Minneapolis Veterans Affairs Medical Center

Minneapolis, MN, United States

Minneapolis Veterans Affairs Medical Center

Minneapolis, MN, United States

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Zauber A.G.,Sloan Kettering Cancer Center | Winawer S.J.,Sloan Kettering Cancer Center | O'Brien M.J.,Boston University | Lansdorp-Vogelaar I.,Erasmus Medical Center | And 8 more authors.
New England Journal of Medicine | Year: 2012

BACKGROUND: In the National Polyp Study (NPS), colorectal cancer was prevented by colonoscopic removal of adenomatous polyps. We evaluated the long-term effect of colonoscopic polypectomy in a study on mortality from colorectal cancer. METHODS: We included in this analysis all patients prospectively referred for initial colonoscopy (between 1980 and 1990) at NPS clinical centers who had polyps (adenomas and nonadenomas). The National Death Index was used to identify deaths and to determine the cause of death; follow-up time was as long as 23 years. Mortality from colorectal cancer among patients with adenomas removed was compared with the expected incidence-based mortality from colorectal cancer in the general population, as estimated from the Surveillance Epidemiology and End Results (SEER) Program, and with the observed mortality from colorectal cancer among patients with nonadenomatous polyps (internal control group). RESULTS: Among 2602 patients who had adenomas removed during participation in the study, after a median of 15.8 years, 1246 patients had died from any cause and 12 had died from colorectal cancer. Given an estimated 25.4 expected deaths from colorectal cancer in the general population, the standardized incidence-based mortality ratio was 0.47 (95% confidence interval [CI], 0.26 to 0.80) with colonoscopic polypectomy, suggesting a 53% reduction in mortality. Mortality from colorectal cancer was similar among patients with adenomas and those with nonadenomatous polyps during the first 10 years after polypectomy (relative risk, 1.2; 95% CI, 0.1 to 10.6). CONCLUSIONS: These findings support the hypothesis that colonoscopic removal of adenomatous polyps prevents death from colorectal cancer. (Funded by the National Cancer Institute and others.) Copyright © 2012 Massachusetts Medical Society. All rights reserved.


Khanna G.,University of Minnesota | Singh J.A.,Kirklin Clinic | Pomeroy D.L.,University of Louisville | Gioe T.J.,Minneapolis Veterans Affairs Medical Center
Journal of Bone and Joint Surgery - Series A | Year: 2011

Background: Although the necessity of long-term follow-up after total knee arthroplasty is unquestioned, this task may become burdensome as greater numbers of total knee arthroplasties are performed. We sought to use comparisons with clinician-assessed values to determine whether patients could reliably assess their own outcome with use of a combination of American Knee Society Score and Oxford Knee Score questionnaires and self-reported knee motion. We hypothesized that patients would self-report worse pain and function and a similar range of knee motion than clinicians would. Methods: One hundred and forty patients (181 knees) scheduled for routine follow-up at two centers after primary total knee arthroplasty were mailed American Knee Society Score and Oxford Knee Score questionnaires, a set of photographs illustrating knee motion in 5° increments for comparison with the patient's range of knee motion, and a goniometer with instructions. The patient's American Knee Society Score, Oxford Knee Score, and knee motion were then independently assessed within two weeks of the self-evaluation by one of three clinicians who had not been involved with the surgery. Patient-reported and clinician-assessed measures were compared with use of a paired-sample t test and the Spearman correlation coefficient. Results: The mean patient-reported American Knee Society pain subscore was 4 points worse than the clinicianassessed score, and the function subscore was 10 points worse (p < 0.001 for both). The mean Oxford Knee Score did not differ significantly between the patient self-assessment and the clinician assessment (p = 0.05). The mean maximum flexion reported by the patient with use of the photographs differed by <1° from the mean value reported by the patient with use of the goniometer or the mean value measured by the clinician; these differences were not clinically important. Conclusions: Patients' self-reported American Knee Society pain and function subscores were worse than the corresponding clinician assessments, but the two Oxford Knee Scores were similar. Range of knee motion may reasonably be self-assessed by comparison with photographs. Long-term follow-up of patients after total knee arthroplasty may be possible with use of patient-reported measures, alleviating the burden of clinic visits yet maintaining contact, but further studies involving other validated instruments is warranted. Copyright © 2011 by The Journal of Bone and Joint Surgery, Incorporated.


