Publications by authors named "John Thornby"

38 Publications

Correction to: Quantitative topographic anatomy of the femoral ACL footprint: a micro-CT analysis.

Med Biol Eng Comput 2018 02;56(2):339

WMG, The University of Warwick, Coventry, CV4 7AL, UK.

An author has corrected their first name and updated their email address - see the affiliation section below. Daniel G. Norman should now be Danielle G. Norman as shown in the authorgroup section above.
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http://dx.doi.org/10.1007/s11517-017-1753-4DOI Listing
February 2018

3D printing of porous hydroxyapatite scaffolds intended for use in bone tissue engineering applications.

Mater Sci Eng C Mater Biol Appl 2015 Feb 8;47:237-47. Epub 2014 Nov 8.

WMG, University of Warwick, Coventry CV4 7AL, UK.

A systematic characterisation of bone tissue scaffolds fabricated via 3D printing from hydroxyapatite (HA) and poly(vinyl)alcohol (PVOH) composite powders is presented. Flowability of HA:PVOH precursor materials was observed to affect mechanical stability, microstructure and porosity of 3D printed scaffolds. Anisotropic behaviour of constructs and part failure at the boundaries of interlayer bonds was highlighted by compressive strength testing. A trade-off between the ability to facilitate removal of PVOH thermal degradation products during sintering and the compressive strength of green parts was revealed. The ultimate compressive strength of 55% porous green scaffolds printed along the Y-axis and dried in a vacuum oven for 6h was 0.88 ± 0.02 MPa. Critically, the pores of 3D printed constructs could be user designed, ensuring bulk interconnectivity, and the imperfect packing of powder particles created an inherent surface roughness and non-designed porosity within the scaffold. These features are considered promising since they are known to facilitate osteoconduction and osteointegration in-vivo. Characterisation techniques utilised in this study include two funnel flow tests, scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), compressive strength testing and computed tomography (CT).
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http://dx.doi.org/10.1016/j.msec.2014.11.024DOI Listing
February 2015

Quantitative topographic anatomy of the femoral ACL footprint: a micro-CT analysis.

Med Biol Eng Comput 2014 11 26;52(11):985-995. Epub 2014 Sep 26.

WMG, The University of Warwick, Coventry, CV4 7AL, UK.

The femoral footprint of the anterior cruciate ligament (ACL) is a much-studied anatomic structure, predominantly due to its importance during ACL reconstruction surgery. A new technique utilising high-resolution micro-computed tomography (micro-CT) is described, allowing detailed three-dimensional (3D) quantitative analysis of this structure. Seven cadaveric knees were scanned using micro-CT, yielding 3D data with a reconstructed voxel size of 60 μm. A novel method of 3D surface extraction was developed and validated, facilitating both qualitative observation of surface details and quantitative topographic assessment using colour-coded relief maps. Images were displayed on an immersive 3D visualisation wall, and ten experienced ACL clinicians were surveyed as to the presence and morphology of osseous landmarks, providing qualitative assessment of whether such features can be reliably identified for navigation during surgery. Both quantitative analysis and qualitative assessment of the footprints in this study showed significant variability in the presence and morphology of osseous landmarks, with the lateral intercondylar ridge being objectively present in four out of seven relief maps, although reportedly seen in six out of seven cases in the qualitative study, suggesting an element of subjectivity and interpretation. This is the first study to utilise micro-CT in the study of ACL anatomy.
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http://dx.doi.org/10.1007/s11517-014-1196-0DOI Listing
November 2014

Inconsistency in 9 mm bullets: correlation of jacket thickness to post-impact geometry measured with non-destructive X-ray computed tomography.

Forensic Sci Int 2014 01 15;234:111-9. Epub 2013 Nov 15.

WMG, University of Warwick, CV4 7AL, United Kingdom.

