Salt Lake City Veterans Affairs Medical Center
Salt Lake City Veterans Affairs Medical Center
Mayer J.,University of Utah |
Greene T.,University of Utah |
Howell J.,Salt Lake City Veterans Affairs Medical Center |
Ying J.,University of Utah |
And 6 more authors.
Clinical Infectious Diseases | Year: 2012
Background. Mandatory reporting of healthcare-associated infections (HAIs) is increasing. Evidence for agreement among different reviewers applying HAI surveillance criteria is limited. We aim to characterize agreement among infection preventionists (IPs) conducting surveillance for central line-associated bloodstream infection (CLABSI) with each other and as compared with simplified laboratory-based definitions.Methods.Abstracted electronic health records were assembled from inpatients with positive blood cultures at a tertiary-care Veterans Affairs (VA) hospital over a 5-year period. Identical patient records were made available to VA IPs from different facilities to report on CLABSI using their usual surveillance methods. Positive blood cultures were also evaluated using laboratory-based definitions. Standard indices of interrater agreement, expressed as a statistic, were computed between IPs, and between IPs and simplified laboratory-based methods.Results.Overall, 114 patient records were reviewed by 18 IPs, the majority of whom specified they followed National Healthcare Safety Network criteria. The overall agreement among IPs by statistic was 0.42 (standard error [SE], 0.06). IPs had better agreement with a simple laboratory-based definition with an average of 0.55 (SE, 0.05). The proportion of patient records that 18 IPs reported with CLABSI ranged from 14 to 39 (overall mean, 28 with a coefficient of variation of 25). When simple laboratory-based methods were applied to different sets of patient records, classification was more consistent with CLABSI assigned in a proportion ranging from 36 to 42 (overall mean, 39). Conclusions. Reliability of IP-conducted surveillance to identify HAI may not be ideal for public reporting goals of interhospital comparisons. © 2012 The Author.
Burningham Z.,Salt Lake City Veterans Affairs Medical Center |
He T.,Salt Lake City Veterans Affairs Medical Center |
Teng C.-C.,Salt Lake City Veterans Affairs Medical Center |
Zhou X.,Salt Lake City Veterans Affairs Medical Center |
And 2 more authors.
Drug Safety | Year: 2017
Introduction: The case–crossover (CCO) design was originally intended to study exposures characterized as intermittent with acute effects. The performance of the CCO design is not well characterized under alternative exposure and outcome relationships. Objective: The purpose of this study was to evaluate the ability of the CCO to identify simulated treatment effects under different drug exposures and outcomes relationships while varying the duration of the 1:1 matched risk and control windows. Methods: The simulated data were obtained from the Observational Medical Dataset Simulator, version 2 (OSIM2). The area under the receiver operator characteristic curve (AUC) was calculated to compare CCO performance across outcome types, simulated relative risk (RR), and duration of risk and control windows. Results: The AUC for acute outcomes was higher for shorter risk and control windows and improved with higher simulated RR. For example, the AUC for the simulated RR of 4 was 0.95 for a 30-day window length and 0.78 for a 360-day window length. The AUC for the accumulative outcomes increased with longer risk and control windows and stronger simulated RR. For example, the AUC for the simulated RR of 4 was 0.85 for a 360-day window length and 0.23 for a 30-day window length. Risk and control window lengths did not appear to sufficiently alter the AUC for insidious onset outcomes. Conclusions: The CCO performed best for acute-onset outcomes, but may be useful for exploring adverse outcomes with accumulative effects. Careful consideration must be given to the hypothesized drug exposure and outcome distribution because specification of risk and control window duration affects CCO performance. © 2017 Springer International Publishing Switzerland
Wasmund S.L.,University of Utah |
Owan T.,University of Utah |
Yanowitz F.G.,University of Utah |
Yanowitz F.G.,LDS Hospital |
And 8 more authors.
Heart Rhythm | Year: 2011
Background Obesity is associated with significantly increased cardiovascular mortality that has been attributed, in part, to sympathetic activation. Gastric bypass surgery (GBS) appears to increase long-term survival in the severely obese, but the mechanisms responsible for this increase are still being sought. Heart rate (HR) recovery after exercise reflects the balance of cardiac autonomic input from the sympathetic and parasympathetic systems. Blunted HR recovery is a very powerful predictor of increased mortality, whereas enhanced HR recovery portends a good prognosis. Objective The purpose of this study was to evaluate the effect of marked weight loss achieved via GBS on HR recovery. Methods Severely obese patients underwent submaximal exercise testing (80% predicted maximum HR) at baseline and 2 years after GBS (n = 153) or nonsurgical treatment (n = 188). Results Patients in the GBS group lost an average of 100 ± 37 lb compared to 3 ± 22 lb in the nonsurgical group (P <.001, GBS vs nonsurgical). Resting HR decreased from 73 bpm to 60 bpm in the GBS group and from 74 bpm to 68 bpm in nonsurgical patients (P <.001). HR recovery improved by 13 bpm in the GBS group but did not change in the nonsurgical group (P <.001 GBS vs nonsurgical). In multivariable analysis, the independent correlates of HR recovery at the 2-year time point were resting HR, treadmill time, age, body mass index, and HOMA-IR (an index of insulin resistance). Conclusion Marked weight loss 2 years after GBS resulted in a significant decrease in resting HR and an enhancement in HR recovery after exercise. These changes likely are attributable to improvement in insulin sensitivity and cardiac autonomic balance. Whether and to what extent this contributes to a reduction in cardiovascular mortality with GBS remains to be determined.
