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Proto D.A.,Michael bakey Veterans Affairs Medical Center | Proto D.A.,Baylor College of Medicine | Pastorek N.J.,Veterans Affairs Medical Center | Pastorek N.J.,Baylor College of Medicine | And 5 more authors.
Archives of Clinical Neuropsychology | Year: 2014

Evaluating performance validity is important in any neuropsychological assessment, and prior research recommends a threshold for invalid performance of two or more performance validity test (PVT) failures. However, extant findings also indicate that failing a single PVT is associated with significant changes in neuropsychological performance. The current study sought to determine if there is an appreciable difference in neuropsychological testing results between individuals failing different numbers of PVTs. In a sample of veterans with reported histories of mild traumatic brain injury (mTBI; N =178), analyses revealed that individuals failing only one PVT performed significantly worse than individuals failing no PVTs on measures of verbal learning and memory, processing speed, and cognitive flexibility. Additionally, individuals failing one versus two PVTs significantly differed only on delayed free recall scores. The current findings suggest that failure of even one PVT should elicit consideration of performance invalidity, particularly in individuals with histories of mTBI. © 2014 Published by Oxford University Press 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.


Chen J.I.,Oklahoma City Veterans Affairs Medical Center | Chen J.I.,Kaiser Permanente | Slater L.N.,Oklahoma City Veterans Affairs Medical Center | Slater L.N.,University of Oklahoma | And 5 more authors.
Annals of Pharmacotherapy | Year: 2013

BACKGROUND: The introduction of the health care-associated pneumonia (HCAP) categorization expanded recommendations for broad-spectrum empiric antibiotics to pneumonia patients presenting from the community with recent health care-system exposure. However, the efficacy of such regimens in improving clinical outcomes in these patients has not been well established. OBJECTIVE: To compare the clinical outcomes of HCAP patients treated initially with HCAP guideline-concordant antibiotic regimens to those treated initially with community-acquired pneumonia (CAP) guideline-concordant antibiotic regimens. METHODS: This retrospective study included HCAP patients presenting from home and admitted to general medical wards. HCAP regimen patients were treated empirically with at least 1 antipseudomonal agent. All other patients were assigned to the CAP regimen group. The primary end point was clinical cure at 30 days postdischarge. Subgroup analysis was performed in patients hospitalized 1- 30 days and 31-90 days before the HCAP admission. RESULTS: Of 228 HCAP admissions, 122 patients received CAP regimens and 106 received HCAP regimens. The 2 groups were similar at baseline, including Pneumonia Severity Index scores. Attributable clinical cure occurred in 75.4% of CAP regimen patients and 69.8% of HCAP regimen patients (p = 0.34). Overall clinical cure occurred in 59.8% of CAP regimen patients and 54.7% of HCAP regimen patients (p = 0.44). The CAP regimen group used fewer days of intravenous antibiotics (4.39 vs 7.75, p < 0.0001) and had shorter lengths of stay (6.36 vs 8.58 days, p < 0.0001). For patients hospitalized 31-90 days earlier, clinical cure was higher in the CAP regimen group (attributable, 82.9% vs 60.0%, p = 0.0090; overall, 67.1% vs 47.5%, p = 0.044). CONCLUSIONS: Compared to CAP guideline-concordant regimens, treatment of HCAP with HCAP guideline-concordant regimens did not increase clinical cure rates and was associated with lower clinical cure rates in patients hospitalized 31-90 days prior to the HCAP admission. This study suggests that broad- spectrum empiric antibiotics may not be necessary in all HCAP patient groups. © 1967-2013 Harvey Whitney Books Co. All rights reserved.


