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Rank M.A.,Mayo Medical School | Rank M.A.,The Robert d Patricia rn Center For The Science Of Health Care Delivery | Shah N.D.,The Robert d Patricia rn Center For The Science Of Health Care Delivery
Journal of Allergy and Clinical Immunology: In Practice | Year: 2014

At least half of US adults with asthma have at least 1 other chronic condition. Having asthma and other chronic conditions are associated with poorer asthma outcomes. Several studies considered the relationship between asthma and other specific chronic conditions; results of these studies indicated that having depression or anxiety and/or panic disorder is associated with an increased risk of developing a new asthma diagnosis and with poorer asthma outcomes. In addition, results of these studies indicated that having asthma is associated with an increased risk of developing a new depression or anxiety and/or panic disorder diagnosis. Theoretical models for understanding multiple chronic conditions have emerged, with models that include a balance between patient workload and capacity; classification of specific conditions as concordant and/or discordant and/or dominant; and identification of the gap between what a patient needs and what health care services are able to offer. Potential implications for clinical providers include screening for chronic conditions not yet recognized, such as mental health disorders, promoting and tracking medication adherence in those who have multiple chronic conditions, and simplifying treatment regimens to reduce patient workload. © 2014 American Academy of Allergy, Asthma & Immunology. Source

Njeru J.W.,Mayo Medical School | Tan E.M.,Mayo Medical School | St. Sauver J.,Mayo Medical School | Jacobson D.J.,Mayo Medical School | And 5 more authors.
Journal of Immigrant and Minority Health | Year: 2015

We examined the prevalence of cardiovascular risk factors among Somali refugees at a midwestern hospital in the U.S. This was a retrospective cohort study of 1007 adult Somali patients and an age and frequency-matched cohort of non-Somali patients actively empanelled to a large, academic primary care practice network in the Midwest United States between January 1, 2011 and December 31, 2012. Cardiovascular risk factors were obtained by chart review and compared between the two cohorts using a Chi squared test. Median age was 35 years (Q1, Q3; 27, 50). The prevalence of diabetes was significantly higher among Somali versus non-Somali patients (12.1 vs 5.3 %; p = 0.0001), as was prediabetes (21.3 vs 17.2 %; p < 0.02) and obesity (34.6 vs 32.1 %; p = 0.047). After adjusting for age, sex, body mass index, education and employment, among the Somali patients, the odds ratio (95 % confidence interval) for diabetes was 2.78 (1.76–4.40) and 1.57 (1.16–2.13) for pre-diabetes. There was a significantly higher prevalence of diabetes, pre-diabetes and obesity among Somali patients compared with non-Somali patients. Further research into the specific causes of these disparities and development of targeted effective and sustainable interventions to address them is needed. © 2015 Springer Science+Business Media New York Source

Thiels C.A.,Mayo Medical School | Thiels C.A.,The Robert d Patricia rn Center For The Science Of Health Care Delivery | Shenoy C.C.,Mayo Medical School | Ubl D.S.,The Robert d Patricia rn Center For The Science Of Health Care Delivery | And 3 more authors.
International Journal of Surgery | Year: 2016

Background: There is a paucity of literature regarding rates, trends, and outcomes of women with endometriosis undergoing elective colorectal resections in the United States. It was been suggested that endometriosis requiring colorectal resection is well suited for minimally invasive surgery. Materials and methods: The American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database was searched from 2005 to 2014 for all elective colorectal resections performed for endometriosis. The proportion of resections was compared over time using a Cochran-Armitage test for trend. Univariate comparisons were made between patients with laparoscopic vs open resections. Results: A total of 101,686 women underwent elective colorectal resections, of which 268 (0.26%) were performed for endometriosis. The proportion of endometriosis as the indication for resection increased over time (R2 = 0.77). Mean age was 42.9 ± 8.4 years with 72.8% non-Hispanic white. Median body mass index was 25.8 [interquartile range: 23.0, 31.5]. Overall, patients were healthy (82.8% American Society of Anesthesiologists classification I or II). Median length of stay was 4 [3, 6] days and 14.2% suffered any complication, with 9.0% having a minor complication and 7.1% having a major complication. There were no 30-day mortalities. The majority of cases (97.4%) were performed by a general/colorectal surgeon and the remainder by gynecologists. Forty-five (16.8%) underwent concurrent hysterectomy. Comparing open (n = 124) to laparoscopic approaches (n = 144) revealed no differences other than a longer length of stay (5 vs 4 days, p < 0.001) and operative time (180.5 vs 138.5 min, p = 0.02) in the open group. Conclusions: Endometriosis is a rare but increasing indication for elective colorectal resection at participating hospitals. The short-term outcomes after colorectal resection in this young and healthy population are acceptable and our data suggests that minimally invasive surgery should be considered in these patients. © 2016 IJS Publishing Group Ltd. Source

Thiels C.A.,Mayo Medical School | Thiels C.A.,The Robert d Patricia rn Center For The Science Of Health Care Delivery | Naik N.D.,Mayo Medical School | Bergquist J.R.,Mayo Medical School | And 5 more authors.
Journal of Surgical Oncology | Year: 2016

Background: Synchronous colon cancers, defined as two or more primary colon cancer detected simultaneously at the time of initial diagnosis, account for up to 5% of all colon cancer diagnoses. Management principles and outcomes remain largely undefined. Methods: A retrospective institutional review of patients undergoing curative intent resection for colon adenocarcinoma (Stages I–III) from 1995 to 2007 was performed. Hereditary causes or inflammatory bowel disease were excluded. Matching was performed and Kaplan–Meier analysis was used to compare overall survival. Results: Of 2,387 patients, 100 (4.2%) had synchronous cancers. Patients with synchronous lesions tended to be older (median 77 vs. 72 years, P < 0.001) with more advanced tumors (41.0% vs. 31.4% Stage III, P = 0.04). After matching, there were no differences in demographics or tumor factors (all P > 0.05). Compared to solitary, synchronous cancers demonstrated an inferior 10-year overall survival (53.9% vs. 36.5%, P = 0.009). Subset analysis of patients with synchronous cancers showed no difference in overall survival between those with extended versus segmental resections at 120-months (P = 0.07). Conclusion: Synchronous colon cancer is associated with decreased overall survival compared to patients with solitary tumors. Extended resection does not confer a survival benefit in these patients. Further research is needed to determine how to mitigate the poor outcomes. J. Surg. Oncol. 2016;114:80–85. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc. Source

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