Di Bella E.V.R.,University of Utah |
Fluckiger J.U.,University of Utah |
Chen L.,University of Utah |
Kim T.H.,University of Sydney |
And 10 more authors.
International Journal of Cardiovascular Imaging | Year: 2012
The A2A receptor agonist, regadenoson, is increasingly used as a vasodilator during nuclear myocardial perfusion imaging. Regadenoson is administered as a single, fixed dose. Given the frequency of obesity in patients with symptoms of heart disease, it is important to know whether the fixed dose of regadenoson produces maximal coronary hyperemia in subjects of widely varying body size. Thirty subjects (12 female, 18 male, mean BMI 30.3 ± 6.5, range 19.6-46.6) were imaged on a 3T magnetic resonance scanner. Imaging with a saturation recovery radial turboFLASH sequence was done first at rest, then during adenosine infusion (140 μg/ kg/min) and 30 min later with regadenoson (0.4 mg/ 5 ml bolus). A 5 cc/s injection of Gd-BOPTA was used for each perfusion sequence, with doses of 0.02, 0.03 and 0.03 mmol/kg, respectively. Analysis of the upslope of myocardial time-intensity curves and quantitative processing to obtain myocardial perfusion reserve (MPR) values were performed for each vasodilator. The tissue upslopes for adenosine and regadenoson matched closely (y = 1.1x + 0.03, r = 0.9). Mean MPR was 2.3 ± 0.6 for adenosine and 2.4 ± 0.9 for regadenoson (p = 0.14). There was good agreement between MPR measured with adenosine and regadenoson (y = 1.1x - 0.06, r = 0.7). The MPR values measured with both agents tended to be lower as BMI increased. There were no complications during administration of either agent. Regadenoson produced fewer side effects. Fixed dose regadenoson and weight adjusted adenosine produce similar measures of MPR in patients with a wide range of body sizes. Regadenoson is a potentially useful vasodilator for stress MRI studies. © Springer Science+Business Media, B.V. 2011.
Huston J.H.,Salt Lake City Veterans Affairs Medical Center |
Ryan J.J.,University of Utah
Pulmonary Circulation | Year: 2016
Epigenetics is an emerging field of research and clinical trials in cancer therapy that also has applications for pulmonary arterial hypertension (PAH), as there is evidence that epigenetic control of gene expression plays a significant role in PAH. The three types of epigenetic modification include DNA methylation, histone modification, and RNA interference. All three have been shown to be involved in the development of PAH. Currently, the enzymes that perform these modifications are the primary targets of neoplastic therapy. These targets are starting to be explored for therapies in PAH, mostly in animal models. In this review we summarize the basics of each type of epigenetic modification and the known sites and molecules involved in PAH, as well as current targets and prospects for clinical trials. © 2016 by the Pulmonary Vascular Research Institute. All rights reserved.
Frech T.,University of Utah |
Novak K.,Salt Lake City Veterans Affairs Medical Center |
Revelo M.P.,University of Utah |
Murtaugh M.,University of Utah |
And 6 more authors.
International Journal of Rheumatology | Year: 2011
Pruritus is a common symptom in systemic sclerosis (SSc), an autoimmune disease which causes fibrosis and vasculopathy in skin, lung, and gastrointestinal tract (GIT). Unfortunately, pruritus has limited treatment options in this disease. Pilot trials of low-dose naltrexone hydrochloride (LDN) for pruritus, pain, and quality of life (QOL) in other GIT diseases have been successful. In this case series we report three patients that had significant improvement in pruritus and total GIT symptoms as measured by the 10-point faces scale and the University of California Los Angeles Scleroderma Clinical Trials Consortium Gastrointestinal Tract 2.0 (UCLA SCTC GIT 2.0) questionnaire. This small case series suggests LDN may be an effective, highly tolerable, and inexpensive treatment for pruritus and GIT symptoms in SSc. Copyright © 2011 Tracy Frech et al.
Rieg T.,University of California at San Diego |
Rieg T.,Veterans Affairs San Diego Healthcare System |
Kohan D.E.,University of Utah |
Kohan D.E.,Salt Lake City Veterans Affairs Medical Center
American Journal of Physiology - Renal Physiology | Year: 2014
Adenylyl cyclases (AC) catalyze formation of cAMP, a critical component of G protein-coupled receptor signaling. So far, nine distinct membrane-bound AC isoforms (AC1-9) and one soluble AC (sAC) have been identified and, except for AC8, all of them are expressed in the kidney. While the role of ACs in renal cAMP formation is well established, we are just beginning to understand the function of individual AC isoforms, particularly with regard to hormonal regulation of transporter and channel phosphorylation, membrane abundance, and trafficking. This review focuses on the role of different AC isoforms in regulating renal water and electrolyte transport in health as well as potential pathological implications of disordered AC isoform function. In particular, we focus on modulation of transporter and channel abundance, activity, and phosphorylation, with an emphasis on studies employing genetically modified animals. As will be described, it is now evident that specific AC isoforms can exert unique effects in the kidney that may have important implications in our understanding of normal physiology as well as disease pathogenesis. © 2014 the American Physiological Society.
