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Climo M.W.,Hunter Holmes ire Veterans Affairs Medical Center | Climo M.W.,Virginia Commonwealth University | Yokoe D.S.,Harvard University | Warren D.K.,University of Washington | And 9 more authors.
New England Journal of Medicine | Year: 2013

BACKGROUND: Results of previous single-center, observational studies suggest that daily bathing of patients with chlorhexidine may prevent hospital-acquired bloodstream infections and the acquisition of multidrug-resistant organisms (MDROs). METHODS: We conducted a multicenter, cluster-randomized, nonblinded crossover trial to evaluate the effect of daily bathing with chlorhexidine-impregnated washcloths on the acquisition of MDROs and the incidence of hospital-acquired bloodstream infections. Nine intensive care and bone marrow transplantation units in six hospitals were randomly assigned to bathe patients either with no-rinse 2% chlorhexidine - impregnated washcloths or with nonantimicrobial washcloths for a 6-month period, exchanged for the alternate product during the subsequent 6 months. The incidence rates of acquisition of MDROs and the rates of hospital-acquired bloodstream infections were compared between the two periods by means of Poisson regression analysis. RESULTS: A total of 7727 patients were enrolled during the study. The overall rate of MDRO acquisition was 5.10 cases per 1000 patient-days with chlorhexidine bathing versus 6.60 cases per 1000 patient-days with nonantimicrobial washcloths (P = 0.03), the equivalent of a 23% lower rate with chlorhexidine bathing. The overall rate of hospital-acquired bloodstream infections was 4.78 cases per 1000 patient-days with chlorhexidine bathing versus 6.60 cases per 1000 patient-days with nonantimicrobial washcloths (P = 0.007), a 28% lower rate with chlorhexidine-impregnated washcloths. No serious skin reactions were noted during either study period. CONCLUSIONS: Daily bathing with chlorhexidine-impregnated washcloths significantly reduced the risks of acquisition of MDROs and development of hospital-acquired blood-stream infections. Copyright © 2013 Massachusetts Medical Society.


Camara A.K.S.,Medical College of Wisconsin | Lesnefsky E.J.,Hunter Holmes ire Veterans Affairs Medical Center | Lesnefsky E.J.,Virginia Commonwealth University | Stowe D.F.,Medical College of Wisconsin | Stowe D.F.,Research Service
Antioxidants and Redox Signaling | Year: 2010

The mitochondrion is the most important organelle in determining continued cell survival and cell death. Mitochondrial dysfunction leads to many human maladies, including cardiovascular diseases, neurodegenerative disease, and cancer. These mitochondria-related pathologies range from early infancy to senescence. The central premise of this review is that if mitochondrial abnormalities contribute to the pathological state, alleviating the mitochondrial dysfunction would contribute to attenuating the severity or progression of the disease. Therefore, this review will examine the role of mitochondria in the etiology and progression of several diseases and explore potential therapeutic benefits of targeting mitochondria in mitigating the disease processes. Indeed, recent advances in mitochondrial biology have led to selective targeting of drugs designed to modulate and manipulate mitochondrial function and genomics for therapeutic benefit. These approaches to treat mitochondrial dysfunction rationally could lead to selective protection of cells in different tissues and various disease states. However, most of these approaches are in their infancy. Copyright © 2010, Mary Ann Liebert, Inc.


Hasnain M.,Health Integrated | Vieweg W.V.R.,Hunter Holmes ire Veterans Affairs Medical Center | Vieweg W.V.R.,Virginia Commonwealth University | Fredrickson S.K.,Hunter Holmes ire Veterans Affairs Medical Center
CNS Drugs | Year: 2010

Individuals receiving certain atypical antipsychotic medications are at risk of gaining weight and developing metabolic problems. There are no established drug treatments to prevent or counter these problems. However, the antihyperglycaemic agent metformin appears promising in some recent studies and we review the literature that evaluates metformin for limiting or reversing atypical antipsychotic drug-induced weight gain and glucose metabolism dysregulation. These studies suggest that metformin is beneficial if started early in antipsychotic drug treatment. Metformin has also been shown to prevent or delay the onset of type 2 diabetes mellitus in high-risk individuals from the general population. Based on these findings, we identify antipsychotic drug-treated patients who might benefit from metformin therapy and offer clinical guidelines for its use. Further long-term studies are needed to extend our observations and improve this strategy. © 2010 Adis Data Information BV. All rights reserved.


