Institution
Portland VA Medical Center
Healthcare•Portland, Oregon, United States•
About: Portland VA Medical Center is a healthcare organization based out in Portland, Oregon, United States. It is known for research contribution in the topics: Population & Veterans Affairs. The organization has 1326 authors who have published 1496 publications receiving 82754 citations.
Topics: Population, Veterans Affairs, Hearing loss, Experimental autoimmune encephalomyelitis, Health care
Papers published on a yearly basis
Papers
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TL;DR: The approach of GRADE to rating quality of evidence specifies four categories-high, moderate, low, and very low-that are applied to a body of evidence, not to individual studies.
5,228 citations
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TL;DR: Most current readmission risk prediction models that were designed for either comparative or clinical purposes perform poorly and although in certain settings such models may prove useful, efforts to improve their performance are needed as use becomes more widespread.
Abstract: Context Predicting hospital readmission risk is of great interest to identify which patients would benefit most from care transition interventions, as well as to risk-adjust readmission rates for the purposes of hospital comparison. Objective To summarize validated readmission risk prediction models, describe their performance, and assess suitability for clinical or administrative use. Data Sources and Study Selection The databases of MEDLINE, CINAHL, and the Cochrane Library were searched from inception through March 2011, the EMBASE database was searched through August 2011, and hand searches were performed of the retrieved reference lists. Dual review was conducted to identify studies published in the English language of prediction models tested with medical patients in both derivation and validation cohorts. Data Extraction Data were extracted on the population, setting, sample size, follow-up interval, readmission rate, model discrimination and calibration, type of data used, and timing of data collection. Data Synthesis Of 7843 citations reviewed, 30 studies of 26 unique models met the inclusion criteria. The most common outcome used was 30-day readmission; only 1 model specifically addressed preventable readmissions. Fourteen models that relied on retrospective administrative data could be potentially used to risk-adjust readmission rates for hospital comparison; of these, 9 were tested in large US populations and had poor discriminative ability (c statistic range: 0.55-0.65). Seven models could potentially be used to identify high-risk patients for intervention early during a hospitalization (c statistic range: 0.56-0.72), and 5 could be used at hospital discharge (c statistic range: 0.68-0.83). Six studies compared different models in the same population and 2 of these found that functional and social variables improved model discrimination. Although most models incorporated variables for medical comorbidity and use of prior medical services, few examined variables associated with overall health and function, illness severity, or social determinants of health. Conclusions Most current readmission risk prediction models that were designed for either comparative or clinical purposes perform poorly. Although in certain settings such models may prove useful, efforts to improve their performance are needed as use becomes more widespread.
1,593 citations
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TL;DR: Heterochronic parabiosis shows that blood-borne factors present in the systemic milieu can inhibit or promote adult neurogenesis in an age-dependent fashion in mice, and identifies chemokines—including CCL11 (also known as eotaxin)—the plasma levels of which correlate with reduced neuroGenesis in heterochronics parabionts and aged mice and which are increased in the plasma and cerebrospinal fluid of healthy ageing humans.
Abstract: In the central nervous system, ageing results in a precipitous decline in adult neural stem/progenitor cells and neurogenesis, with concomitant impairments in cognitive functions. Interestingly, such impairments can be ameliorated through systemic perturbations such as exercise. Here, using heterochronic parabiosis we show that blood-borne factors present in the systemic milieu can inhibit or promote adult neurogenesis in an age-dependent fashion in mice. Accordingly, exposing a young mouse to an old systemic environment or to plasma from old mice decreased synaptic plasticity, and impaired contextual fear conditioning and spatial learning and memory. We identify chemokines--including CCL11 (also known as eotaxin)--the plasma levels of which correlate with reduced neurogenesis in heterochronic parabionts and aged mice, and the levels of which are increased in the plasma and cerebrospinal fluid of healthy ageing humans. Lastly, increasing peripheral CCL11 chemokine levels in vivo in young mice decreased adult neurogenesis and impaired learning and memory. Together our data indicate that the decline in neurogenesis and cognitive impairments observed during ageing can be in part attributed to changes in blood-borne factors.
