Showing papers by "Texas Medical Center published in 2007"

Healthcare Outcomes Associated with Beers' Criteria: A Systematic Review

Abstract: Objective:To examine healthcare outcomes associated with Beers' criteria of inappropriate medication use based on a literature review.Data Sources:A search of MEDLINE, International Pharmaceutical Abstracts, and Cumulative Index to Nursing and Allied Health Literature was conducted to identify articles published from October 1991 to October 2006. The following key words were used: Beers, inappropriate, medication, drug, use, prescribing, and elderly. A manual search was also conducted using the references listed in the articles identified through the database search.Study Selection And Data Extraction:Studies that examined the impact or outcomes of Beers' criteria of inappropriate medication use (1991, 1997, and 2003 critera) were selected. Each article was examined for study setting, data source, study sample, study design, criteria, analysis and covariates, type of healthcare outcome, and study findings. Of 235 articles retrieved, 18 presented studies that examined healthcare outcomes associated with in...

Milk-derived proteins and peptides of potential therapeutic and nutritive value

Abstract: Milk and colostrum are rich in proteins and peptides which play a crucial role in development of the immune system in mammalian offspring. Immunotropic properties of these compounds prompted investigators to search for their utility in prevention and therapy of various disorders in humans. The following constituents of milk are of particular interest: 1) Lactoferrin (LF)--exhibits antibacterial, antifungal, antiviral, antiparasite and antitumor activities. It is protective with regard to intestinal epithelium, promotes bone growth and accelerates recovery of the immune system function in immunocompromised animal; 2) A Proline-Rich Polypeptide (PRP) shows a variety of immunotropic functions, including promotion of T-cell maturation and inhibition'of autoimmune disorders. PRP was recently found to improve or stabilize the Instrumental Activity of Daily Living status in Alzheimer's disease patients. 3) Casein--has been protective in experimental bacteremia by eliciting myelopoiesis. Casein hydrolyzates were also protective in diabetic animals, reduced the tumor growth and diminished colicky symptoms in infants. Casein-derived peptides have been found to have antihypertensive effects. Glycomacropeptide (GMP)--a peptide derived from kappa casein, exhibits antibacterial and antithrombotic activities. 4) Alpha lactalbumin (LA)--demonstrates antiviral, antitumor and anti-stress properties. LA-enriched diets were anxiolytic, lowered blood pressure in rats, prevented diarrhea and led to a better weight gain in malnourished children. 5) Lysozyme--is effective in treatment of periodentitis and prevention of tooth decay. Milk enriched in lysozyme was used in feeding premature infants suffering from concomitant diseases. 6) Lactoperoxidase--shows antibacterial properties. In conclusion, milk-derived proteins and peptides are bio-accessible and safe for the prevention and treatment of numerous disorders in humans.

Postgenomic Adventures with Rhodobacter sphaeroides

Abstract: This review describes some of the recent highlights taken from the studies of Rhodobacter sphaeroides 2.4.1. The review is not intended to be comprehensive, but to reflect the bias of the authors as to how the availability of a sequenced and annotated genome, a gene-chip, and proteomic profile as well as comparative genomic analyses can direct the progress of future research in this system.

