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Kansas City, MO, United States

Madhoun M.F.,The University of Oklahoma Health Sciences Center | Wani S.B.,Aurora University | Rastogi A.,Kansas City Veterans Affairs Medical Center | Early D.,University of Washington | And 3 more authors.
Endoscopy | Year: 2013

Background and study aims: It is uncertain if needle gauge impacts the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of pancreatic mass lesions. Our aim was to use meta-analysis to more robustly define the diagnostic accuracy of EUS-FNA for pancreatic masses using 22 G and 25 G needles. Patients and methods: Studies were identified by searching nine medical databases for reports published between 1994 and 2011, using a reproducible search strategy comprised of relevant terms. Only studies comparing the overall diagnostic accuracy of 22 G vs. 25 G EUS needles that used surgical histology or at least 6 months clinical follow up for a gold standard were included. Two reviewers independently scored the identified studies for methodology and abstracted pertinent data. When required, the original investigators were contacted to provide additional data. Pooling was conducted by both fixed-effects and random-effects models. Diagnostic characteristics (sensitivity, specificity, positive and negative likelihood ratios) with 95 % confidence intervals (CIs) were calculated. Results: Eight studies involving 1292 subjects met the defined inclusion criteria. Of the 1292 patients, 799 were in the 22 G group and 565 were in the 25 G group (both needles were used in 72 patients). The pooled sensitivity and specificity of the 22 G needle were 0.85 (95 %CI 0.82 - 0.88) and 1 (95 %CI 0.98 - 1) respectively. The pooled sensitivity and specificity of the 25 G needle were 0.93 (95 %CI 0.91 - 0.96) and 0.97 (95 %CI 0.93 - 0.99) respectively. The bivariate generalized linear random-effect model indicated that the 25 G needle is associated with a higher sensitivity (P = 0.0003) but comparable specificity (P = 0.97) to the 22 G needle. Conclusions: This meta-analysis suggests 25 G needle systems are more sensitive than 22 G needles for diagnosing pancreatic malignancy.© Georg Thieme Verlag KGStuttgart . New York.


Oni O.,Kansas City Veterans Affairs Medical Center
American journal of disaster medicine | Year: 2012

Experiencing natural disasters such as hurricanes is associated with post-traumatic stress disorder (PTSD) and depression. We examined the role played by perceived stress and coping styles in explaining and modifying this association among pregnant women exposed to Hurricane Katrina. The study comprised 192 women (133 from New Orleans and 59 from Baton Rouge) who were pregnant during Hurricane Katrina or became pregnant immediately after the hurricane. Women were interviewed regarding their hurricane experience, perceived stress, and mental health outcomes. Coping styles was assessed using the Brief COPE, PTSD symptoms using the Post-Traumatic Checklist, and depressive symptoms using the Edinburgh Depression Scale. Multivariable regression models were run to determine the effects of coping styles on mental health and the interactions among coping styles, hurricane experience, and perceived stress on mental health. Apart from the positive reframing and humor coping styles, all coping styles correlated positively with PTSD or depression (p < 0.05). The instrumental support, denial, venting, and behavioral disengagement coping styles were significantly associated with worsened PTSD symptoms among those who reported higher perceived stress (p < 0.05). Use of a humor coping style seemed to reduce the effect of perceived stress on depressive symptoms (p = 0.02 for interaction) while use of instrumental support (p = 0.04) and behavioral disengagement (p < 0.01) were both associated with more symptoms of depression among those who perceived more stress. There were no strong interactions between coping style and hurricane experience. Coping styles are potential moderators of the effects of stress on mental health of pregnant women.


Timberlake G.T.,Kansas City Veterans Affairs Medical Center
Investigative ophthalmology & visual science | Year: 2012