Bergeson A.G.,University of Utah |
Tashjian R.Z.,University of Utah |
Tashjian R.Z.,Salt Lake City Veterans Affairs Medical Center |
Greis P.E.,University of Utah |
And 3 more authors.
American Journal of Sports Medicine | Year: 2012
Background: Increased age, larger tear size, and more advanced fatty degeneration of the rotator cuff musculature have been correlated with poorer healing rates after rotator cuff repair. Platelets are an endogenous source of growth factors present during rotator cuff healing.Hypothesis: Augmentation of rotator cuff repairs with platelet-rich fibrin matrix (PRFM) may improve the biology of rotator cuff healing and thus improve functional outcome scores and retear rates after repair.Study Design: Cohort study; Level of evidence, 3.Methods: Rotator cuff tears at risk for retear were prospectively identified using an algorithm; points were assigned for age (50-59 years = 1; 60-69 years = 2; >70 years = 3), anterior-to-posterior tear size (2-2.9 cm = 0; 3-3.9 cm = 1; >4 cm = 2), and fatty atrophy (Goutallier score 0-2 = 0; Goutallier score 3-4 = 1). Three points were required for enrollment. Arthroscopic rotator cuff repair was performed with the addition of PRFM. Preoperative and 1-year postoperative magnetic resonance imaging (MRI) and functional outcome scores were obtained. Imaging and functional outcomes were compared with historical controls meeting the same enrollment criteria.Results: Sixteen and 21 patients were enrolled in the PRFM and control groups, respectively. Mean age (65 ± 7 and 65 ± 9 years; P =.89), tear size (3.8 ± 1.1 and 3.9 ± 1.1 cm; P =.79), and median Goutallier scores (2 and 3; P =.18) were similar between the PRFM and control groups, respectively. Retear rates (56.2% vs 38.1%) were statistically significantly higher (P =.024) in the PRFM group compared with controls. Functional outcome scores postoperatively were not significantly improved compared with controls. Complications included 2 infections in the PRFM group.Conclusion: The augmentation of at-risk rotator cuff tears with PRFM did not result in improved retear rates or functional outcome scores compared with controls. © 2012 American Orthopaedic Society for Sports Medicine.
PubMed | Salt Lake City Veterans Affairs Medical Center and University of Utah
Type: Journal Article | Journal: Pulmonary circulation | Year: 2016
Epigenetics is an emerging field of research and clinical trials in cancer therapy that also has applications for pulmonary arterial hypertension (PAH), as there is evidence that epigenetic control of gene expression plays a significant role in PAH. The three types of epigenetic modification include DNA methylation, histone modification, and RNA interference. All three have been shown to be involved in the development of PAH. Currently, the enzymes that perform these modifications are the primary targets of neoplastic therapy. These targets are starting to be explored for therapies in PAH, mostly in animal models. In this review we summarize the basics of each type of epigenetic modification and the known sites and molecules involved in PAH, as well as current targets and prospects for clinical trials.
PubMed | Salt Lake City Veterans Affairs Medical Center
Type: Journal Article | Journal: BMC medical education | Year: 2017
We developed two objective structured clinical examinations (OSCEs) to educate and evaluate trainees in the evaluation and management of shoulder and knee pain. Our objective was to examine the evidence for validity of these OSCEs.A multidisciplinary team of content experts developed checklists of exam maneuvers and criteria to guide rater observations. Content was proposed by faculty, supplemented by literature review, and finalized using a Delphi process. One faculty simulated the patient, another rated examinee performance. Two faculty independently rated a portion of cases. Percent agreement was calculated and Cohens kappa corrected for chance agreement on binary outcomes. Examinees self-assessment was explored by written surveys. Responses were stratified into 3 categories and compared with similarly stratified OSCE scores using Pearsons coefficient.A multi-disciplinary cohort of 69 examinees participated. Examinees correctly identified rotator cuff and meniscal disease 88% and 89% of the time, respectively. Inter-rater agreement was moderate for the knee (87%; k=0.61) and near perfect for the shoulder (97%; k=0.88). No correlation between stratified self-assessment and OSCE scores were found for either shoulder (0.02) or knee (-0.07).Validity evidence supports the continuing use of these OSCEs in educational programs addressing the evaluation and management of shoulder and knee pain. Evidence for validity includes the systematic development of content, rigorous control of the response process, and demonstration of acceptable interrater agreement. Lack of correlation with self-assessment suggests that these OSCEs measure a construct different from learners self-confidence.