Hasnain M.,Memorial University of Newfoundland | Vieweg W.V.R.,Virginia Commonwealth University | Lesnefsky E.J.,Hunter Holmes ire Veterans Affairs Medical Center | Pandurangi A.K.,Virginia Commonwealth University
Journal of Psychosomatic Research | Year: 2011

Objective: We lack evidence that routine screening for depression in patients with coronary heart disease (CHD) improves patient outcome. This lack has challenged the advisory issued by the American Heart Association (AHA) to routinely screen for depression in CHD patients. We assess the AHA advisory in the context of well-established criteria of screening for diseases. Methods: Using principles and criteria for screening developed by the World Health Organization and the United Kingdom National Screening Committee, we generated criteria pertinent to screening for depression in CHD patients. To find publications relevant to these criteria and clinical setting, we performed a broadly based literature search on "depression and CHD," supplemented by more focused literature searches. Results: Evidence for an association between depression and CHD is strong. Despite this, the AHA advisory has several limitations. It did not account for the complexity of the association between depression and CHD. It acknowledged there was no evidence that screening for depression leads to improved outcomes in cardiovascular populations but still recommended routine screening without providing an alternative evidence-based explanation. It ignored the paucity of literature about the safety and cost-effectiveness of routine screening for depression in CHD and failed to define the nature and extent of resources needed to implement such a program effectively. Conclusion: We conclude that the AHA advisory is premature. We must first demonstrate the efficacy, safety, and cost-effectiveness of screening and define the resources necessary for its implementation and monitoring. Meanwhile, organizations representing cardiologists, psychiatrists, and general practitioners must coordinate efforts to manage depression and CHD through collaborative care, and work with the policy makers to develop the necessary infrastructure and services delivery system needed to optimize the outcome of depressed and at-risk-for-depression patients suffering from CHD. © 2010 Elsevier Inc.


Koffel E.,Minneapolis Veterans Affairs Medical Center | Farrell-Carnahan L.,Hunter Holmes ire Veterans Affairs Medical Center
Military Medicine | Year: 2014

Insomnia is increasingly common among the general population, even more so among veterans. Given the adverse impact of insomnia on both mental and physical health of veterans, it is important to provide effective treatments within the Veterans Health Administration (VHA) system. Group-based cognitive behavioral therapy for insomnia (CBT-I) provides a viable option for treatment. This study reports the feasibility, acceptability, initial effectiveness, and durability of group-based CBT-I in a clinical sample of veterans with comorbid medical and mental health diagnoses; the treatment was provided in a real-world VHA hospital setting using a manualized protocol that was explicitly adapted from the existing 1:1 CBT-I VHA protocol. Overall, we found the treatment to be feasible and acceptable to veterans, as well as effective. We found medium to large effect sizes for both questionnaire and sleep diary measures, including sleep onset latency, awakenings during the night, sleep efficiency, insomnia scores, and dysfunctional beliefs about sleep. Improvements in insomnia symptoms were maintained over 1 month. © AMSUS - The Society of Federal Health Professionals, 2014 Printed in U.S.A. All rights reserved.


Fatouros P.P.,Virginia Commonwealth University | Shultz M.D.,Hunter Holmes ire Veterans Affairs Medical Center | Shultz M.D.,Virginia Commonwealth University
Nanomedicine | Year: 2013

Metallofullerenes have incited research endeavors across many disciplines owing to their wide range of properties obtainable by altering the metal component inside the fullerene cage or by a variety of surface functionalities. With a metal component of gadolinium, gadofullerenes have particularly shown promise in MRI applications owing to their high proton relaxivity and isolation of the metal from the biological environment. This article aims to give a perspective on the development of metallofullerenes as MRI contrast agents and further applications that distinguish them as a new class of imaging agent. © 2013 Future Medicine Ltd.


Desilets A.R.,Manchester College | Asal N.J.,Hunter Holmes ire Veterans Affairs Medical Center | Dunican K.C.,Manchester College
Consultant Pharmacist | Year: 2012

Objective: To investigate current concerns regarding the use of proton-pump inhibitors (PPIs) in older adults. Data Sources: A literature search was conducted in MEDLINE (1948 to April week 3 2011) to identify relevant publications. Key words searched included proton-pump inhibitor, safety, adverse events, elderly, and older adults. Additional data sources were obtained through a bibliographic review of selected articles. Data Selection: Relevant studies conducted in older adults published in English that examined risks associated with the use of PPIs were included in this review. Data Synthesis: The older adult population in the United States is growing at an astounding rate. With the increase in age, there are many factors that make the elderly susceptible to acid-related gastrointestinal disorders that require treatment with PPIs. However, PPI use in the elderly has been shown to lead to a number of health concerns. Recent data have shown that PPI use is associated with an increased risk of fractures, Clostridium difficile infection, community-acquired pneumonia, vitamin and mineral deficiencies, and drug interactions. These concerns will be further investigated and weighed against the benefits of PPI use in this population. Conclusions: Patient-specific characteristics must be taken into consideration when recommending and/or prescribing PPIs to older adults. © 2012 American Society of Consultant Pharmacists, Inc. All rights reserved.