Fundamental to any ballistic armour standard is the reference projectile to be defeated. Typically, for certification purposes, a consistent and symmetrical bullet geometry is assumed, however variations in bullet jacket dimensions can have far reaching consequences. Traditionally, characteristics and internal dimensions have been analysed by physically sectioning bullets--an approach which is of restricted scope and which precludes subsequent ballistic assessment. The use of a non-destructive X-ray computed tomography (CT) method has been demonstrated and validated (Kumar et al., 2011 [15]); the authors now apply this technique to correlate bullet impact response with jacket thickness variations. A set of 20 bullets (9 mm DM11) were selected for comparison and an image-based analysis method was employed to map jacket thickness and determine the centre of gravity of each specimen. Both intra- and inter-bullet variations were investigated, with thickness variations of the order of 200 μm commonly found along the length of all bullets and angular variations of up to 50 μm in some. The bullets were subsequently impacted against a rigid flat plate under controlled conditions (observed on a high-speed video camera) and the resulting deformed projectiles were re-analysed. The results of the experiments demonstrate a marked difference in ballistic performance between bullets from different manufacturers and an asymmetric thinning of the jacket is observed in regions of pre-impact weakness. The conclusions are relevant for future soft armour standards and provide important quantitative data for numerical model correlation and development. The implications of the findings of the work on the reliability and repeatability of the industry standard V50 ballistic test are also discussed.
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http://dx.doi.org/10.1016/j.forsciint.2013.11.002DOI Listing
January 2014

Functional outcomes of children with index pollicizations for thumb deficiency.

J Hand Surg Am 2013 Feb 4;38(2):250-7. Epub 2013 Jan 4.

Department of Orthopedic Surgery and Division of Plastic Surgery, Baylor College of Medicine, Houston, TX 77030, USA.

Purpose: To gain a comprehensive perspective on outcomes by performing an array of tests on patients who had undergone index pollicization for isolated thumb aplasia or severe hypoplasia in the absence of clinical radial dysplasia; this led us to create a graphical snapshot for future comparison. Another purpose was to compare the function of the contralateral hand and to compare parent and patient perspectives.

Methods: We evaluated 22 hands (18 patients) by grip as well as lateral and tripod pinch strength tests; the pegboard Functional Dexterity Test (FDT); the Jebsen Hand Function Test (JHFT); and a parent/patient questionnaire. We compared operated hands with both contralateral nonoperated hands and nondominant hands in published normal data. We also compared contralateral nonoperated hands with dominant hands in published normal data, and FDT results and JHFT outcomes in children greater than 6 years old with published normal data. We evaluated questionnaire results.

Results: Mean grip as well as lateral and tripod pinch strength in operated hands were 3.4, 1.2, and 1.2 kg, and in normal nondominant hands were 11.7, 4.4, and 3.9 kg, respectively. Patients' contralateral nonoperated hands were weaker than normal dominant hands. Mean timed FDT results in operated hands was 127 seconds, compared with 44 seconds in published normal data. In 2 of 5 JHFT subtests administered, no difference existed between operated hands and published normal data. A graphical snapshot took various outcome measures into consideration and showed a global assessment. Mean parent and patient questionnaire scores were 10 and 22, respectively (best = 12; worst = 60).

Conclusions: Comprehensive subjective and objective outcome testing suggested that an optimistic view of function after index pollicization is warranted. A graphical snapshot followed function over time. The contralateral hand fared worse than published normal data. Parent and patient perspectives were favorable.

Type Of Study/level Of Evidence: Therapeutic III.
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http://dx.doi.org/10.1016/j.jhsa.2012.10.032DOI Listing
February 2013

Hypnosis treatment for chronic low back pain.

Int J Clin Exp Hypn 2010 Jan;58(1):53-68

Anesthesiology Pain Program, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, USA.

Chronic low back pain (CLBP) is a significant healthcare problem, and many individuals with CLBP remain unresponsive to available interventions. Previous research suggests that hypnosis is effective for many chronic pain conditions; however, data to support its efficacy for CLBP are outdated and have been limited primarily to case studies. This pilot study indicated that a brief, 4-session standardized self-hypnosis protocol, combined with psycho-education, significantly and substantially reduced pain intensity and pain interference. Significant session-to-session improvements were also noted on pain ratings and mood states; however, follow-up data suggest that these benefits may not have been maintained across time in this sample. These findings need to be replicated and confirmed in a larger clinical trial, which could also assess the long-term effects of this treatment.
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http://dx.doi.org/10.1080/00207140903310824DOI Listing
January 2010

Risk factors and outcomes of fungal ventricular-assist device infections.

Clin Infect Dis 2010 Mar;50(5):664-71

Baylor College of Medicine, Houston, Texas, USA.

Background: Infection is a common complication of ventricular-assist devices (VADs) and is associated with rehospitalization, thromboembolic events, VAD malfunction, delay in heart transplantation, and a high mortality rate. The objectives of this study were to investigate the frequency of fungal VAD infections and assess various risk factors and their effects on mortality as compared with bacterial VAD infections.