Houston J.B.,University of Missouri | Pfefferbaum B.,The University of Oklahoma Health Sciences Center | Sherman M.D.,Oklahoma City Veterans Affairs Medical Center | Melson A.G.,Family Development and Intervention Services | Brand M.W.,The University of Oklahoma Health Sciences Center
Journal of Loss and Trauma | Year: 2013

Frequency and quality of family deployment communication was assessed and examined in conjunction with emotions and behaviors reported by military children and spouses (N = 26) before, during, and after deployment. Child deployment communication with siblings was associated with positive child outcomes. Conversely, before and during deployment child communication with a deployed parent was related to more child emotional reactions and behavioral problems. For spouses, more and better communication with children and the deployed partner was related to the spouse's having less negative temper or stress reactions. Use of newer communication technology during deployment was related to negative child outcomes. © 2013 Copyright Taylor and Francis Group, LLC.


Gardner A.W.,The University of Oklahoma Health Sciences Center | Gardner A.W.,Oklahoma City Veterans Affairs Medical Center | Ritti-Dias R.M.,University of Pernambuco | Stoner J.A.,The University of Oklahoma Health Sciences Center | And 4 more authors.
Journal of Vascular Surgery | Year: 2011

Objective: This study compared oxygen uptake before and after the onset of claudication in individuals with peripheral artery disease (PAD) during a 6-minute walk test, and identified predictors of the change in oxygen uptake after the onset of claudication pain. Methods: The study included 50 individuals with PAD. During a 6-minute walk test, 33 experienced claudication (pain group), and 17 were pain-free (pain-free group). Oxygen uptake and ambulatory cadence were the primary outcomes evaluated during the 6-minute walk test. Results: The pain group experienced onset of claudication pain at a mean (standard deviation) of 179 (45) meters and continued to walk to achieve a 6-minute walk distance of 393 (74) meters, which was similar to the 401 (76) meters walked in the pain-free group (P = .74). Oxygen uptake increased (P < .0001) after the onset of pain in the pain group, and this change was greater (P = .025) than the increase in oxygen uptake from the second to fifth minutes of walking in the pain-free group. Ambulatory cadence decreased after the onset of pain in the pain group (P = .0003). The change in oxygen uptake was associated with metabolic syndrome (P = .0023), 6-minute walk distance (P = .0037), age (P = .0041), and oxygen uptake during the second minute of the test (P = .012). Conclusion: Claudication increases oxygen uptake of self-paced, over-the-ground ambulation, despite a decrease in cadence. The pain-mediated increase in oxygen uptake was blunted in individuals with metabolic syndrome, suggesting that the ability to increase oxygen uptake during ambulation is impaired. The clinical significance is that claudication increases the metabolic cost of ambulation, thereby increasing the relative intensity of exercise and reducing the tolerance to sustain ambulation. © 2011 Society for Vascular Surgery.


Yang X.,The University of Oklahoma Health Sciences Center | Yang S.,The University of Oklahoma Health Sciences Center | McKimmey C.,The University of Oklahoma Health Sciences Center | Liu B.,Aurora University | And 4 more authors.
Carcinogenesis | Year: 2010

Genistein is a major isoflavone with known hormonal and tyrosine kinase-modulating activities. Genistein has been shown to promote the growth of estrogen receptor positive (ER+)MCF-7 cells. In ERnegative (ER-)/erbB-2-overexpressing (erbB-2+) cells, genistein has been shown to inhibit cell growth through its tyrosine kinase inhibitor activity. The effects of genistein on cell growth and tamoxifen response in ER+/erbB-2-altered breast cancers (known as luminal type B and noted in ~10 to 20% of breast cancers) have not been well explored. Using erbB-2-transfected ER+ MCF-7 cells, we found that genistein induced enhanced cellular proliferation and tamoxifen resistance when compared with control MCF-7 cells. These responses were accompanied by increased phosphorylation of ERα and ER signaling, without increase in ER protein levels. Genistein-treatedMCF-7/erbB-2 cells also showed enhanced activation/phosphorylation of erbB-2, Akt and mitogen-activated protein kinase (MAPK)/extracellular signal-regulated kinase. Blockade of the phosphatidylinositol 3-kinase and/or MAPK pathways abrogated genistein-induced growth promotion, suggesting that genistein effects involve both critical signaling pathways.We also found that p27/kip1 was markedly downregulated in genistein-treated MCF-7/erbB-2 cells. Overexpression of p27/kip1 attenuated genistein-mediated growth promotion. In aggregate, our data suggest that the concomitant coexpression of ER and erbB-2 makes breast cancers particularly susceptible to the growth-promoting effects of genistein across a wide range of doses. The underlying mechanisms involve enhanced ER-erbB-2 cross talk and p27/kip1 downregulation. © The Author 2010. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org.