Kunisaki K.M.,University of Minnesota | Niewoehner D.E.,University of Minnesota | Niewoehner D.E.,Minneapolis Veterans Affairs Medical Center | Singh R.J.,Mayo Medical School | Connett J.E.,University of Minnesota
European Respiratory Journal | Year: 2011

Low blood vitamin D levels have been postulated to be a risk factor for worse lung function, based largely on cross-sectional data. We sought to use longitudinal data to test the hypothesis that baseline plasma 25-hydroxyvitamin D (25(OH)D) is lower in subjects with more rapid lung function decline, compared to those with slow lung function decline. We conducted a nested, matched case-control study in the Lung Health Study 3 cohort. Cases and controls were continuous smokers with rapid and slow lung function decline, respectively, over ,6 yrs of follow-up. We compared baseline 25(OH)D levels between cases and controls, matching date of phlebotomy and clinical centre. Among 196 subjects, despite rapid and slow decliners experiencing strikingly and significantly different rates of decline of forced expiratory volume in 1 s (-152 versus -0.3 mL·yr-1; p<0.001), there was no significant difference in baseline 25(OH)D levels (25.0 versus 25.9 ng·mL-1; p=0.54). There was a high prevalence of vitamin D insufficiency (35%) and deficiency (31%); only 4% had a normal 25(OH)D level in the winter. Although vitamin D insufficiency and deficiency are common among continuous smokers with established mild-to-moderate chronic obstructive pulmonary disease, baseline 25(OH)D levels are not predictive of subsequent lung function decline. Copyright©ERS 2011.


Warshaw E.M.,Minneapolis Veterans Affairs Medical Center | Warshaw E.M.,University of Minnesota | Gravely A.A.,Minneapolis Veterans Affairs Medical Center | Nelson D.B.,Minneapolis Veterans Affairs Medical Center | Nelson D.B.,University of Minnesota
Journal of the American Academy of Dermatology | Year: 2015

Background Teledermatology may be less optimal for skin neoplasms than for rashes. Objectives We sought to determine agreement for skin neoplasms. Methods This was a repeated measures study. Each lesion was examined by a clinic dermatologist and a teledermatologist; both generated a primary diagnosis, up to 2 differential diagnoses, and management. Macro images and polarized light dermoscopy images were obtained; for pigmented lesions only, contact immersion dermoscopy image was obtained. Results There were 3021 lesions in 2152 patients. Of 1685 biopsied lesions, there were 410 basal cell carcinomas (24%), 240 squamous cell carcinomas (14%), and 41 melanomas (2.4%). Agreement was fair to substantial for primary diagnosis (45.7%-80.1%; kappa 0.32-0.62), substantial to almost perfect for aggregated diagnoses (primary plus differential; 78.6%-93.9%; kappa 0.77-0.90), and fair for management (66.7%-86.1%; kappa 0.28-0.41). Diagnostic agreement rates were higher for pigmented lesions (52.8%-93.9%; kappa 0.44-0.90) than nonpigmented lesions (47.7%-87.3%; kappa 0.32-0.86), whereas the reverse was found for management agreement (pigmented: 66.7%-79.8%, kappa 0.19-0.35 vs nonpigmented: 72.0%-86.1%, kappa 0.38-0.41). Agreement rates using macro images were similar to polarized light dermoscopy; contact immersion dermoscopy, however, significantly improved rates for pigmented lesions. Limitations We studied a homogeneous population. Conclusions Diagnostic agreement was moderate to almost perfect whereas management agreement was fair. Polarized light dermoscopy increased rates modestly whereas contact immersion dermoscopy significantly increased rates for pigmented lesions.