Fine manual tasks require coordination of vision, eye movements, and motor control. Macular scotomas from age-related macular degeneration (AMD) may adversely affect this coordination. The purpose of this research was to find whether the preferred retina locus for fixation (fPRL) also guided the hand in performing fine manual tasks and how the fingers, fPRL, and scotomas interacted in task performance. Subjects with bilateral macular scotomas from AMD and normally sighted controls traced an irregular "maze" line pattern with the index finger while viewing their hand and the maze in a scanning laser ophthalmoscope (SLO). Video images from the SLO showing the fingers and maze on the retina during the task were analyzed to produce retinal maps showing the scotoma and bivariate ellipses of fPRL and fingertip retinal positions. Fingertip retinal ellipses surrounded and were approximately centered on the fPRL ellipses. Fingertip retinal bivariate area was positively correlated with fPRL bivariate area and the percent time the fPRL was on the maze was correlated with visual acuity. Maze-tracing accuracy was positively correlated with saccade rate for scotoma subjects. Concentric overlap of fPRL and fingertip retinal ellipses indicates that it is the fPRL that guides the hand in the maze-tracing visuomotor task, just as the fovea guides the fingertip for visually normal subjects. It is likely that factors other than fPRL and scotoma characteristics contribute to poorer maze-tracing performance by scotoma subjects in comparison with controls.


Campbell A.R.,Center for Behavioral Medicine | Anderson K.D.,Kansas City Veterans Affairs Medical Center
American Journal of Health-System Pharmacy | Year: 2010

Purpose. The effects of varenicline treatment for smoking cessation on mental health (MH) stability in veterans with posttraumatic stress disorder (PTSD) was studied. Methods. Data were collected by retrospective chart review at a Veterans Affairs medical center. Patients with PTSD who were prescribed varenicline for smoking cessation between May 2006 and July 2008 were included; all patients had failed previous attempts to quit using nicotine replacement therapy, bupropion, or both. The average numbers of encounters per month with MH professionals in a six-month baseline period before varenicline, during treatment, and after treatment were compared. The numbers of MH encounters were compared for patients with multiple MH disorders including major depressive disorder, schizophrenia, or bipolar disorder and those with PTSD alone. Patients who had completed a full course of varenicline therapy (4-12 weeks) without MH decompensation were surveyed to determine the rate of smoking cessation. Results. Data were analyzed for 78 patients. MH encounters during varenicline therapy increased 29% over baseline. There was no significant difference in the numbers of encounters in the baseline and postvarenicline periods. MH decompensations were documented for 4 patients during varenicline therapy and 2 after completion of therapy. Before, during, and after varenicline, patients with multiple MH disorders had significantly more MH encounters than those with PTSD alone. Of the 42 patients in the follow-up survey, 19 (45%) said they refrained from smoking for 30 days and 13 (31%) for 90 days. Conclusion. Varenicline appeared to have destabilizing effects on MH in veterans with PTSD.


Rao G.A.,Kansas City Veterans Affairs Medical Center | Rao G.A.,University of South Carolina | Pandya P.K.,Kansas City Veterans Affairs Medical Center | Pandya P.K.,University of Kansas
Gastroenterology | Year: 2011

Background & Aims: Patients with chronic hepatitis C infection are 2- to 3-fold more likely to develop type 2 diabetes, which reduces their chances of achieving a sustained virologic response (SVR). To identify differences in predictors of SVR in patients with and without diabetes who received combination antiviral therapy, we conducted a retrospective analysis of a national Veterans Affairs administrative database. Methods: We analyzed data from the Veterans Affairs Medical SAS Datasets and Decision Support System for entire cohort and separately for diabetic patients (n = 1704) and nondiabetic patients (n = 6589). Significant predictors of SVR were identified by logistic regression analysis. Results: Diabetic patients had a lower SVR compared with nondiabetic patients (21% vs 27%, respectively, P < .001). Diabetic patients had higher clustering of previously established negative predictors of SVR. On multivariate analysis of diabetic patients for SVR, the positive predictors were higher low-density lipoprotein (odds ratio [OR], 1.45; P = .0129), use of statin (OR, 1.52; P = .0124), and lower baseline viral load (OR, 2.31; P < .001), whereas insulin therapy (OR, 0.7; P = .0278) was a negative predictor. Diabetic patients on statins had higher pretreatment viral loads (log 6.2 vs 6.4, respectively, P = .006) but better early virologic response. There was a graded inverse relationship between Hemoglobin A1c and SVR rate (P = .0482). This relationship was significant among insulin users (P = .0154) and non-significant among metformin users (P = .5853). Conclusions:: Statin use was associated with an improved SVR among both diabetic patients and nondiabetic patients receiving combination antiviral therapy. Diabetic patients who received insulin achieved lower SVR compared with those not receiving insulin. Poor diabetes control was associated with lower SVR rates. © 2011 AGA Institute.

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