Clinically important potential drug-drug interactions in outpatient settings

Abstract: Background Although many potential drug-drug interactions (DDIs) are discussed in the clinical literature, only limited numbers of these are clinically important. Little is known about prescribing of agents involved in these clinically important DDIs at the national level. Objective This study examined concomitant prescribing of drug combinations that have potential for clinically important DDIs in outpatient settings in the United States. Methods The 2000-2002 National Ambulatory Medical Care Survey and the outpatient department portion of the 2000-2002 National Hospital Ambulatory Medical Care Survey were used to examine 25 clinically important DDIs that are most likely to harm patients if not detected. Descriptive statistics were used to characterize clinically important DDIs, whereas logistic regression analysis was applied to outpatient visits to examine patients at risk for clinically important DDIs. Results An estimated 0.63% (95% confidence interval, 0.51-0.75) of outpatient visits involving 2 or more medications resulted in prescription combinations with potential for clinically important DDIs for an annual visit estimate of 2.26 million, or annual visit rate of 8.12 visits per 1000 persons. Fourteen of the 25 prescription combinations with potential for clinically important DDIs were prescribed in outpatient settings, with warfarin accounting for many of the visits that yielded the prescribing of interacting medications. A majority (82%) of the prescriptions for potentially interacting medications occurred in visits involving 5 or more medications. The study found that patients over 44 years of age, especially elderly, Medicare beneficiaries, and those prescribed multiple medications are at risk for receiving prescription combinations with potential for a clinically important DDI. Conclusions Although a small percentage of outpatient visits resulted in prescription combinations with potential for clinically important DDIs, these interactions can have significant implications due to medication-related morbidity and mortality. Pharmacists can play a critical role in managing the medication therapy of patients at risk for clinically important DDIs. Further research is needed to evaluate the economic, clinical, and humanistic outcomes of clinically important DDIs, especially among those at risk.

Female genital mutilation: Potential for HIV transmission in sub-Saharan Africa and prospect for epidemiologic investigation and intervention.

Abstract: Female Genital Mutilation (FGM) which involves alteration of the female genitalia for non-medical grounds is prevalent in Sub-Saharan Africa, associated with long-term genitourinary complications, and possible HIV transmission. This mini-review aims to examine FGM and the possibility of HIV transmission through this procedure. We performed an electronic search using Medline for articles published between 1966 to 2006 for evidence of FGM practice, its complications, and the nexus between this procedure and HIV sero-positivity. The results indicate ongoing FGM practice, albeit prevalence reduction, due probably to the increasing knowledge of the consequences of FGM as a result of non-sterile techniques. Secondly, the complications of FGM are well established which include Genitourinary disorders. Further, while data is limited on HIV transmission via FGM, there is biologic plausibility in suggesting that FGM may be associated with increasing prevalence of HIV in sub-Saharan Africa. This paper recommends further studies in order to assess the association between FGM and HIV transmission.

Intra-arterial therapies for acute ischemic stroke.

Abstract: Background: There are no randomized trials comparing intra-arterial (IA) therapy with best medical treatment for acute ischemic stroke. To assess potential benefit from this therapeutic approach, we performed a systematic review of published IA series. Because outcome from stroke is highly dependent on baseline characteristics, we compared results against prognostic models adjusted for admission National Institute of Health Stroke Scale (NIHSS) scores and age. Methods: We selected articles from MEDLINE and Cochrane Databases based on specified criteria that included 3-month clinical follow-up. Outcome functions from prognostic models were generated and difference from prediction calculated for each study. Best and worst mortality performers were identified and assessed for factors that distinguished them. Results: We identified 27 reports with 30 treatment series representing 1,117 patients. Percent difference from predicted outcomes varied from −51 to +24.6% for mortality and −30.3 to +28.7% for good functional outcome. A mean overall difference in the percent that died compared with prediction was 0.25% (SD: ±3.5%; 95% CI: ±0.53) and in the percentage of those that achieved a good functional outcome compared with prediction was −0.15% (SD: ±2.7%; 95% CI: ±0.44). The quartile of better mortality performers relative to worst performers had a 4.8-point more severe NIHSS score at baseline ( p = 0.028) and employed 50% lower doses of the most frequently used thrombolytic urokinase ( p = 0.0034). Conclusion: We found considerable variability and lack of evidence for a net improvement in outcome after intra-arterial therapy relative to predicted natural history, substantiating the need for a prospective comparison with best medical therapy. The features associated with better performers identified here may be useful in designing such a trial.

UFuRT: A Work ⴀ Centered Framework and Process for Design and Evaluation of Information Systems

Abstract: A current and significant challenge in the design and implementation of information systems (IS) is to deal with the high failure rate of IS projects. A large number of IS projects fail. Most of these failures are not due to flawed technology, but rather due to the lack of systematic considerations of human and other non-technology issues in the design and implementation processes. In other words, designing and implementing IS is not so much an IT project as a human project about human-centered computing such as human-computer interaction, workflow, organizational change, and process reengineering. To address the high failure rate, we need a process that would increase efficiency and productivity, increase ease of use and ease of learning, increase user adoption, retention, and satisfaction, and decrease human errors, decrease development time and cost, and decrease support and training cost. In this paper we present a work-centered process called UFuRT for the design and evaluation of information systems.

