Maron D.J.,Vanderbilt University |
Boden W.E.,State University of New York at Buffalo |
O'Rourke R.A.,South Texas Veterans Health Care System Audie Murphy Campus |
Hartigan P.M.,Veterans Affairs Cooperative Studies Program Coordinating Center |
And 20 more authors.
Journal of the American College of Cardiology | Year: 2010
Objectives: This paper describes the medical therapy used in the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial and its effect on risk factors. Background: Most cardiovascular clinical trials test a single intervention. The COURAGE trial tested multiple lifestyle and pharmacologic interventions (optimal medical therapy) with or without percutaneous coronary intervention in patients with stable coronary disease. Methods: All patients, regardless of treatment assignment, received equivalent lifestyle and pharmacologic interventions for secondary prevention. Most medications were provided at no cost. Therapy was administered by nurse case managers according to protocols designed to achieve predefined lifestyle and risk factor goals. Results: The patients (n = 2,287) were followed for 4.6 years. There were no significant differences between treatment groups in proportion of patients achieving therapeutic goals. The proportion of smokers decreased from 23% to 19% (p = 0.025), those who reported <7% of calories from saturated fat increased from 46% to 80% (p < 0.001), and those who walked ≥150 min/week increased from 58% to 66% (p < 0.001). Body mass index increased from 28.8 ± 0.13 kg/m2 to 29.3 ± 0.23 kg/m2 (p < 0.001). Appropriate medication use increased from pre-randomization to 5 years as follows: antiplatelets 87% to 96%; beta-blockers 69% to 85%; renin-angiotensin-aldosterone system inhibitors 46% to 72%; and statins 64% to 93%. Systolic blood pressure decreased from a median of 131 ± 0.49 mm Hg to 123 ± 0.88 mm Hg. Low-density lipoprotein cholesterol decreased from a median of 101 ± 0.83 mg/dl to 72 ± 0.88 mg/dl. Conclusions: Secondary prevention was applied equally and intensively to both treatment groups in the COURAGE trial by nurse case managers with treatment protocols and resulted in significant improvement in risk factors. Optimal medical therapy in the COURAGE trial provides an effective model for secondary prevention among patients with chronic coronary disease. (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation; NCT00007657). © 2010 American College of Cardiology Foundation.
PubMed | James ley Va Medical Center, Watson Clinic Center for Cancer Care and Research, National Cancer Institute, H. Lee Moffitt Cancer Center and Research Institute and 5 more.
Type: Journal Article | Journal: Cancer prevention research (Philadelphia, Pa.) | Year: 2015
Preclinical, epidemiologic, and prior clinical trial data suggest that green tea catechins (GTC) may reduce prostate cancer risk. We conducted a placebo-controlled, randomized clinical trial of Polyphenon E (PolyE), a proprietary mixture of GTCs, containing 400 mg (-)-epigallocatechin-3-gallate (EGCG) per day, in 97 men with high-grade prostatic intraepithelial neoplasia (HGPIN) and/or atypical small acinar proliferation (ASAP). The primary study endpoint was a comparison of the cumulative one-year prostate cancer rates on the two study arms. No differences in the number of prostate cancer cases were observed: 5 of 49 (PolyE) versus 9 of 48 (placebo), P = 0.25. A secondary endpoint comparing the cumulative rate of prostate cancer plus ASAP among men with HGPIN without ASAP at baseline, revealed a decrease in this composite endpoint: 3 of 26 (PolyE) versus 10 of 25 (placebo), P < 0.024. This finding was driven by a decrease in ASAP diagnoses on the Poly E (0/26) compared with the placebo arm (5/25). A decrease in serum prostate-specific antigen (PSA) was observed on the PolyE arm [-0.87 ng/mL; 95% confidence intervals (CI), -1.66 to -0.09]. Adverse events related to the study agent did not significantly differ between the two study groups. Daily intake of a standardized, decaffeinated catechin mixture containing 400 mg EGCG per day for 1 year accumulated in plasma and was well tolerated but did not reduce the likelihood of prostate cancer in men with baseline HGPIN or ASAP.