Kunisaki K.M.,Minneapolis Veterans Affairs Medical Center | Rector T.S.,Center for Chronic Disease Outcomes Research | Rector T.S.,University of Minnesota
International Journal of COPD | Year: 2011

Background: Patients with chronic obstructive pulmonary disease (COPD) demonstrate Variable responses to inhaled corticosteroids (ICS). The factors contributing to this variability are not well understood. Data from patients with asthma have suggested that low 25-hydroxyvitamin D [25(OH)D] levels contribute to a lack of ICS response in asthma. The objective of this study was to determine whether serum levels of 25(OH)D were related to ICS responses in patients with COPD. Methods: A total of 60 exsmokers with severe COPD (mean forced expiratory volume in one second [FEV1] 1.07 L, 36% of predicted) spent 4 weeks free of any ICS, followed by 4 weeks of ICS use (fluticasone propionate 500 μg twice daily). Spirometry was performed prior to and after 4 weeks of ICS use. Blood 25(OH)D levels were measured prior to ICS use and examined for relationships to changes in FEV1 following the 4 weeks of ICS use. Results: The mean 25(OH)D level was 23.3 ± 9.3 ng/mL. There was a high prevalence of Vitamin D insufficiency (35%) and deficiency (40%). There was no relationship between baseline 25(OH)D and changes in FEV1 following 4 weeks of ICS. Conclusion: Baseline 25(OH)D does not contribute to the variation in short-term FEV1 responses to ICS in patients with severe COPD. © 2011 Kunisaki and Rector, publisher and licensee Dove Medical Press Ltd.


Goodwin B.E.,University of Alabama | Sellbom M.,University of Alabama | Arbisi P.A.,Minneapolis Veterans Affairs Medical Center | Arbisi P.A.,University of Minnesota
Psychological Assessment | Year: 2013

The current investigation examined the utility of the overreporting validity scales of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008) in detecting noncredible reporting of symptoms of posttraumatic stress disorder (PTSD) in a sample of disability-seeking veterans. We also examined the effect of mental health knowledge on the utility of these scales by investigating the extent to which these scales differentiate between veterans with PTSD and individuals with mental health training who were asked to feign symptoms of PTSD on the test. Group differences on validity scale scores indicated that these scales were associated with large effect sizes for differentiating veterans who overreported from those with PTSD and for differentiating between mental health professionals and veterans with PTSD. Implications of these results in terms of clinical practice are discussed. © 2013 American Psychological Association.


Kunisaki K.M.,Minneapolis Veterans Affairs Medical Center | Kunisaki K.M.,University of Minnesota | Niewoehner D.E.,Minneapolis Veterans Affairs Medical Center | Niewoehner D.E.,University of Minnesota | Connett J.E.,University of Minnesota
American Journal of Respiratory and Critical Care Medicine | Year: 2012

Rationale: Low blood levels of 25-hydroxyvitamin D (25[OH]D) have been associated with a higher risk of respiratory infections in general populations and higher risk of exacerbations of lung disease in people with asthma. We hypothesized that low blood levels of 25(OH)D in patients with chronic obstructive pulmonary disease (COPD) would be associated with an increased risk of acute exacerbations of COPD (AECOPD). Objectives: To determine if baseline 25(OH)D levels relate to subsequent AECOPD in a cohort of patients at high risk for AECOPD. Methods: Plasma 25(OH)D was measured at baseline in 973 participants on entry to a 1-year study designed todetermine if daily azithromycin decreased the incidence of AECOPD. Relationships between baseline 25(OH)D and AECOPD over 1 year were analyzed with time to first AECOPD as the primary outcome and exacerbation rate as the secondary outcome. Measurements and Main Results: In this largely white (85%) sample of North American patients with severe COPD (mean FEV 1 1.12L; 40% of predicted), mean 25(OH)D was 25.7 ± 12.8 ng/ml. A total of 33.1% of participants were vitamin D insufficient (≥20 ng/ml but <30 ng/ml); 32% were vitamin D deficient (<20 ng/ml); and 8.4% had severe vitamin D deficiency (<10 ng/ml). Baseline 25(OH)D levels had no relationship to time to first AECOPD or AECOPD rates. Conclusions: In patients with severe COPD, baseline 25(OH)D levels are not predictive of subsequent AECOPD. Clinical trial registered with www.clinicaltrials.gov (NCT00119860).