Jan Y.-K.,The University of Oklahoma Health Sciences Center | Liao F.,The University of Oklahoma Health Sciences Center | Burns S.,Oklahoma City Veterans Affairs Medical Center
Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics) | Year: 2011

This study investigated the effect of spinal cord injury (SCI) on nonlinear complexity of skin blood flow oscillations (BFO). Complexity of the characteristic frequencies embedded in BFO was described by the scaling coefficient derived by detrended fluctuation analysis (DFA) and the range of scaling coefficients derived from multifractal detrended fluctuation analysis (MDFA) in specific scale intervals. 23 subjects were recruited into this study, including 11 people with SCI and 12 healthy controls. Local heating-induced maximal sacral skin blood flow was measured by laser Doppler flowmetry. The results showed that metabolic BFO (0.0095-0.02 Hz) exhibited significantly lower complexity in people with SCI as compared with healthy controls (p<0.01) during maximal vasodilation. This study demonstrated that complexity analysis of BFO can provide information of blood flow dynamics beyond traditional spectral analysis. © 2011 Springer-Verlag.


Gentry C.A.,Oklahoma City Veterans Affairs Medical Center | Nguyen A.T.,Oklahoma City Veterans Affairs Medical Center
Annals of Pharmacotherapy | Year: 2013

Background: Adverse events associated with high-dose trimethoprim-sulfamethoxazole (TMP-SMX) for outpatient infections, particularly those likely caused by community-acquired methicillin-resistant Staphylococcus aureus, have not been adequately characterized. Objective: Describe hyperkalemia and acute renal injury associated with high-dose TMP-SMX. Methods: An electronic medical record database retrospective study was conducted of outpatients receiving high-dose or low-dose TMP-SMX, comparing the incidences of hyperkalemia and acute renal injury. Results: Of 6162 patients, more developed hyperkalemia (3.06% vs 1.05%, P < .0001) or acute renal injury (1.99% vs 0.700%, P = .0001) in the high-dose TMP-SMX group. Variables independently associated with hyperkalemia included age >58 years (odds ratio [OR] = 3.44; 95% CI = 1.86-7.0; P < .0001), concomitant receipt of an NSAID (OR = 1.71; 95% CI = 1.02-2.79; P = .044) or an ACE inhibitor (OR = 3.27; 95% CI = 2.06-5.14; P < .0001), high-dose TMP-SMX prescribed (OR = 2.92; 95% CI = 1.85-4.60; P < .0001), and baseline elevated serum creatinine (OR = 45.1; 95% CI = 21.7-93.2; P < .0001). Variables independently associated with acute renal injury included concomitant receipt of an ACE inhibitor (OR = 2.36; 95% CI = 1.01-5.24; P = .048) or a potassium supplement (OR = 4.10; 95% CI = 1.45-10.1; P = .010), high-dose TMP-SMX prescribed (OR = 3.70; 95% CI = 1.70-8.12; P = .0012), and baseline elevated serum creatinine (OR = 2110; 95% CI = 724-7980; P < .0001). Conclusions: Serum creatinine and potassium concentrations should be monitored in outpatients receiving high-dose TMP-SMX. © The Author(s) 2013.