Lloyd J.,BRAINS Inc. |
Lloyd J.,James ley Va Medical Center |
Conidi F.,Florida Center for Headache and Sports Neurology |
Conidi F.,Florida State University
Journal of Neurosurgery | Year: 2016
Objective Helmets are used for sports, military, and transportation to protect against impact forces and associated injuries. The common belief among end users is that the helmet protects the whole head, including the brain. However, current consensus among biomechanists and sports neurologists indicates that helmets do not provide significant protection against concussion and brain injuries. In this paper the authors present existing scientific evidence on the mechanisms underlying traumatic head and brain injuries, along with a biomechanical evaluation of 21 current and retired football helmets. Methods The National Operating Committee on Standards for Athletic Equipment (NOCSAE) standard test apparatus was modified and validated for impact testing of protective headwear to include the measurement of both linear and angular kinematics. From a drop height of 2.0 m onto a flat steel anvil, each football helmet was impacted 5 times in the occipital area. Results Skull fracture risk was determined for each of the current varsity football helmets by calculating the percentage reduction in linear acceleration relative to a 140-g skull fracture threshold. Risk of subdural hematoma was determined by calculating the percentage reduction in angular acceleration relative to the bridging vein failure threshold, computed as a function of impact duration. Ranking the helmets according to their performance under these criteria, the authors determined that the Schutt Vengeance performed the best overall. Conclusions The study findings demonstrated that not all football helmets provide equal or adequate protection against either focal head injuries or traumatic brain injuries. In fact, some of the most popular helmets on the field ranked among the worst. While protection is improving, none of the current or retired varsity football helmets can provide absolute protection against brain injuries, including concussions and subdural hematomas. To maximize protection against head and brain injuries for football players of all ages, the authors propose thresholds for all sports helmets based on a peak linear acceleration no greater than 90 g and a peak angular acceleration not exceeding 1700 rad/sec2. © AANS, 2016.
Hinojosa R.,Rehabilitation Outcomes Research Center |
Haun J.,James ley Va Medical Center |
Hinojosa M.S.,University of Florida |
Rittman M.,Rehabilitation Outcomes Research Center
Topics in Stroke Rehabilitation | Year: 2011
Research suggests that individuals recovering from a stroke often experience social isolation, which is linked to increased depressive symptomatology and decreased ability to manage activities of daily living. Research also indicates that different racial and ethnic groups are more adversely affected than whites. This article uses poststroke narratives to explore the relationship between social isolation, depressive symptomatology, and the ability to manage activities of daily living poststroke for white, African American, and Puerto Rican veterans. Findings suggest those who were socially isolated during the fi rst year of poststroke recovery reported higher levels of depressive symptoms and a decreased ability to manage daily activities. Implications for stroke rehabilitation practice are discussed. © 2011 Thomas Land Publishers, Inc..
Cooper D.B.,San Antonio Military Medical Center |
Cooper D.B.,Defense and Veterans Brain Injury Center |
Chau P.M.,San Antonio Military Medical Center |
Armistead-Jehle P.,U.S. Army |
And 4 more authors.
Military Medicine | Year: 2012
Military personnel deployed to combat theaters in Iraq and Afghanistan are at risk of sustaining mild traumatic brain injuries (mTBI) from causes such as improvised explosive devices, motor vehicle accidents, and falls. Despite the high incidence of mTBI in deployed personnel, questions remain about the effects of blast-related vs. nonblast- related mTBI on acute and long-term sequelae. This investigation is a retrospective review of service members who presented for evaluation of suspected mTBI and underwent neurocognitive screening evaluation. mTBI diagnosis was made by semistructured clinical interview. Only individuals in whom mechanism of injury could be determined (blast vs. non-blast) were included. Sixty individuals were included in the final sample: 32 with blast mTBI and 28 with non-blast mTBI. There were no differences between the blast-related and non-blast-related mTBI groups on age, time since injury, combat stress symptoms, or headache. Analysis of variance showed no significant between-group differences on any of the neurocognitive performance domains. Although speculation remains that the effects of primary blast exposure are unique, the results of this study are consistent with prior research suggesting that blast-related mTBI does not differ from other mechanisms of injury with respect to cognitive sequelae in the postacute phase. © Association of Military Surgeons of the U.S. All rights reserved.
Zaremba J.L.,Mann Grandstaff Medical Center |
Carroll K.,VA Healthcare System |
Manley K.,James ley Va Medical Center
Dimensions of Critical Care Nursing | Year: 2014
In 2004, practice standards for electrocardiographic (ECG) monitoring were published to address the need for an expanded use of ECG monitoring beyond heart rate and basic rhythm determination. This article reports the data collected from a survey distributed throughout the Veterans Healthcare Administration hospitals to determine the extent to which practice standards have been adopted. Survey data were used to identify the differences between actual practice and evidence-based standards. The results were divided into ECG electrode application, lead selection, alarm limits, monitoring capabilities, monitoring during patient transport, and education and competencies. The results confirm the need for improvement, including a thorough evaluation of facility practices and education. The data demonstrate the differences among actual practice and evidence-based recommendations. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Crowley R.S.,University of Pittsburgh |
Legowski E.,University of Pittsburgh |
Medvedeva O.,University of Pittsburgh |
Reitmeyer K.,University of Pittsburgh |
And 5 more authors.
