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Dispennette R.,Charleston Area Medical Center | Elliott D.,West Virginia University | Nguyen L.,Veterans Affairs North Texas Health Care System | Richmond R.,Charleston Area Medical Center General Division
Consultant Pharmacist | Year: 2014

Objective: Determine the association between different measures of drug exposure such as an increased Drug Burden Index (DBI) and a higher Anticholinergic Risk Scale (ARS) score in vulnerable elders and risk of readmission to the hospital. Design: The study is a retrospective cohort comparing ARS and DBI between patients readmitted and not readmitted to the hospital within 30 days of initial admission. Data collected included drugs considered to have anticholinergic, sedative, or both types of properties (Appendix 1), medication strengths, doses per day, patient age, Vulnerable Elders Survey (VES-13) score upon admission, patient diagnoses, and rates of admission. Setting: Nonprofit, 838-bed, regional health system of four hospitals. Patients, Participants: Patients were included in the study if they were admitted to a hospital floor, were 65 years of age or older, were assessed using VES-13, and did not have routinely visiting family to engage them as observed by floor nurses. Interventions: None; retrospective study. Main Outcome Measures: Readmission rate. Results: The mean difference in DBI and ARS scores were higher in the readmitted group. Hydrocodone and hydroxyzine were the most commonly used drugs in the readmitted group that were considered when determining DBI. Conclusion: There is a role for screening and clinical intervention in vulnerable elders using DBI and ARS to help identify those at greatest risk for readmission to the hospital. © 2014 American Society of Consultant Pharmacists, Inc. Source

Jain N.,University of Texas Southwestern Medical Center | Reilly R.F.,Veterans Affairs North Texas Health Care System
Nature Reviews Nephrology | Year: 2014

Traditional strategies for management of patients with chronic kidney disease (CKD) have not resulted in any change in the growing prevalence of CKD worldwide. A historic belief that eating healthily might ameliorate kidney disease still holds credibility in the 21 st century. Dietary sodium restriction to <2.3 g daily, a diet rich in fruits and vegetables and increased water consumption corresponding to a urine output of 3-4 l daily might slow the progression of early CKD, polycystic kidney disease or recurrent kidney stones. Current evidence suggests that a reduction in dietary net acid load could be beneficial in patients with CKD, but the supremacy of any particular diet has yet to be established. More trials of dietary interventions are needed, especially in diabetic nephropathy, before evidence-based recommendations can be made. In the meantime, nephrologists should discuss healthy dietary habits with their patients and provide individualized care aimed at maximizing the potential benefits of dietary intervention, reducing the incidence of CKD and delaying its progression to end-stage renal disease. Keeping in mind the lack of data on hard outcomes, dietary recommendations should take into account barriers to adherence and be tailored to different cultures, ethnicities and geographical locations. © 2014 Macmillan Publishers Limited. All rights reserved. Source

Genta R.M.,Miraca Life science Research Institute | Genta R.M.,University of Texas Southwestern Medical Center | Feagins L.A.,Veterans Affairs North Texas Health Care System | Feagins L.A.,University of Texas Southwestern Medical Center
Best Practice and Research: Clinical Gastroenterology | Year: 2013

The small intestine has comparatively low rates of epithelial cancers and is, for the most part, inaccessible to ordinary endoscopic visualization. As a result, few solid data are available on the pathological, clinical, and therapeutic aspects of epithelial dysplasia in the small intestine. In this review, we discuss the duodenal adenoma, the most readily visualized dysplastic lesion of the small intestine and the only one that can be detected in an early phase and resected endoscopically before it progresses to high-grade or invasive carcinoma. Particular emphasis is placed on the relationship between duodenal adenoma and colon neoplasia. Because of their different behaviour, detection and management of ampullary adenomas is discussed separately. Even if the absolute risk remains small, the incidence of adenocarcinoma in the small bowel is increased 32-fold in patients with ileal Crohn's disease. Therefore, the follow up and management of these patients is discussed with particular emphasis on the occurrence of dysplasia in the small bowel mucosa of the post-restorative proctocolectomy patients. © 2013 Elsevier Ltd. All rights reserved. Source

Lwin T.,Caris Research Institute | Melton S.D.,Veterans Affairs North Texas Health Care System | Melton S.D.,University of Texas Southwestern Medical Center | Genta R.M.,Caris Research Institute | Genta R.M.,University of Texas Southwestern Medical Center
Modern Pathology | Year: 2011

There is limited information about normal eosinophil counts in the gastric mucosa. The purpose of this study was to evaluate the histopathology of 60 patients whose biopsies showed increased eosinophils in the gastric mucosa. We also investigated the eosinophil content in gastric biopsies from normal controls (matched for age, sex, and zip code), from patients with Helicobacter pylori gastritis, and patients with Crohn's disease. Eosinophils were counted in five random high-power fields (HPFs) and reported in eosinophils/mm 2. Involvement of the muscularis mucosae or submucosa, sheets of eosinophils, and infiltration of the gastric epithelium were also evaluated. The median eosinophil count in the study patients was 539 eosinophils/mm 2; mean±SD=653±418 eosinophils/mm2; range 127-2108. Sheets of eosinophils were seen in 38 patients, 27 showed involvement of the muscularis mucosae or submucosa. There were 7 patients without epithelial infiltration by eosinophils, whereas 34 were tallied as rare and 19 were scored as abundant. No study patient had no evidence of H. pylori. The mean eosinophil count for the 135 normal controls was 15.5±16.8 SD eosinophils/mm 2 (range 0-110); in the 93 controls with H. pylori gastritis the mean eosinophil count was 25±32.6 SD eosinophils/mm2 (range 0-219); and for the 53 controls with Crohn's disease it was 31.4±44.4 SD eosinophils/mm2 (range 0-203). There were no significant differences between the counts in biopsies from the antrum and corpus, and no significant variations by age, geographic location, or season. This study confirms that, in the United States population, the normal gastric eosinophilic counts are usually <38 eosinophils/mm2. We recommend histological eosinophilic gastritis for the diagnosis of gastric biopsies that show an average density ≥127 eosinophils/mm2 (or ≥30 eosinophils per HPF) in at least five HPFs in the absence of known associated causes of eosinophilia. © 2011 USCAP, Inc. All rights reserved. Source

Nishank J.,Veterans Affairs North Texas Health Care System | Nishank J.,University of Texas Southwestern Medical Center | Susan Hedayati S.,Veterans Affairs North Texas Health Care System | Susan Hedayati S.,University of Texas Southwestern Medical Center
Kidney International | Year: 2013

A new observational study in Canadian patients shows a U-shaped association between longitudinal change in estimated glomerular filtration rate over a 4-year period and all-cause mortality. This study confirms the findings of previous studies done in middle-aged Taiwanese patients, community-dwelling Medicare beneficiaries, and chronic kidney disease patients. Future studies are needed to confirm whether such simple objective risk assessment tools can identify subgroups of people at maximum risk for adverse events. © 2013 International Society of Nephrology. Source

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