HCA (49.1%, P=0.001) and CA BSI (22.2%, P<0.0001). Methicillin resistance in Staphylococcus aureus was highly prevalent; HA BSI (84.5%), HCA BSI (60.6%) and CA BSI (33.3%). CONCLUSION HCA BSI comprises one-quarter of all BSIs in hospitalized patients with SCI&D. Although those with HCA and CA BSI share similarities, several differences in medical characteristics and causal microorganism are noted. Treatment and management strategies for HCA and CA infections need to vary.
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Affiliation(s)
- C T Evans
- Department of Veterans Affairs, Center for Management of Complex Chronic Care, Edward Hines Jr. VA Hospital, Hines, IL 60141, USA.
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Blumentals WA, Foulis PR, Schwartz SW, Mason TJ. Analgesic therapy and the prevention of bladder cancer. Urol Oncol 2004; 22:11-5. [PMID: 14969797 DOI: 10.1016/s1078-1439(03)00100-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2003] [Revised: 05/18/2003] [Accepted: 05/30/2003] [Indexed: 01/31/2023]
Abstract
The aim of this study was to measure the association between analgesic use and risk of bladder cancer among patients seen at the James A. Haley Veterans' Administration (VA) Hospital in Tampa, FL. A total of 330 cases were obtained using a combination of computerized pathology records, and inpatient and outpatient diagnoses. Controls were randomly selected from the VA computerized administrative database, and 1293 controls were included for analysis. Unconditional logistic regression analysis was performed to assess the risk of bladder cancer after adjusting for age, gender, and cigarette smoking. Among analgesic users, we were able to identify a nearly 20% reduction in risk potentially consistent with a protective role (OR = 0.81, 95% CI = 0.63, 1.05). Nonsmokers had a 43% decrease in risk (OR = 0.57, 95% CI = 0.33, 0.98). While smoking is a strong and recognized cause of bladder cancer, 50% of bladder cancer cases are not attributable to tobacco consumption. Given that nonsmokers prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) were observed to have a 43% reduction in risk, it is important to study whether nonsmokers may benefit from therapy with NSAIDs.
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Affiliation(s)
- William A Blumentals
- Department of Epidemiology and Biostatistics, University of South Florida, Tampa, FL, USA.
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Abstract
Thromboembolic (TE) events preceding cancer have been observed. Some studies failed to find this correlation. We retrospectively examined the cancer incidence following thromboembolic events in patients at our medical center. Medical records of 183 patients with established thromboembolic events documented in their records were selected and reviewed. Time interval between primary, secondary, and recurrent TE events preceding cancer diagnosis was analyzed. Two hundred age- and sex-matched controls seen during the same period and without any evidence of TE were randomly selected and charts reviewed for malignancy. Cancer occurred after TE in 48 of 183 patients (26.2%). In controls, cancer was diagnosed in 23 (11.5%). This was statistically significant with an odds ratio of 2.736 (1.586, 4.720). In the 64 primary TE patients, the cancer incidence was 37.5%. The 63 patients with recurrent TE had an incidence of 35.4%, and 56 secondary TE patients had an incidence of 27.1%. Time between initial TE and cancer diagnosis was <6 months in 27 (56.3%) patients, between 6 months and 1 year in 12 (25.0%), 1-5 years in 5 (10.4%), and >5 years in 4 (8.3%). Fourteen (31.1%) TE patients presented with metastatic cancer. This study indicates that thromboembolic events are important predictors of cancer. Cancer in this population occurs within a year in the majority of patients. Cancer screening in patients without identifiable risk factors for thrombosis could be helpful for early detection, diagnosis, and management of cancer.
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Affiliation(s)
- Hussain I Saba
- Section of Hematology, Department of Internal Medicine, James A. Haley Veterans Hospital, 13000 Bruce B. Downs Boulevard, Tampa, FL 33612, USA.
