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Vander Velde N.,Southeast Louisiana Veterans Health Care System | Chen L.,Southeast Louisiana Veterans Health Care System | Guo A.,Southeast Louisiana Veterans Health Care System | Sharma H.,Southeast Louisiana Veterans Health Care System | And 5 more authors.
Journal of Oncology Practice | Year: 2013

Purpose: This study investigated the treatment patterns and outcomes for US veteran patients with chronic myeloid leukemia- chronic phase (CML-CP) initiated on imatinib (IM). Patients and Methods: Patients (age ≥18 years) with at least one CML diagnosis (International Classification of Diseases, Ninth Edition Clinical Modification: 205.1x) during the period January 1, 2000, to June 30, 2011, and initiated on IM as first-line therapy were identified in the VISN 16 data warehouse (N = 137). Accelerated and blastic phases (AP/BP) were identified on the basis of WHO classification using complete blood count (CBC) data. Rates of IM dose adjustment, discontinuation, and switching to another drug therapy were estimated. Time to discontinuation, progression to AP/ BP, and survival were assessed using Kaplan-Meier analysis (KM). Results: During follow-up, 19.0% of patients had at least one dose increase; of these, 19.2% switched to another therapy. Dose reductions occurred in 25.6% of patients. Among patients who discontinued IM (n=74; 54.0%), whereas 16.2% switched to other therapies, 27.0% neither restarted IM nor switched to other therapies. KM showed that 25.6% and 42.4% of patients discontinued IM treatment by year 1 and 2, and 8.1% and 16.0% demonstrated disease progression by year 1 and 2, respectively. Among patients who experienced disease progression (n = 28), 32.1% continued IM postprogression, 32.1% discontinued IM before progression, 28.6% discontinued IM postprogression without switching, and 7.1% switched to other therapies postprogression. The mortality rates were 3.0% and 9.5% after IM initiation, and 21.7% and 42.7% after disease progression by year 1 and 2, respectively. Conclusion: In this veteran population, a substantial number of IM-treated patients, including those with disease progression, either discontinued or interrupted IM use without switching to other therapies. Copyright © 2013 by American Society of Clinical Oncology.

Trautner B.W.,Baylor College of Medicine | Trautner B.W.,Center for Innovations in Quality | Petersen N.J.,Center for Innovations in Quality | Petersen N.J.,Baylor College of Medicine | And 8 more authors.
American Journal of Infection Control | Year: 2014

Background Inappropriate use of antibiotics to treat asymptomatic bacteriuria (ASB) is a significant contributor to antibiotic overuse in hospitalized patients despite evidence-based guidelines on ASB management. We surveyed whether accurate knowledge of how to manage catheter-associated urine cultures was associated with level of training, familiarity with ASB guidelines, and various cognitive-behavioral constructs. Methods We used a survey to measure respondents' knowledge of how to manage catheter-associated bacteriuria, familiarity with the content of the relevant Infectious Diseases Society of America guidelines, and cognitive-behavioral constructs. The survey was administered to 169 residents and staff providers. Results The mean knowledge score was 57.5%, or slightly over one-half of the questions answered correctly. The overall knowledge score improved significantly with level of training (P <.0001). Only 42% of respondents reported greater than minimal recall of ASB guideline contents. Self-efficacy, behavior, risk perceptions, social norms, and guideline familiarity were individually correlated with knowledge score (P <.01). In multivariable analysis, behavior, risk perception, and year of training were correlated with knowledge score (P <.05). Conclusions Knowledge of how to manage catheter-associated bacteriuria according to evidence-based guidelines increases with experience. Addressing both knowledge gaps and relevant cognitive biases early in training may decrease the inappropriate use of antibiotics to treat ASB. Copyright © 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Halade G.V.,University of Texas Health Science Center at San Antonio | Rahman Md.M.,University of Texas Health Science Center at San Antonio | Bhattacharya A.,University of Texas Health Science Center at San Antonio | Barnes J.L.,University of Texas Health Science Center at San Antonio | And 3 more authors.
Journal of Immunology | Year: 2010