Advances in Health Sciences Education | Year: 2013
The purpose of this study is threefold: (1) to develop an automated, computer-based method to detect heuristics and biases as pathologists examine virtual slide cases, (2) to measure the frequency and distribution of heuristics and errors across three levels of training, and (3) to examine relationships of heuristics to biases, and biases to diagnostic errors. The authors conducted the study using a computer-based system to view and diagnose virtual slide cases. The software recorded participant responses throughout the diagnostic process, and automatically classified participant actions based on definitions of eight common heuristics and/or biases. The authors measured frequency of heuristic use and bias across three levels of training. Biases studied were detected at varying frequencies, with availability and search satisficing observed most frequently. There were few significant differences by level of training. For representativeness and anchoring, the heuristic was used appropriately as often or more often than it was used in biased judgment. Approximately half of the diagnostic errors were associated with one or more biases. We conclude that heuristic use and biases were observed among physicians at all levels of training using the virtual slide system, although their frequencies varied. The system can be employed to detect heuristic use and to test methods for decreasing diagnostic errors resulting from cognitive biases. © 2012 The Author(s).
Moering R.G.,James ley Va Medical Center
Psychological Injury and Law | Year: 2011
In conducting Compensation and Pension (C&P) examinations, one of the most significant sources of evidence supporting a veteran's claim for service connection are found in the veteran's service medical records and service personnel records. Although specific numbers are unknown, a majority of mental health providers who conduct C&P examinations are not veterans and have limited knowledge and understanding of the records they are being asked to review. In cases of an initial posttraumatic stress disorder (PTSD) examination, the Federal Register requires C&P examiners to determine if the veteran's claim is consistent with the places, types, and circumstances of the veteran's service. This article reviews specific data within personnel records to help verify those elements. Additionally, perhaps one of the most difficult types of evaluations faced by any C&P examiner is a PTSD claim for personal assault (e. g., military sexual trauma). This article reviews the types of information within the records to help identify specific "Markers" associated with personal trauma. © 2011 Springer Science + Business Media, LLC.
Schinka J.A.,James ley Va Medical Center
Current Psychiatry Reports | Year: 2010
Extensive research supports the use of informant ratings in diagnosing dementia. In comparison, far fewer studies have examined the use of informant ratings in identifying mild cognitive impairment (MCI), a state that occurs as healthy older adults make the gradual transition to dementia. A review of available studies that have examined discrepancies between MCI patient and informant reports has for the most part demonstrated that informant ratings reveal greater loss of everyday functional ability and cognitive competency. Additionally, current findings support a significantly greater association of informant ratings with objective measures of patient cognitive performance and characteristics of underlying dementing processes. Structured measures used to examine the diagnostic efficacy of informant ratings in identifying cases of MCI are reviewed. Two recently developed instruments seem especially promising, but further validation efforts will be required before they can be considered to meet standards for clinical use. © 2010 Springer Science+Business Media, LLC.
Manimala N.J.,James ley Va Medical Center |
Frost C.D.,James ley Va Medical Center |
Lane M.L.,James ley Va Medical Center |
Higuera M.,James ley Va Medical Center |
And 3 more authors.
European Journal of Clinical Investigation | Year: 2013
Background: c-Fos is a cellular proto-oncogene which dimerizes with c-Jun proto-oncogene to form AP-1 transcription factor, which upregulates transcription of genes involved in proliferation and cancer formation. Four cardiac hormones, that is, long-acting natriuretic peptide (LANP), vessel dilator, kaliuretic peptide (KP) and atrial natriuretic peptide (ANP) with anticancer effects in vivo are potent inhibitors of the Ras-MEK 1/2-ERK 1/2 kinase cascade and signal transducer and activator of transcription-3 (STAT-3) that activate c-Fos and c-Jun. These four cardiac hormones were investigated for their effects on proto-oncogenes c-Fos and c-Jun within the nucleus of cancer cells. Materials and methods: Four cardiac hormones were evaluated for their ability to decrease proto-oncogenes c-Fos and c-Jun, measured by ELISA in extracted nuclei of three human cancer cell lines. Results: Vessel dilator, LANP, KP and ANP over a concentration range of 100 pM-10 μM, maximally decreased c-Fos by 61%, 60%, 61% and 59% in human hepatocellular cancer cells, by 82%, 74%, 78% and 74% in small-cell lung cancer cells, and by 82%, 73%, 78% and 74% in human renal adenocarcinoma cells. c-Jun was maximally reduced by vessel dilator, LANP, KP and ANP by 43%, 31%, 61% and 35% in hepatocellular cancer cells, by 65%, 49%, 59% and 40% in small-cell lung cancer cells, and by 47%, 43%, 57% and 49% in renal cancer cells. Conclusion: Four cardiac hormones are potent inhibitors of c-Fos and c-Jun proto-oncogenes within the nucleus of cancer cells. © 2013 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.