Methods: We conducted a retrospective chart review of patients with infected VADs at a single tertiary care center. The frequency, risk factors, and outcomes of fungal versus bacterial VAD infections were compared.

Results: Of the 300 patients who received a VAD, 108 (36%) developed VAD infection, including 85 bacterial and 23 fungal infections. Most common bacterial causes of infection were Staphylococcus aureus, coagulase-negative staphylococci, enterococci, and Pseudomonas aeuruginosa. The most common fungal etiologic agent was Candida albicans. Only the use of total parenteral nutrition was associated with the development of a fungal VAD infection in multivariate analysis (odds ratio, 6.95; 95% confidence interval, 1.71-28.16; P=.007). Patients who experienced fungal VAD infection were less likely to be cured (17.4% vs 56.3%; P=.001) and had greater mortality (91% vs 61%; P=.006), compared with those who experienced bacterial VAD infection.

Conclusions: Fungi were responsible for approximately one-fifth of VAD infections and were associated with a mortality rate of 91%. Restriction of total parenteral nutrition use is essential in decreasing the rate of fungal VAD infection. Trials are needed for investigating the use of echinocandins or lipid formulations of amphotericin B for prevention and/or treatment of fungal VAD infection.
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http://dx.doi.org/10.1086/650454DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767975PMC
March 2010

Meta-analysis of EEG biofeedback in treating epilepsy.

Clin EEG Neurosci 2009 Jul;40(3):173-9

Michael E. DeBakey Veterans Affairs Hospital and Baylor College of Medicine, Houston, Texas, USA.

About one third of patients with epilepsy do not benefit from medical treatment. For these patients electroencephalographic (EEG) biofeedback is a viable alternative. EEG biofeedback, or neurofeedback, normalizes or enhances EEG activity by means of operant conditioning. While dozens of scientific reports have been published on neurofeedback for seizure disorder, most have been case series with too few subjects to establish efficacy. The purpose of this paper is to meta-analyze existing research on neurofeedback and epilepsy. We analyzed every EEG biofeedback study indexed in MedLine, PsychInfo, and PsychLit databases between 1970 and 2005 on epilepsy that provided seizure frequency change in response to feedback. Sixty-three studies have been published, 10 of which provided enough outcome information to be included in a meta-analysis. All studies consisted of patients whose seizures were not controlled by medical therapies, which is a very important factor to keep in mind when interpreting the results. Nine of 10 studies reinforced sensorimotor rhythms (SMR) while 1 study trained slow cortical potentials (SCP). All studies reported an overall mean decreased seizure incidence following treatment and 64 out of 87 patients (74%) reported fewer weekly seizures in response to EEG biofeedback. Treatment effect was mean log (post/pre) where pre and post represent number of seizures per week prior to treatment and at final evaluation, respectively. Due to prevalence of small groups, Hedges's g was computed for effect size. As sample heterogeneity was possible (Q test, p=.18), random effects were assumed and the effect of intervention was -0.233, SE = 0.057, z = -4.11, p<.001. Based on this meta-analysis, EEG operant conditioning was found to produce a significant reduction on seizure frequency. This finding is especially noteworthy given the patient group, individuals who had been unable to control their seizures with medical treatment.
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http://dx.doi.org/10.1177/155005940904000310DOI Listing
July 2009

Psychiatric consultation with medical evacuees of Hurricane Katrina.

Wilderness Environ Med 2009 ;20(1):1-5

Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA.

Objective: To study the scope of clinical activities and the postoperational attitudes of mental health professionals responding emergently to a mass urban evacuation.

Methods: Eleven mental health care providers participating in a reception team for medical evacuees after Hurricane Katrina were asked to complete a survey seeking data regarding cases encountered, psychopharmacologic interventions, and mental health support for evacuated medical personnel. Participants rated their levels of agreement with statements characterizing various aspects of the clinical experience.

Results: Nine of 11 providers returned surveys, for a response rate of 82%. Among 35 evacuees requiring immediate psychiatric consultation, acute stress disorder and dementia, equally represented among these cases, accounted for half the diagnoses. Medication interventions were relatively uncommon. Consultants provided mental health support to 14 evacuated medical professionals. Although somewhat uncertain about their role, psychiatric consultants strongly agreed that they would be willing to serve in future disaster operations of this type.