The therapeutic efficacy of individual components of fish oils (FOs) in various human inflammatory diseases still remains unresolved, possibly due to low levels of n-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) or lower ratio of DHA to EPA. Because FO enriched with DHA (FO-DHA) or EPA (FO-EPA) has become available recently, we investigated their efficacy on survival and inflammatory kidney disease in a well-established animal model of human systemic lupus erythematosus. Results show for the first time that FO-DHA dramatically extends both the median (658 d) and maximal (848 d) life span of (NZB x NZW)F1 (B x W) mice. In contrast, FO-EPA fed mice had a median and maximal life span of ∼384 and 500 d, respectively. Investigations into possible survival mechanisms revealed that FO-DHA (versus FO-EPA) lowers serum anti-dsDNA Abs, IgG deposition in kidneys, and proteinuria. Further, FO-DHA lowered LPS-mediated increases in serum IL-18 levels and caspase-1-dependent cleavage of pro-IL-18 to mature IL-18 in kidneys. Moreover, FO-DHA suppressed LPS-mediated PI3K, Akt, and NF-κB activations in kidney. These data indicate that DHA, but not EPA, is the most potent n-3 fatty acid that suppresses glomerulonephritis and extends life span of systemic lupus erythematosus-prone short-lived B 3 W mice, possibly via inhibition of IL-18 induction and IL-18-dependent signaling.

Nakhoul N.L.,Tulane University | Abdulnour-Nakhoul S.M.,Tulane University | Schmidt E.,Tulane University | Doetjes R.,Tulane University | And 2 more authors.
American Journal of Physiology - Cell Physiology | Year: 2010

Rhbg is a membrane glycoprotein that is involved in NH3/NH 4 + transport. Several models have been proposed to describe Rhbg, including an electroneutral NH4 +/H + exchanger, a uniporter, an NH4 + channel, or even a gas channel. In this study, we characterized the pH sensitivity of Rhbg expressed in Xenopus oocytes. We used two-electrode voltage clamp and ion-selective microelectrodes to measure NH4 +-induced [and methyl ammonium (MA+)] currents and changes in intracellular pH (pHi), respectively. In oocytes expressing Rhbg, 5 mM NH 4Cl (NH3/NH4 +) at extracellular pH (pHo) of 7.5 induced an inward current, decreased pHi, and depolarized the cell. Raising pHo to 8.2 significantly enhanced the NH4 +-induced current and pHi changes, whereas decreasing bath pH to 6.5 inhibited these changes. Lowering pHi (decreased by butyrate) also inhibited the NH4 +-induced current and pHi decrease. In oocytes expressing Rhbg, 5 mM methyl amine hydrochloride (MA/MA+), often used as an NH4Cl substitute, induced an inward current, a pHi increase (not a decrease), and depolarization of the cell. Exposing the oocyte to MA/MA + at alkaline bath pH (8.2) enhanced the MA+-induced current, whereas lowering bath pH to 6.5 inhibited the MA+ current completely. Exposing the oocyte to MA/MA+ at low pHi abolished the MA+-induced current and depolarization; however, pHi still increased. These data indicate that 1) transport of NH4 + and MA/MA+ by Rhbg is pH sensitive; 2) electrogenic NH 4 + and MA+ transport are stimulated by alkaline pHo but inhibited by acidic pHi or pHo; and 3) electroneutral transport of MA by Rhbg is likely but is less sensitive to pH changes.

Kachroo S.,Bristol Myers Squibb | Kawabata H.,Bristol Myers Squibb | Colilla S.,Bristol Myers Squibb | Shi L.,Tulane University | And 5 more authors.
Journal of Managed Care Pharmacy | Year: 2015

BACKGROUND: Hypoglycemia is a major barrier to achieving optimal glycemic control and managing diabetes successfully in patients with diabetes. Falls are the most significant consequences caused by hypoglycemia episodes. Both hypoglycemia and falls lead to substantial economic burden on the health care system in the United States. OBJECTIVE: To examine the association of hypoglycemia with fall-related outcomes in elderly patients with type 2 diabetes mellitus (T2DM). METHODS: Records were obtained for T2DM patients (N = 1,147,937) from January 1, 2008, to December 31, 2011. The nonhypoglycemia patients were randomly matched 1:1 by age and gender to the hypoglycemia patients. Fall-related events (composite of fall-related outcomes) were defined using ICD-9-CM codes. Conditional logistic regression models were used to compare the fall-related events within 30 days, 90 days, 180 days, and 365 days between the 2 cohorts. RESULTS: A total of 21,613 hypoglycemia patients were matched with 21,613 nonhypoglycemic patients. Patients with hypoglycemia had higher fall-related events within 30 days, 90 days, 180 days, and 365 days (P < 0.001 for all frequency differences). Conditional logistic regression analyses showed an elevated risk for fall-related events over 365 days (aOR = 1.95, 95% CI = 1.70-2.24). Subgroup analysis showed elevated risk for patients aged < 75 years and ≥ 75 years. Elevated risks were also seen for individual fall-related outcomes of fractures, head injuries, long-term care placement, and hospital admissions. CONCLUSIONS: The risk of fall-related events over 365 days increased 2-fold among elderly patients with diabetes who experienced hypoglycemia. © 2015, Academy of Managed Care Pharmacy.

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