Schram S.E.,University of Minnesota | Warshaw E.M.,Minneapolis Veterans Affairs Medical Center | Laumann A.,Northwestern University
International Journal of Dermatology | Year: 2010

Nickel sensitivity is common and increasing in prevalence. This review discusses nickel sensitivity and its association with body piercing and other environmental factors, occupational relevance, and potential implications for implantable metal medical devices. In addition, current European legislation that limits the release of nickel from jewelry is highlighted and an argument for similar legislation elsewhere is presented. © 2010 The International Society of Dermatology.


Sy J.T.,University of Wyoming | Dixon L.J.,University of Wyoming | Lickel J.J.,Baltimore Medical Center | Nelson E.A.,Minneapolis Veterans Affairs Medical Center | Deacon B.J.,University of Wyoming
Behaviour Research and Therapy | Year: 2011

The current study attempted to replicate the finding obtained by Powers, Smits, and Telch (2004; Journal of Consulting and Clinical Psychology, 72, 448-545) that both the availability and utilization of safety behaviors interfere with the efficacy of exposure therapy. An additional goal of the study was to evaluate which explanatory theories about the detrimental effects of safety behaviors best account for this phenomenon. Undergraduate students (N= 58) with high claustrophobic fear were assigned to one of three treatment conditions: (a) exposure only, (b) exposure with safety behavior availability, and (c) exposure with safety behavior utilization. Participants in each condition improved substantially, and there were no significant between-group differences in fear reduction. Unexpectedly, exposure with safety behavior utilization led to significantly greater improvement in self-efficacy and claustrophobic cognitions than exposure only. The extent to which participants inferred danger from the presence of safety aids during treatment was associated with significantly less improvement on all outcome measures. The findings call into question the hypothesized deleterious effects of safety behaviors on the outcome of exposure therapy and highlight a possible mechanism through which the mere presence of safety cues during exposure trials might affect treatment outcomes depending on participants' perceptions of the dangerousness of exposure stimuli. © 2011.


Drekonja D.,Minneapolis Veterans Affairs Medical Center | Reich J.,Minneapolis Veterans Affairs Medical Center | Gezahegn S.,Minneapolis Veterans Affairs Medical Center | Greer N.,Minneapolis Veterans Affairs Medical Center | And 4 more authors.
Annals of Internal Medicine | Year: 2015

Background: The role of fecal microbiota transplantation (FMT) for Clostridium difficile infection (CDI) is not well-known. Purpose: To assess the efficacy, comparative effectiveness, and harms of FMT for CDI. Data Sources: MEDLINE (1980 to January 2015), Cochrane Library, and ClinicalTrials.gov, followed by hand-searching references from systematic reviews and identified studies. Study Selection: Any study of FMT to treat adult patients with CDI; case reports were only used to report harms. Data Extraction: Data were extracted by 1 author and verified by another; 2 authors independently assessed risk of bias and strength of evidence. Data Synthesis: Two randomized, controlled trials (RCTs); 28 case-series studies; and 5 case reports were included. Two RCTs and 21 case-series studies (516 patients receiving FMT) reported using FMT for patients with recurrent CDI. A high proportion of treated patients had symptom resolution; however, the role of previous antimicrobials is unclear. One RCT comparing FMT with 2 control groups (n = 43) reported resolution of symptoms in 81%, 31%, and 23% of the FMT, vancomycin, or vancomycinplus- bowel lavage groups, respectively (P<0.001 for both control groups vs. FMT). An RCT comparing FMT route (n = 20) reported no difference between groups (60% in the nasogastric tube group and 80% in the colonoscopy group; P = 0.63). Across all studies for recurrent CDI, symptom resolution was seen in 85% of cases. In 7 case-series studies of patients with refractory CDI, symptom resolution ranged from 0% to 100%. Among 7 patients treated with FMT for initial CDI, results were mixed. Limitation: Most studies were uncontrolled case-series studies; only 2 RCTs were available for analysis. Conclusion: Fecal microbiota transplantation may have a substantial effect with few short-term adverse events for recurrent CDI. Evidence is insufficient on FMT for refractory or initial CDI treatment and on whether effects vary by donor, preparation, or delivery method.

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