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Murr MM, Yang J, Fier A, Foulis PR, Loughorn TP, Epling-Burnette PK, Norman JG. Pancreatitis-associated ascitic fluid induces hepatocyte death independent of local cytokines. J Surg Res 2002; 106:308-13. [PMID: 12175984 DOI: 10.1006/jsre.2002.6474] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Kupffer-cell-derived cytokines mediate liver injury, yet macrophage pacification does not abolish hepatocyte injury. We undertook this study to examine the role of pancreatitis-associated ascitic fluid (PAAF) in liver injury. METHODS Pathogen-free PAAF was perfused into healthy rat livers in situ for 60 min (n = 5, sham = 5, LPS = 5). AST, ALT, LDH, and TNF were measured in the effluent. Primary cultures of rat Kupffer cells or hepatocytes were treated with PAAF; AST, ALT, LDH, and TNF were measured and cell proliferation was determined by MTT assay. A hepatocyte human cell line (CCL-13) was treated with PAAF and apoptosis was measured by flow cytometry. RESULTS Liver perfusion with PAAF induced a >15-fold increase in AST/ALT/LDH (P < 0.001 PAAF vs sham), but not in TNF. In vitro, Kupffer cell viability was sharply reduced by PAAF in a dose-dependent manner; however, 5% PAAF (50% viability) did not induce TNF production from Kupffer cells. PAAF induced a multifold increase in AST/ALT/LDH from fresh hepatocytes (P < 0.001 vs control), which was not attenuated by a protease inhibitor. The CCL-13 cell population was reduced to 15 +/- 2% of baseline by PAAF (P < 0.001 vs control), whereas elastase, trypsin, or TNF had no effect. PAAF increased the percentage of nonviable CCL-13 cells (78 +/- 4% vs 28 +/- 1%, P < 0.001 vs control). Neither protease inhibitor nor heat inactivation of PAAF altered this pattern of hepatocyte death. CONCLUSION PAAF induces direct hepatocyte injury and death by heat-stable factors other than pancreatic enzymes but not via local production of Kupffer-cell-derived cytokines.
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Affiliation(s)
- Michel M Murr
- Department of Surgery, James A. Haley Veterans Hospital, University of South Florida, Tampa 33620, USA
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Schrot RJ, Foulis PR, Morrison AD, Farese RV. A computerized model for home glucose monitoring proficiency testing: efficacy of an innovative testing program. Diabetes Educ 1999; 25:48-55. [PMID: 10232180 DOI: 10.1177/014572179902500107] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE A newly instituted computerized system for proficiency testing of home glucose monitoring was evaluated comparing accuracy of patient determination of glucose with serum values measured in the laboratory. METHODS Patients returning for routine blood glucose testing ordered by their care provider brought their glucose monitoring equipment to the laboratory. They performed a finger-stick glucose check in the laboratory while the laboratory phlebotomist drew blood for glucose determination; both results were computer analyzed. Patients with a 25% or less variation from the laboratory were considered proficient, while those with greater than 25% variation were defined as nonproficient. RESULTS Over a 19-month period, 300 of the 3208 patients notified about the study completed proficiency testing at least once. Using the defined proficiency of 25% variation or less, 12% of the participants were nonproficient. Using a variation of 15% or less, 31% of patients were nonproficient. CONCLUSIONS An annual methodology evaluation such as the one in this study should become a standard of care to identify patients for remedial classes to correct the source of error. The goal must be to meet or exceed the American Diabetes Association standard of 15% total error in home glucose monitoring.
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Affiliation(s)
- R J Schrot
- Department of Family Medicine, James A. Haley Veterans Administration Hospital, University of South Florida College of Medicine, Tampa, Florida (Dr Schrot)
| | - P R Foulis
- Department of Pathology and Laboratory Medicine, James A. Haley Veterans Administration Hospital, University of South Florida College of Medicine, Tampa, Florida (Dr Foulis)
| | - A D Morrison
- Department of Internal Medicine, James A. Haley Veterans Administration Hospital, University of South Florida College of Medicine, Tampa, Florida (Drs Morrison and Farese)
| | - R V Farese
- Department of Internal Medicine, James A. Haley Veterans Administration Hospital, University of South Florida College of Medicine, Tampa, Florida (Drs Morrison and Farese)
- Department of Biochemistry/Molecular Biology, James A. Haley Veterans Administration Hospital, University of South Florida College of Medicine, Tampa, Florida (Dr Farese)
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Cowper SE, Lopez MA, Foulis PR. Chemistry: The Lack of Diagnostic Utility of Lactate Dehydrogenase Isoenzymes: Evaluation of Acute Myocardial Infarction. Lab Med 1998. [DOI: 10.1093/labmed/29.10.629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Foulis PR. The Use and Creation of Windows Help Files in the Laboratory. Lab Med 1997. [DOI: 10.1093/labmed/28.3.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
BACKGROUND Most published reviews and audits of blood and blood component transfusion have focused on the issue of overtransfusion and on the inappropriate use of red cell components. There is growing concern that efforts to curb unnecessary transfusions may result in a trend toward undertransfusion of patients. There is little published information that addresses this issue or the magnitude of this practice. STUDY DESIGN AND METHODS Undertransfusion was evaluated by examining the transfusion records from a 3-month period for 55 patients who met the study criteria of having either a hemoglobin level < 7 g per dL or a platelet count of < 10 x 10(9) per L. If the identified patient did not receive a transfusion within 24 hours of the reported hemoglobin level or platelet count, the medical record was reviewed by a resident physician. RESULTS A total of 213 individual hemoglobin levels and platelet counts, representing the 55 patients, met our transfusion criteria. All except 8 of the identified patients received red cells and/or platelet transfusions. Reasons for not transfusing red cells included the patient's response to nutritional support and iron supplementation, refusal of blood, and noncompliance. Reasons for not transfusing platelets included falsely low platelet count because of platelet clumping in vitro, contraindication based on clinical diagnosis (e.g., immune thrombocytopenic purpura), and the patient's death before transfusion. CONCLUSION Red cell and platelet transfusions were appropriately ordered for all patients who met the transfusion criteria. Undertransfusion is not a problem at this institution according to the criteria established. It is recommended that other institutions expand their blood utilization audits to include investigation for evidence of undertransfusion. Further research regarding the issue of undertransfusion is warranted and could be expanded to include other components.