Hypothalamic progesterone receptor-A mediates gonadotropin surges, self priming and receptivity in estrogen-primed female mice.

Abstract: Ovarian progesterone (Prog) is an essential steroid hormone for the secretion of GnRH and reproductive behavior. It exerts primary effects through the progesterone receptor (PR). When analyzed separately in vitro, PR isoforms (PR-A, PR-B) display striking differences in transcriptional activity. The present study was undertaken to determine the in vivo impact of each isoform on hypothalamic function in female mice with ablation of a single isoform, either PR-A or PR-B. To this end, we used single-cell RNA analyses, reverse transcriptase real-time (q)PCR mRNA analyses of punched-out tissue, immunohistochemistry, and reproductive behavior. We provide evidence for the requirement of PR-A in individual ventrolateral ventromedial nucleus (vlVMN) neurons for Prog-facilitated proceptive and receptive behaviors in estrogen benzoate (EB)-primed females and the reciprocal male interactions. We clarify histological and molecular mechanisms of PR isoform activity by showing that (1) PR-A is predominant in individual vlVMN neurons controlling female lordosis circuitry, whilst (2) PR-B is predominant in those VMN subdivisions that provide for amplification of PR-A activity. We go on to demonstrate that PR-A is dominant in the anteroventral periventricular nucleus but not the arcuate nucleus that feed fibers into and around the VMN. In the medial preoptic area, high levels of GnRH RNA in EB-primed PR-A-expressing mice were seen coincident with increased plasma LH levels. Two consecutive GnRH pulses enhanced LH only in primed PR-A-expressing females. In all, the findings are consistent with the hypothesis that hypothalamic PR-A-mediated genomic activities result in reproductive behavior coordinated with ovulation.

Silent myocardial ischemia: Current perspectives and future directions.

Abstract: Silent myocardial ischemia (SMI) is increasingly being recognized as part of the spectrum of ischemic heart disease. The spectrum of SMI ranges from asymptomatic coronary artery disease to critical illness necessitating intensive care. Although many diagnostic tools have been used to identify low- and high-risk subgroups, their use is limited by modest sensitivities and specificities. The present review identifies current concepts in the management of SMI in various clinical settings, as well as emerging technologies that may simplify the diagnosis and treatment of this condition.

Outcomes of decompression for lumbar spinal canal stenosis based upon preoperative radiographic severity

Abstract: Background The relationship between severity of preoperative radiographic findings and surgical outcomes following decompression for lumbar degenerative spinal canal stenosis is unclear. Our aim in this paper was to gain insight into this relationship. We determined pre-operative radiographic severity on MRI scans using strict methodological controls and correlated such severity with post-operative outcomes using prospectively collected data.

Association of Spirituality and Sobriety During a Behavioral Spirituality Intervention for Twelve Step (TS) Recovery

Abstract: Twelve-Step (TS) recovery utilizes spirituality to promote sobriety, yet there are no proven programs designed to facilitate spiritual involvement. We developed a seven-week behavioral spirituality intervention titled "Knowing Your Higher Power" for implementation along with usual TS care. Twenty-six participants from a recovery center enrolled. We assessed behavior at baseline, 7-week, and 12-week follow-up. The sample showed significant increase in spiritual involvement and beliefs over the 12-week measurement period and a significantly greater spirituality score in those maintaining total sobriety compared to those that relapsed. These findings encourage a controlled trial to determine if this work has efficacy for practitioners in substance abuse treatment.

Is Functional Decline Necessary for a Diagnosis of Alzheimer’s Disease?