Rabadi M.H.,Oklahoma City Veterans Affairs Medical Center | Rabadi M.H.,University of Oklahoma | Aston C.E.,University of Oklahoma
Medical Science Monitor | Year: 2016

Background: The goal of this observational study was to examine the effect of common chronic medical conditions (CMCs) on long-term disability (activity limitation) in veterans already diagnosed with multiple sclerosis (MS). Material/Methods: We retrospectively reviewed the electronic charts of 124 veterans with MS who have been regularly followed in our MS clinic for 10 or more years. General linear model analysis examined whether MS-related severity as measured by the Expanded Disability Status Scale (EDSS) and the presence of CMCs affected long-term disability as measured by the total score on the Functional Independence Measure (TFIM). Results: Commonly encountered CMCs were increased BMI (61%), hyperlipidemia (78%), hypertension (65%), current smokers (47%), and arthritis/arthralgia (24%). Results suggest that the number of CMCs was not predictive of final TFIM scores; of the variables examined, only initial EDSS score was predictive of final TFIM scores. Conclusions: The presence of CMCs did not affect the long-term disability in veterans diagnosed with MS, this was due mainly to CMCs being closely monitored and co-treated with other medical specialties. © Med Sci Monit.


PubMed | Oklahoma City Veterans Affairs Medical Center and University of Oklahoma
Type: | Journal: Medical science monitor : international medical journal of experimental and clinical research | Year: 2016

BACKGROUND The goal of this observational study was to examine the effect of common chronic medical conditions (CMCs) on long-term disability (activity limitation) in veterans already diagnosed with multiple sclerosis (MS). MATERIAL AND METHODS We retrospectively reviewed the electronic charts of 124 veterans with MS who have been regularly followed in our MS clinic for 10 or more years. General linear model analysis examined whether MS-related severity as measured by the Expanded Disability Status Scale (EDSS) and the presence of CMCs affected long-term disability as measured by the total score on the Functional Independence Measure (TFIM). RESULTS Commonly encountered CMCs were increased BMI (61%), hyperlipidemia (78%), hypertension (65%), current smokers (47%), and arthritis/arthralgia (24%). Results suggest that the number of CMCs was not predictive of final TFIM scores; of the variables examined, only initial EDSS score was predictive of final TFIM scores. CONCLUSIONS The presence of CMCs did not affect the long-term disability in veterans diagnosed with MS, this was due mainly to CMCs being closely monitored and co-treated with other medical specialties.


Nguyen A.T.,Oklahoma City Veterans Affairs Medical Center
Current drug safety | Year: 2013

High-dose trimethoprim-sulfamethoxazole (TMP-SMX) for the empiric treatment of community-acquired methicillin-resistant Staphylococcus aureus skin and soft tissue infections has been evaluated for efficacy, but characterization of adverse reactions is lacking. To describe adverse reactions associated with high-dose TMP-SMX therapy, a retrospective medical record review of outpatients receiving TMP-SMX was conducted. Each episode (case) of a patient receiving high-dose TMP-SMX (at least 4 double-strength tablets per day) was matched by next closest prescription number with a patient (control) receiving standard-dose TMP-SMX. 982 cases were reviewed; 491 in each arm. At least one adverse drug reaction (ADR) occurred in 9.1% of patients. There was a significant difference in the incidence for any ADR between high-dose and standard-dose groups (13.0% vs 5.09%, respectively; p<0.0001). More patients taking high-dose TMP-SMX developed hyperkalemia (3.46% vs 0.81%, p=0.0066), acute renal injury (3.67% vs 1.63%, p=0.044), and rash (1.83% vs 0.20%, p=0.021). Patients receiving high-dose TMP-SMX had significantly higher rates of electrolyte abnormality ADR (5.09% vs 1.63%, p=0.0021), gastrointestinal ADR (5.30% vs 2.24%, p=0.011), renal ADR (3.67% vs 1.63%, p=0.044), central nervous system ADR (2.65% vs 0.81%, p=0.047), and hypersensitivity (2.24% vs 0.41%, p=0.022). Concomitant receipt of an angiotensin-converting enzyme (ACE) inhibitor was a univariate variable associated with hyperkalemia, and advanced age and receipt of high-dose TMP-SMX were independent variables. ADRs such as hyperkalemia are more likely to be associated with the use of high-dose TMP-SMX in the ambulatory setting. Clinicians should use caution when initiating high-dose TMP-SMX and consider laboratory monitoring in patients of advanced age or those receiving concomitant ACE inhibitor therapy.

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