Conclusions: In major disasters, psychiatric consultants are likely to play a critical role in providing emergency mental health services for both medical evacuees and evacuated medical professionals.
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http://dx.doi.org/10.1580/06-WEME-OR-040.1DOI Listing
May 2009

beta-Blockade in noncardiac surgery: outcome at all levels of cardiac risk.

Arch Surg 2008 Oct;143(10):940-4; discussion 944

Department of Surgery, Veterans Affairs Boston Healthcare System (112), 1400 VFW Pkwy, West Roxbury, MA 02132, USA.

Hypothesis: We hypothesized that the relationship among beta-blocker use, heart rate control, and perioperative cardiovascular outcome would be similar in patients at all levels of cardiac risk.

Design: Retrospective cohort study.

Setting: Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.

Patients: Among all patients who underwent various noncardiac surgical procedures in 2000, those who received perioperative beta-blockers were matched and compared with a control group from the same patient population.

Main Outcome Measures: Thirty-day stroke, cardiac arrest, myocardial infarction, and mortality, as well as mortality at 1 year.

Results: Patients at all levels of cardiac risk who received beta-blockers had lower preoperative and intraoperative heart rates. The beta-blocker group had higher rates of 30-day myocardial infarction (2.94% vs 0.74%, P =.03) and 30-day mortality (2.52% vs 0.25%, P =.007) compared with the control group. In the beta-blocker group, patients who died perioperatively had significantly higher preoperative heart rate (86 vs 70 beats/min, P =.03). None of the deaths occurred among the patients at high cardiac risk.

Conclusion: Among patients at all levels of cardiac risk undergoing noncardiac surgery, administration of beta-blockers should achieve adequate heart rate control and should be carefully monitored in patients who are not at high cardiac risk.
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http://dx.doi.org/10.1001/archsurg.143.10.940DOI Listing
October 2008

A 5-year interval evaluation of function after pollicization for congenital thumb aplasia using multiple outcome measures.

Plast Reconstr Surg 2008 Jul;122(1):198-205

Houston, Texas From the Division of Plastic Surgery and Department of Orthopedic Surgery, Baylor College of Medicine; Hand Surgery Service, Texas Children's Hospital; Plastic Surgery Section, Veterans Affairs Medical Center; Physiotherapy Sports Medicine; and Department of Internal Medicine, Baylor College of Medicine, Michael E. DeBakey Veterans Affairs Medical Center.

Background: The authors aimed to determine the functional improvement rate over a 5-year interval among patients who had undergone index finger pollicization for isolated thumb absence compared with age-matched controls. They also investigated suggestions in previous reports that tissue remodeling in reconstructed thumbs causes improvements in function outpacing normal development.

Methods: Five patients (seven hands) evaluated 5 years earlier with grip, lateral pinch, and tripod pinch strength tests; the pegboard Functional Dexterity Test; the Jebsen Hand Function Test; standard radiographs; and parent questionnaires on appearance, social interactions, and functionality were reevaluated. Percentage changes were compared with expected changes from published norms.

Results: Regarding grip strength, patients showed a 148 percent increase compared with 102 percent in controls. Regarding lateral and tripod pinch, patients had 99 and 125 percent increases compared with 78 and 69 percent in controls, respectively; the differences were not significant between groups. Functional dexterity outcomes showed the same trend. Controls improved in the five administered subtests of the Jebsen tests. In three Jebsen subtests, patients accomplished the tasks in 40 to 45 percent less time than 5 years previously. Parent perspectives were comparable to 5 years previously. Previously, 60 percent of responses were in the best category and 4 percent were in the worst category. Those percentages were 58 and 6 percent, respectively, in this study.

Conclusions: Although this was a small study group, it seems that children who have undergone index finger pollicization have changes in function comparable to normal development. Parents still have positive perspectives of the reconstructed thumb. There is no evidence that tissue remodeling causes improvement outpacing normal development.
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http://dx.doi.org/10.1097/PRS.0b013e318177427dDOI Listing
July 2008

Impact of three-dimensional vision in laparoscopic training.

World J Surg 2008 Jan;32(1):110-8

Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, Texas 77030, USA.

Background: Simulators are being used to teach laparoscopic skills before residents get to the operating room. It is unknown whether the use of three-dimensional (3D) vision will facilitate laparoscopic training. Therefore, our objective was to compare the effectiveness of using 3D imaging over the traditional two-dimensional (2D) imaging to teach laparoscopic simulator skills to novice individuals and assess whether 3D imaging ameliorates laparoscopic performance for surgeons who have already adapted to working within a 2D surgical environment.