Abstract: Background: The purpose of this study is to examine baseline differences and annualized cognitive and functional change scores in mild Alzheimer’s disease (AD) patients with and wit

Intravital imaging of fluorescent markers and FRET probes by DNA tattooing

Abstract: Advances in fluorescence microscopy and mouse transgenesis have made it possible to image molecular events in living animals. However, the generation of transgenic mice is a lengthy process and intravital imaging requires specialized knowledge and equipment. Here, we report a rapid and undemanding intravital imaging method using generally available equipment. By DNA tattooing we transfect keratinocytes of living mice with DNA encoding fluorescent biosensors. Subsequently, the behavior of individual cells expressing these biosensors can be visualized within hours and using conventional microscopy equipment. Using this "instant transgenic" model in combination with a corrected coordinate system, we followed the in vivo behavior of individual cells expressing either FRET- or location-based biosensors for several days. The utility of this approach was demonstrated by assessment of in vivo caspase-3 activation upon induction of apoptosis. This "instant skin transgenic" model can be used to follow the in vivo behavior of individual cells expressing either FRET- or location-based probes for several days after tattooing and provides a rapid and inexpensive method for intravital imaging in murine skin.

Genomic Comparisons of Humans and Chimpanzees

Abstract: The genome consists of the entire DNA present in the nucleus of the fertilized embryo, which is then duplicated in every cell in the body. A draft sequence of the chimpanzee genome is now available, providing opportunities to better understand genetic contributions to human evolution, development, and disease. Sequence differences from the human genome were confirmed to be ∼1% in areas that can be precisely aligned, representing ∼35 million single base-pair differences. Some 45 million nucleotides of insertions and deletions unique to each lineage were also discovered, making the actual difference between the two genomes ∼4%. We discuss the opportunities and challenges that arise from this information and the need for comparison with additional species, as well as population genetic studies. Finally, we present a few examples of interesting findings resulting from genome-wide analyses, candidate gene studies, and combined approaches, emphasizing the pros and cons of each approach.

Photopolymerized Sol‐Gel Monolithic Column for Capillary Electrochromatography (CEC) and CEC Coupled to Atmospheric Pressure Photoionization Mass Spectrometry

Abstract: A sol‐gel photopolymerization procedure was adopted to prepare the monolith in a 100 µm I.D. UV‐transparent capillary using methacryloxy‐propyltrimethoxysilane as the monomer. The chromatographic behavior of the column is evaluated with two mixtures of neutral compounds, namely 16 polycyclic aromatic hydrocarbons (PAH), and 11 alkyl phenyl ketones. The feasibility of applying this column for the CEC‐APPI‐MS separation and detection of these compounds was investigated.

Constitutively active FOXO1a and a DNA-binding domain mutant exhibit distinct co-regulatory functions to enhance progesterone receptor A activity

Abstract: FOXO (Forkhead box O1 transcription factors) factors interact with and modify the activity of other transcription factors, including nuclear hormone receptors. However, not all of the structural domains within the FOXO proteins that mediate these functional interactions have been clearly defined. To address this issue, we used a constitutively active (nuclear) mutant of FOXO1a (designated FOXOA3) and within FOXOA3 made additional mutations to alter the putative nuclear hormone interacting domain (NID), minimal activation domain (MAD), DNA-binding domain (DBD), and the N terminus. We document that FOXOA3 enhanced the hormone-dependent transcriptional activity of liganded progesterone receptors A (PGRA) on a glucocorticoid response element-responsive promoter, PGRA on the insulin-like growth factor-binding protein 1 promoter, and estrogen receptor alpha on an estrogen response element-responsive promoter. The effects of FOXOA3 on PGRA were dependent, in part, on an intact NID, the MAD, and N-terminal domain. In striking contrast, a FOXOA3 DNA-binding mutant (FOXOA3-mDBD) modulated PGRA, PGRB, and ESR1 activities by distinctly different mechanisms, markedly elevating ligand-independent activity of these nuclear hormone receptors even in the double mutant lacking the MAD. Furthermore, both FOXOA3 and FOXOA3-mDBD enhanced the activity of a transcriptionally defective PGRA lacking its AF1 transactivation domain, indicating that this region of the receptor is not essential in this context. Since FOXOA3, FOXOA3-mDBD, and FOXOA3-mNID all bound PGRA in a GST pull-down assay, it appears that the LXXLL (leucine-X-X-leucine-leucine) motif within the NID is not critical for FOXOA3 interactions with PGRA, but may modify the recruitment of other co-regulatory molecules. Collectively, the results show that FOXOA3 exerts co-regulatory functions independent of DNA binding and that the DNA-binding defective form of FOXO1a is transcriptionally active as a co-regulator of these nuclear hormone receptors.