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Affiliation(s)
- B Mair
- Department of Pathology and Laboratory Medicine, University of South Florida College of Medicine, Tampa, USA
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Foulis PR, Wallach PM, Adelman HM, Sanford BH, McCain J, Reed D, Schlede CM, Kokseng CU, Taylor CD. Performance of the Coumatrak system in a large anticoagulation clinic. Am J Clin Pathol 1995; 103:98-102. [PMID: 7817953 DOI: 10.1093/ajcp/103.1.98] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
There is a need to monitor anticoagulation accurately, inexpensively, and rapidly. The accuracy and precision of a simple fingerstick method was studied in a large outpatient anticoagulation clinic using the Coumatrak method. The Coumatrak apparatus has been studied in the home setting, and three recent reports suggest that it is practical, accurate, and possibly superior to the standard method. These results differ from recently published studies. This technique was found to be less than acceptable in precision and accuracy. This method requires further study before it can be recommended for wide-spread use in making decisions for patient care.
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Affiliation(s)
- P R Foulis
- University of South Florida Health Sciences Center, Tampa
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Studnicki J, Bradham DD, Marshburn J, Foulis PR, Straumfjord JV. A feedback system for reducing excessive laboratory tests. Arch Pathol Lab Med 1993; 117:35-9. [PMID: 8418759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
At the James A. Haley Veterans Hospital in Tampa, Fla, a program has been implemented to reduce the amount of potentially excessive laboratory testing. The major program components are a set of test frequency guidelines and a system of feedback to resident physicians that compares their test ordering patterns against the predetermined guidelines. The guidelines are analyte specific and differentiate between normal and abnormal test values reported during 1-day and 7-day time periods. The feedback process includes both systematic reporting of objective data and individual and group education and counseling sessions related to the appropriate use of laboratory tests. A reduction in the percentage of tests that fell outside the guidelines (outliers) was achieved following implementation of the program.
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Affiliation(s)
- J Studnicki
- Department of Health Policy and Management, College of Public Health, University of South Florida, Tampa 33612
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30
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Ramirez G, Bittle PA, Colice GL, Santacruz R, Hidalgo A, Noguera I, Agosti SJ, Foulis PR. Blood biochemical characteristics of cattle at sea level and at moderately high altitude (3,000 m). Am J Vet Res 1992; 53:547-50. [PMID: 1586027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We investigated the biochemical composition of blood from Holstein cows, native breed (criollas), and cows descended from fighting bulls (Vacas de lidia) raised at an altitude of 3,000 m (moderately high altitude, MHA), and compared the results with those from Holsteins and cows of similar genetic ancestry as the criollas (scrub cows), both raised at sea level (SL), to determine blood biochemical values characteristic of adaptation to high altitude. Only potassium and calcium concentrations were similar among groups. Glucose concentration was lower in MHA cows, with the exception of Vacas de lidia. Serum bicarbonate concentration was lower in MHA cows; this finding can be explained by hyperventilation in the hypoxic environment. Serum magnesium concentration was lower in SL and MHA Holsteins than in other groups. Serum phosphate concentration was lower in scrub cows, MHA Holsteins, and criollas than in other groups. Cholesterol concentrations were lower in SL Holsteins, whereas triglycerides were higher in scrub cows and MHA Vacas de lidia. Concentration of high-density lipoprotein was significantly greater in Vacas de lidia and less in MHA criollas than in the other groups. Uric acid and total protein were higher in MHA groups. Using radioimmunoassay for human proteins, thyroxine-binding globulin was undetectable. Total and free thyroxine and free triiodothyronine were higher in scrub cows, followed by Vacas de lidia; lower values were detected in SL and MHA Holsteins and MHA criollas.