Schubert M.L.,Virginia Commonwealth University | Schubert M.L.,Hunter Holmes ire Veterans Affairs Medical Center
Current Opinion in Gastroenterology | Year: 2015

Purpose of review This review summarizes the past year's literature regarding the neuroendocrine and intracellular regulation of gastric acid secretion, discussing both basic and clinical aspects. Recent findings Gastric acid facilitates the digestion of protein as well as the absorption of iron, calcium, vitamin B12, and certain medications. High acidity kills ingested microorganisms and limits bacterial overgrowth, enteric infection, and possibly spontaneous bacterial peritonitis. The main stimulants of acid secretion are gastrin, released from antral gastrin cells; histamine, released from oxyntic enterochromaffin-like cells; and acetylcholine, released from antral and oxyntic intramural neurons. Ghrelin and coffee also stimulate acid secretion whereas somatostatin, cholecystokinin, glucagon-like peptide-1, and atrial natriuretic peptide inhibit acid secretion. Although 95% of parietal cells are contained within the oxyntic mucosa (fundus and body), 50% of human antral glands contain parietal cells. Proton pump inhibitors are considered well tolerated drugs, but concerns have been raised regarding dysbiosis, atrophic gastritis, hypergastrinemia, hypomagnesemia, and enteritis/colitis. Summary Our understanding of the functional anatomy and physiology of gastric secretion continues to advance. Such knowledge is crucial for improved management of acid-peptic disorders, prevention and management of neoplasia, and the development of novel medications. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Schubert M.L.,Virginia Commonwealth University | Schubert M.L.,Hunter Holmes ire Veterans Affairs Medical Center
Current Opinion in Gastroenterology | Year: 2014

Purpose of review: This review summarizes the past year's literature regarding the neural, paracrine, hormonal, and intracellular regulation of gastric acid secretion. Recent findings: Gastric acid facilitates the digestion of protein as well as the absorption of iron, calcium, vitamin B12, and certain medications. High gastric acidity, in combination with pepsin and lipase, kills ingested microorganisms and may play a role in preventing bacterial overgrowth, enteric infection, and possibly spontaneous bacterial peritonitis, community-acquired pneumonia, and infection with Mycobacterium tuberculosis. Stimulants of acid secretion include histamine, gastrin, acetylcholine, and ghrelin. Inhibitors include somatostatin, gastric inhibitory polypeptide, calcitonin gene-related peptide, and adrenomedullin. Helicobacter pylori stimulates or inhibits depending upon the time course of infection and the area of the stomach predominantly infected. Proteins implicated in H-K-ATPase membrane trafficking include myosin IIB, F-actin, ezrin, and Rab GTPases. Summary: Our understanding of the regulation of gastric acid secretion continues to advance. Such knowledge is crucial for the management of acid-peptic disorders and the development of novel medications, such as cholecystokinin-2 receptor antagonists. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Hasnain M.,Sir Thomas Roddick Hospital | Fredrickson S.K.,Hunter Holmes ire Veterans Affairs Medical Center | Vieweg W.V.R.,Virginia Commonwealth University | Pandurangi A.K.,Virginia Commonwealth University
Current Diabetes Reports | Year: 2010

Patients with schizophrenia are at increased risk for developing the metabolic syndrome or its individual components due to their lifestyle, suspected genetic predisposition, and exposure to antipsychotic medications that can cause weight gain and other metabolic side effects. Despite the availability of clinical guidelines, screening for and monitoring of metabolic problems in this patient population continue to be suboptimal. We provide an overview specifically addressing 1) why patients with schizophrenia are at increased risk for metabolic problems; 2) how commonly used antipsychotic medications vary in terms of their metabolic liability; 3) how to effectively screen for and monitor metabolic problems in patients receiving antipsychotic medications; 4) what interventions can prevent, limit, or reverse the metabolic side effects of antipsychotic drug treatment; and 5) what are the barriers to the care of these patients. © Springer Science+Business Media, LLC 2010.

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