Glucose-sensing pulmonary delivery of human insulin to the systemic circulation of rats.

Abstract: In an attempt to achieve post-inhalation self-regulated insulin release, we constructed a microparticle agglomerate of nano-sized liposomal particles, with the agglomeration facilitated by cross-linkages capable of cleavage by glucose. The particles exhibited a small aerodynamic diameter within the human respirable range, but a large geometric diameter that prevents macrophage uptake and clearance. Upon intratracheal instillation of the “glucose-sensitive” microparticle into the lungs of rats, hyperglycemic events triggered an acceleration of the release of insulin achieving normoglycemia shortly after “sensing” the elevated systemic glucose. This work is a demonstration of an inhalable particle with long residence times in the lungs capable of modulating insulin release based on systemic glucose levels.

Poorly differentiated carcinoma arising in a Warthin's tumor of the parotid gland: pathogenesis, histopathology, and surgical management of malignant Warthin's tumors.

Abstract: Warthin's tumor is a benign lymphoepithelial neoplasm representing 10 per cent of all parotid gland tumors. Malignant transformation of a Warthin's tumor is an extremely rare event. We report a case of a patient with poorly differentiated carcinoma arising from a Warthin's tumor, as well as review the pathogenesis, histopathology, and surgical management of malignant Warthin's tumors.

Pituitary tumors: diagnosis, management, and implications for reproduction.

Abstract: Pituitary tumors are the most common intracranial neoplasms. They are commonly encountered by the gynecologist during an evaluation for galactorrhea, menstrual disturbances, or infertility. Although the majority of these tumors are benign, their impact on the endocrine and nervous system can be striking. The availability of neuroimaging techniques has allowed for more rapid diagnosis, affording earlier treatment. This review is intended to describe the common pituitary tumors seen by the gynecologist, and their impact on reproduction and fertility in the female patient.

Herding cats: Designing DigitalCommons @ The Texas Medical Center, a multi‐institutional repository

Abstract: Purpose – The purpose of this paper is to examine a pilot program implemented by the Houston Academy of Medicine‐Texas Medical Center Library and The University of Texas School of Nursing at Houston to design the multi‐institutional repository for the Texas Medical Center. Design/methodology/approach – The steps involved in the program are outlined and the lessons learned from the implementation are analyzed. Findings – The success of the institutional repository depends on appropriate communication with faculty, a deep understanding of the publishing process, identifying appropriate partners, designing a flexible technology infrastructure, and engaging in active collaboration with key players. The Library is the logical center for this activity. Practical implications – The paper should assist libraries with the unique activities involved in creating a viable multi‐institutional repository in a research‐intense academic medical environment. Originality/value – This paper analyzes the challenges inherent in introducing institutional digital repositories to the academic medical community. Currently, institutional repositories are being developed in only a small percentage of the academic medical centers in the USA.

Association of occupation and safety practices with work-injury absence among public hospital employees in Latin America: a study from Costa Rica

Abstract: Background: Injury-related statistics in developing countries are rare. Objective: To assess the relationship between occupational and safety-related risk factors and absences from work during the preceding 6 months due to work-related injury among public hospital employees in Costa Rica. Methods: Data were used from a cross-sectional survey conducted in December 2000 among a stratified random sample of 1000 employees from 10 of the 29 public hospitals in Costa Rica. The questionnaire included sociodemographic data, occupational exposures, and organizational risk factors. A dichotomous variable was created to indicate work-injury absence. At-risk employees (n = 466) were classified as having had a work-injury absence if they reported having been absent for at least 1 day in the preceding 6 months because of a work-related injury. OR and 95% CI were calculated using unconditional logistic regression models. Results: There is a greater likelihood of injury-related absence in non-professional occupational positions (ie, auxiliary personnel (OR = 2.29) and general services employees (OR = 5.55)) than in professional positions, and in employees who show poor compliance with safety practices (OR = 2.03) and have high interference from their job task (OR = 3.79) compared with their counterparts. Conclusions: Work-injury absence appears not only to be a function of work injury, but also a function of occupation and degree of compliance with safety practices.