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Affiliation(s)
- G Ramirez
- Department of Internal Medicine, James A. Haley Veterans Administration Hospital, Tampa, FL
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31
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Studnicki J, Bradham DD, Marshburn J, Foulis PR, Straumfjord JV. Measuring the Impact of Standing Orders on Laboratory Utilization. Lab Med 1992. [DOI: 10.1093/labmed/23.1.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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32
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Abstract
A 73-year-old man was admitted for evaluation of unexplained hypercalcemia and was found to have a large-cell non-Hodgkin's lymphoma with stage IV disease. Treatment with cyclophosphamide, doxorubicin (Adriamycin), vincristine sulfate, and prednisone chemotherapy returned his calcium levels to normal. Hypercalcemia with lymphoma is rare, and persistent evaluation for malignancy is essential.
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MESH Headings
- Aged
- Antineoplastic Combined Chemotherapy Protocols/blood
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Calcium/blood
- Humans
- Hypercalcemia/blood
- Hypercalcemia/etiology
- Lymphoma, Large B-Cell, Diffuse/blood
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Non-Hodgkin/blood
- Lymphoma, Non-Hodgkin/complications
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/pathology
- Male
- Time Factors
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Affiliation(s)
- M A Krolick
- Department of Internal Medicine, University of South Florida, Tampa 33612-4799
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Mourad WA, Straumfjord JV, Persky L, Helal MA, Foulis PR. Decreased acid phosphatase activity in prostate secretion associated with prostatic carcinoma. Clin Chem 1990. [DOI: 10.1093/clinchem/36.8.1517a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- W A Mourad
- Dept. of Pathol., James A. Haley V.A. Hosp., Tampa, FL
| | | | - L Persky
- Dept. of Pathol., James A. Haley V.A. Hosp., Tampa, FL
| | - M A Helal
- Dept. of Pathol., James A. Haley V.A. Hosp., Tampa, FL
| | - P R Foulis
- Dept. of Pathol., James A. Haley V.A. Hosp., Tampa, FL
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Mourad WA, Straumfjord JV, Persky L, Helal MA, Foulis PR. Decreased acid phosphatase activity in prostate secretion associated with prostatic carcinoma. Clin Chem 1990; 36:1517. [PMID: 2387049] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- W A Mourad
- Dept. of Pathol., James A. Haley V.A. Hosp., Tampa, FL
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35
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Milam MW, Balerdi MJ, Toney JF, Foulis PR, Milam CP, Behnke RH. Epithelioid angiomatosis secondary to disseminated cat scratch disease involving the bone marrow and skin in a patient with acquired immune deficiency syndrome: a case report. Am J Med 1990; 88:180-3. [PMID: 2301445 DOI: 10.1016/0002-9343(90)90471-o] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- M W Milam
- Department of Internal Medicine, University of South Florida College of Medicine, Tampa 33612
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36
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Abstract
Cutaneous chromomycosis developed in an elderly man with steroid-dependent chronic obstructive pulmonary disease. This patient had no history of foreign travel. Chromomycosis acquired in the United States is rare and may be seen in immunosuppressed patients, as exemplified by this case. Satisfactory response was observed in this patient with surgical debridement and continuing oral ketoconazole therapy.
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Affiliation(s)
- J N Greene
- Department of Medicine, University of South Florida College of Medicine, Tampa
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37
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Foulis PR, Sanford BH, Gottfried M. Drug induced morphologic changes in the liver. Ann Clin Lab Sci 1988; 18:215-28. [PMID: 3291740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The pathologic evaluation of hepatic changes secondary to drug ingestion is a difficult task because of the limited histologic response of the liver to hepatotoxins. The majority of these pharmacologic agents produce cholestasis, hepatitis, or both. Some drugs will produce damage if given for a sufficient time and in sufficient amount; this reaction is termed predictable. Other agents cause injury only in a small number of individuals; this reaction is unrelated to dosage or duration of administration and is termed unpredictable. In time, after discontinuing the offending agent, morphologic alterations of the liver and clinical findings will revert to normal except in certain conditions. Some drugs will produce cirrhosis as a sequelae while others may progress to chronic hepatitis. The accurate and complete evaluation of hepatic morphology requires a thorough clinical history since the histologic changes of certain illnesses may mimic the changes of drug-induced hepatic damage. For the clinician, drug-induced hepatic injury is important because of the central function the liver plays in drug metabolism and its susceptibility to damage.