1,341 citations
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Veterans Health Administration1, Northwestern University2, University of Nebraska Omaha3, University of Pennsylvania4, University of California, San Francisco5, University of Michigan6, National Institutes of Health7, University of Kansas8, Oregon Health & Science University9, Portland VA Medical Center10, United States Department of Veterans Affairs11, Baylor College of Medicine12, Virginia Commonwealth University13, University of Iowa14
TL;DR: Deep brain stimulation was more effective than best medical therapy in improving on time without troubling dyskinesias, motor function, and quality of life at 6 months, but was associated with an increased risk of serious adverse events.
Abstract: Context Deep brain stimulation is an accepted treatment for advanced Parkinson disease (PD), although there are few randomized trials comparing treatments, and most studies exclude older patients. Objective To compare 6-month outcomes for patients with PD who received deep brain stimulation or best medical therapy. Design, Setting, and Patients Randomized controlled trial of patients who received either deep brain stimulation or best medical therapy, stratified by study site and patient age ( Intervention Bilateral deep brain stimulation of the subthalamic nucleus (n = 60) or globus pallidus (n = 61). Patients receiving best medical therapy (n = 134) were actively managed by movement disorder neurologists. Main Outcome Measures The primary outcome was time spent in the “on” state (good motor control with unimpeded motor function) without troubling dyskinesia, using motor diaries. Other outcomes included motor function, quality of life, neurocognitive function, and adverse events. Results Patients who received deep brain stimulation gained a mean of 4.6 h/d of on time without troubling dyskinesia compared with 0 h/d for patients who received best medical therapy (between group mean difference, 4.5 h/d [95% CI, 3.7-5.4 h/d]; P Conclusion In this randomized controlled trial of patients with advanced PD, deep brain stimulation was more effective than best medical therapy in improving on time without troubling dyskinesias, motor function, and quality of life at 6 months, but was associated with an increased risk of serious adverse events. Trial Registration clinicaltrials.gov Identifier: NCT00056563
1,218 citations
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Veterans Health Administration1, University of Nebraska Medical Center2, Loyola University Chicago3, University of California, San Francisco4, University of Michigan5, National Institutes of Health6, University of Kansas7, Portland VA Medical Center8, Oregon Health & Science University9, Baylor College of Medicine10, University of Pennsylvania11, University of California, Los Angeles12, University of Iowa13, United States Department of Veterans Affairs14
TL;DR: Patients with Parkinson's disease had similar improvement in motor function after either pallidal or subthalamic stimulation, and nonmotor factors may reasonably be included in the selection of surgical target for deep-brain stimulation.
Abstract: Background Deep-brain stimulation is the surgical procedure of choice for patients with advanced Parkinson's disease. The globus pallidus interna and the subthalamic nucleus are accepted targets for this procedure. We compared 24-month outcomes for patients who had undergone bilateral stimulation of the globus pallidus interna (pallidal stimulation) or subthalamic nucleus (subthalamic stimulation). Methods At seven Veterans Affairs and six university hospitals, we randomly assigned 299 patients with idiopathic Parkinson's disease to undergo either pallidal stimulation (152 patients) or subthalamic stimulation (147 patients). The primary outcome was the change in motor function, as blindly assessed on the Unified Parkinson's Disease Rating Scale, part III (UPDRS-III), while patients were receiving stimulation but not receiving antiparkinsonian medication. Secondary outcomes included self-reported function, quality of life, neurocognitive function, and adverse events. Results Mean changes in the primary out...
1,158 citations
Authors
Showing all 1330 results
Name | H-index | Papers | Citations |
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Dennis C. Turk | 116 | 503 | 53456 |
Michael Heinrich | 115 | 829 | 62505 |
Eric S. Orwoll | 105 | 530 | 37891 |
Fay B. Horak | 95 | 398 | 37171 |
Jeffrey Kaye | 91 | 425 | 38849 |
John G. Nutt | 90 | 333 | 27431 |
Michael R. McClung | 86 | 286 | 28679 |
Jeffrey S. Mogil | 85 | 251 | 27060 |
Susan L. Swain | 84 | 332 | 27152 |
Roger Chou | 81 | 388 | 38851 |
John C. Crabbe | 78 | 360 | 23777 |
Joseph F. Quinn | 78 | 302 | 25218 |
Edward A. Neuwelt | 75 | 341 | 20219 |
Olivier Civelli | 73 | 262 | 24576 |
Susan D. Block | 71 | 236 | 20998 |