Methods: This prospective study involved 36 surgical residents and students. Inexperienced participants included medical students and first- and second-year surgical residents (n = 25). Experienced participants included third- and fifth-year surgical residents (n = 11). Participants were tested on six laparoscopic skills using 2D or 3D imaging systems and then retested about 3 months later using the opposing imaging system. Evaluation of performance was based on the time elapsed to task completion and the errors committed during that time.

Results: The experienced participants performed better than the inexperienced participants regardless of the imaging system. Inexperienced participants initially tested using 2D imaging required significantly more time and/or made more errors to complete five of the six laparoscopic tasks compared to those initially tested using 3D imaging (p < 0.05). After initial testing on 3D imaging, inexperienced participants retested using 2D imaging performed significantly better on five of six tasks compared to the scores of inexperienced participants initially tested on 2D imaging (p < 0.05). In contrast, the inexperienced participants' retested on 3D after initial 2D imaging did not improve on any laparoscopic task compared to the scores of inexperienced participants initially tested on 3D imaging. Among the experienced participants, no significant difference in time or errors to task completion was observed under 2D imaging compared to 3D imaging during the first or second testing session.

Conclusions: Our study indicates that 3D imaging offers significant advantages in the teaching of laparoscopic skills to inexperienced individuals.
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http://dx.doi.org/10.1007/s00268-007-9253-6DOI Listing
January 2008

Exercise prevents fatigue and improves quality of life in prostate cancer patients undergoing radiotherapy.

Arch Phys Med Rehabil 2007 Nov;88(11):1416-22

Diagnostic and Therapeutic Care Line (Radiotherapy Section), Michael E. DeBakey VA Medical Center, Houston TX, USA.

Objective: To show fatigue prevention and quality of life (QOL) improvement from cardiovascular exercise during radiotherapy.

Design: Prospective enrollment (n=21), randomized to exercise (n=11) and control groups (n=10), with pre- and post-radiotherapy between- and within-group comparisons.

Setting: Academic medical center.

Participants: Localized prostate cancer patients undergoing radiotherapy.

Interventions: The interventional group received radiotherapy plus aerobic exercise 3 times a week for 8 weeks whereas the control group received radiotherapy without exercise.

Main Outcome Measures: Pre- and post-radiotherapy differences in cardiac fitness, fatigue, depression, functional status, physical, social, and functional well-being, leg strength, and flexibility were examined within and between 2 groups.

Results: No significant differences existed between 2 groups at pre-radiotherapy assessment. At post-radiotherapy assessment, the exercise group showed significant within group improvements in: cardiac fitness (P<.001), fatigue (P=.02), Functional Assessment of Cancer Therapy-Prostate (FACT-P) (P=.04), physical well-being (P=.002), social well-being (P=.02), flexibility (P=.006), and leg strength (P=.000). Within the control group, there was a significant increase in fatigue score (P=.004) and a decline in social well-being (P<.05) at post-radiotherapy assessment. Between-group differences at post-radiotherapy assessment were significant in cardiac fitness (P=.006), strength (P=.000), flexibility (P<.01), fatigue (P<.001), FACT-P (P=.006), physical well-being (P<.001), social well-being (P=.002), and functional well-being (P=.04).

Conclusions: An 8-week cardiovascular exercise program in patients with localized prostate cancer undergoing radiotherapy improved cardiovascular fitness, flexibility, muscle strength, and overall QOL and prevented fatigue.
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http://dx.doi.org/10.1016/j.apmr.2007.08.110DOI Listing
November 2007

Coating urinary catheters with an avirulent strain of Escherichia coli as a means to establish asymptomatic colonization.

Infect Control Hosp Epidemiol 2007 Jan 29;28(1):92-4. Epub 2006 Dec 29.

Department of Medicine, Infectious Diseases Section, Center for Prostheses Infection, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas 77030, USA.

We investigated whether insertion of urinary catheters that had been coated with Escherichia coli HU2117 could establish bladder colonization with this nonvirulent organism. Ten of 12 subjects were successfully colonized for 14 days or more. The rate of symptomatic UTI during colonization was 0.15 per 100 patient-days.
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http://dx.doi.org/10.1086/510872DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2047818PMC
January 2007

Using cranial electrotherapy stimulation to treat pain associated with spinal cord injury.

J Rehabil Res Dev 2006 Jul-Aug;43(4):461-74

Pain Section, Anesthesiology (145), Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA.