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Affiliation(s)
- P R Foulis
- Department of Pathology, University of South Florida, Tampa 33612
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38
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Abstract
A computerized reporting and information system for microbiology employing a relatively inexpensive microcomputer is described. A comprehensive approach to accessioning and result entry for microbiology is presented. A daily laboratory worklist is generated for each work area, providing the responsible technologist with information on previously processed specimens. Manipulation of patient and specimen information permits the performance of various functions, including the generation of billing reports, workload statistics, quality-control summaries, epidemiologic surveys, and cumulative reports. The employment of many user-definable data lexicons allows optimal use of disk space while affording rapid information retrieval. Data file maintenance is automatically accomplished by the system, requiring no user intervention.
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Abstract
A comprehensive summary report of quality-control data is of great value in monitoring the accuracy and precision of the clinical chemistry laboratory. This report allows a retrospective appraisal alerting laboratory personnel to possible test control material degradation or instrument malfunction. A microcomputer-based program package is described, designed to reduce the errors and lengthy preparation inherent in the manual generation of such a report. Quality-control summary data is automatically compared with a predefined set of statistical criteria, and any aberrant values are flagged, thus eliminating subjective and nonuniform data interpretation. Statistical comparisons include: number of control points, delta mean, delta standard deviation, standard deviation index, and F-ratio. The summary report is well accepted by the laboratory staff, and its incorporation into the decision-making process allows for an efficient, critical, and uniformly rigorous examination of analytic proficiency.
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Abstract
Workload recording as designed by the College of American Pathologists has proven to be an invaluable aid in the assessment of overall laboratory operation. The administrative information derived from the compilation of these workload statistics is utilized to provide effective and these workload statistics is utilized to provide effective and efficient laboratory management. A microcomputer-based system for the pathology department that permits the accumulation of daily raw workoad data is descirbed. A monthly cummulative summary report is subsequently produced, complete with computer-derived College of American Pathologists workload units.
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Foulis PR, Norbut AM, Mendelow H, Kessler GF. Pathology accessioning and retrieval system with encoding by computer (PARSEC). A microcomputer-based system for anatomic pathology featuring automated SNOP coding and multiple administrative functions. Am J Clin Pathol 1980; 73:748-53. [PMID: 7395803 DOI: 10.1093/ajcp/73.6.748] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
A pathology accessioning and retrieval system with encoding by computer (PARSEC) has been developed, employing a relatively inexpensive microcomputer. PARSEC performs a variety of administrative functions for anatomic pathology, including accessioning of surgical specimens, storage of patient demographic information, editing, retrieval, and archiving of patient data, as well as CAP (college of American Pathologists) workload units, billing, and inventory functions for histopathology. In addition, appropriate gross and microscopic descriptions and pathologic diagnoses can be entered into the system by a text editor. Automatic assignment of SNOP (Systematized Nomenclature of Pathology) codes, is accomplished via an online SNOP lexicon, allowing the ultimate generation of completed surgical pathology reports. The data base management system employed makes optimum use of disk storage space, while permitting rapid data retrieval. Data file maintenance is automatically accomplished by the system, requiring no user intervention.
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42
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Norbut AM, Foulis PR, Bellot PA. Lymphoepithelioid cellular lymphoma (Lennert's lymphoma) in association with malignant lymphoma, histiocytic type. Am J Clin Pathol 1980; 73:597-602. [PMID: 6989233 DOI: 10.1093/ajcp/73.4.597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The present case is unusual in that it demonstrates the presence of the histologic pattern of Lennert's lymphoma in a patient who had a 14-year history of recurrent reticulum cell sarcoma (histiocytic lymphoma). This particular lesion also exhibits clinical and pathologic similarities to angioimmunoblastic lymphadenopathy and malignant lymphoma of peripheral T-lymphocyte origin. Whether the appearance of Lennert's lymphoma in this patient represents a regression of the previous reticulum cell sarcoma (histiocytic lymphoma) to a more benign form, a response to therapy, an alteration in the immune system, or a new lymphoreticular malignancy remains to be answered.
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