Pharmacotherapy with atomoxetine for US children and adolescents.

Abstract: Background. Atomoxetine, a non-stimulant medication, was approved for treatment of Attention Deficit/ Hyperactivity Disorder (ADHD) in 2002. However, there is a paucity of recent practice-based national data on the use of atomoxetine. This article compares the use of atomoxetine with that of stimulant medications in outpatient treatment of U.S. children and adolescents, and examines the predictors of atomoxetine use in this population.Methods. The 2003–2004 National Ambulatory Medical Care Survey and the outpatient department portion of the 2003–2004 National Hospital Ambulatory Medical Care Survey were used to determine the utilization of atomoxetine and stimulants in youth < 20 years. Bivariate analyses were used to examine the use of atomoxetine relative to that of stimulant medications in children and adolescents (n = 1,133). Multiple logistic regression analysis was applied to visits involving youths with ADHD to examine predictors of atomoxetine use (n = 1,361).Results. An estimated 14.51 million vi...

The prevalence of food insecurity and associated factors among households with children in Head Start programs in Houston, Texas and Birmingham, Alabama

Abstract: This study measured food security and hunger of households enrolled in Head Start in Houston, Texas, and Birmingham, Alabama and assessed factors that could affect food security. Interviewers collected data from primary caregivers on demographic characteristics, dietary intake, and the six-item US food security module. The prevalence of food insecurity of 688 households with Head Start children was 34.9%, or twice that of the national average among households with children in 2004 (17.6%). Moreover, the prevalence of food insecurity for households of White children (34.1%) and of Hispanic children

Reconstruction of oncologic defects of the eyelid, lips and ear

Abstract: Non melanomatous skin cancers constitute a major part of the cancers that occur in the face, especially in the darker skinned people. Surgical excision stays as the main modality of treatment in these giving very good cure rates. The major drawback of surgery is the resultant functional and esthetic deformity, which has been considerably reduced with proper application of reconstructive surgery principles. In order to achieve good outcome attention has to be given to understand the anatomy as well as tissue requirement at specific areas of the face. There is a great variation in the reconstructive methods in the different sites. This article reviews briefly the anatomy and methods of reconstruction available for the post cancer excisions involving the lips, eyelids and the auricle.

Pharmacogenomics in Drug Discovery and Development

Abstract: Pharmacogenomics is the study that examines how genetic variations affect the ways in which people respond to drugs. The ways people respond to drugs are complex traits that are influenced by many different genes. Pharmacogenomics intends to develop rational means of optimizing drug therapy, with respect to the patients' genotype, to maximize efficacy with minimal adverse drug reactions. Pharmacogenomics has the potential to revolutionize the practice of medicine, and promises to usher in an area of personalized medicine, in which drugs and drug combinations are optimized for each individual's unique genetic makeup. Indeed, pharmacogenomics is exploited as an essential step for target discovery and drug development in the pharmaceutical industry. The goal of the personalized medicine is to get the right dose of the right drug to the right patient at the right time. In this article, we will review the use of pharmacogenomics in drug discovery and development.

Cardiopulmonary resuscitation in the elderly: a clinical and ethical perspective

Abstract: The daily practice of cardiopulmonary resuscitation (CPR) in elderly patients has brought up the attention of outcome research and resource allocation. Determinants to predict survival have been well identified. There has been empirical evidence that CPR is of doubtful utility in the geriatric population, more studies have showed controversial data. Sometimes situations in which CPR needs to be given in the elderly, causes stress to healthcare providers, due to lack of communication of the patient's wishes and the belief that it will not be successful. It is of importance to state that we have the duty to identify on time the patients that will most likely benefit from CPR, and find out the preferences of the same. Whenever it is possible to institute these guidelines, we will avoid patient suffering. (J Geriatr Cardiol 2007;4:117-9.)