Treatments for chronic pain in persons with spinal cord injury (SCI) have been less than effective. Cranial electrotherapy stimulation (CES), a noninvasive technique that delivers a microcurrent to the brain via ear clip electrodes, has been shown to effectively treat several neurological and psychiatric disorders. The present study examined the effects of daily 1-hour active CES or sham CES treatment (randomly assigned) for 21 days on pain intensity and interference with activities in 38 males with SCI. The active CES group (n = 18) reported significantly decreased daily pain intensity compared with the sham CES group (n = 20) (mean change: active CES = -0.73, sham CES = -0.08; p = 0.03). Additionally, the active CES group reported significantly decreased pain interference (-14.6 pre- vs postintervention, p = 0.004) in contrast to the nonsignificant decrease in the sham CES group (-4.7 pre- vs postintervention, p = 0.24). These results suggest that CES can effectively treat chronic pain in persons with SCI.
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http://dx.doi.org/10.1682/jrrd.2005.04.0066DOI Listing
October 2007

Are patient ratings of chronic pain services related to treatment outcome?

J Rehabil Res Dev 2006 Jul-Aug;43(4):451-60

Pain Section, Anesthesiology (145), Michael E. DeBakey Department of Veterans Affairs Medical Center, Houston, TX 77030, USA.

Consumer ratings of satisfaction with treatment are rarely used as measures of treatment outcome. This study examined the relationships between service ratings and psychometric outcomes of patients receiving pain-management services in a tertiary teaching hospital. A group of 122 patients who completed a multidisciplinary pain-management program rated their satisfaction with and effectiveness of services received and changes in their pain condition and quality of life (QOL). They also completed pre- and posttreatment measures of pain severity, pain interference, depression, and disability. Pain severity, pain interference, and depression significantly decreased following treatment. The patients' ratings of services were significantly associated with outcome measures. Pre- to posttreatment changes in pain severity and pain interference were associated with treatment satisfaction and effectiveness, improvement in pain condition, and QOL. Pre- to posttreatment change in disability was significantly related to ratings of treatment effectiveness, improvement in pain condition, and quality of life. The findings suggest that pain intensity, pain interference, and disability are important outcome dimensions of pain-management programs.
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http://dx.doi.org/10.1682/jrrd.2004.10.0128DOI Listing
October 2007

Mortality risk factors in chronic haemodialysis patients with infective endocarditis.

Nephrol Dial Transplant 2006 Aug 27;21(8):2184-90. Epub 2006 Apr 27.

Division of Nephrology, N210 Means Hall, 1654 Upham Drive, Columbus, OH 43210, USA.

Background: It is well documented that infective endocarditis (IE) is strongly associated with morbidity and mortality in haemodialysis (HD) patients. Less clear are the mortality risk factors for IE, particularly in an urban African-American dialysis population.

Methods: IE patients were identified from the medical records for the period from January 1999 to February 2004 and confirmed by Duke criteria. The patients were classified as 'survivors' and 'non-survivors' depending on in-hospital mortality, and risk factors for IE mortality were determined by comparing the two cohorts. Survivors were followed as out-patients with death as the endpoint.

Results: A total of 52 patients with 54 episodes of IE were identified. A catheter was the HD access in 40 patients (74%). Mitral valve (50%) was the commonest valve involved, and Gram-positive infections accounted for 87% of IE. In-hospital mortality was high (37%) and valve replacement was required for 13 IE episodes (24%). On logistic regression analyses, mitral valve disease [P = 0.002; odds ratio (OR) = 15.04; 95% confidence interval (CI) = 2.70-83.61] and septic embolism (P = 0.0099; OR = 9.56; 95% CI = 1.72-53.21) were significantly associated with in-hospital mortality. Using the Cox proportional hazards model, mitral valve involvement (P = 0.0008; hazard ratio 4.05; 95% CI = 1.78-9.21) and IE related to drug-resistant organisms such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus sp. (P = 0.016; hazard ratio 2.43; 95% CI = 1.18-5.00) were associated with poor outcome after hospital discharge.

Conclusions: IE was associated with high mortality in our predominantly African-American dialysis population, when the mitral valve was involved, or septic emboli occurred and if MRSA or VRE were the causal organisms.
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http://dx.doi.org/10.1093/ndt/gfl200DOI Listing
August 2006

Bacterial interference for prevention of urinary tract infection: a prospective, randomized, placebo-controlled, double-blind pilot trial.

Clin Infect Dis 2005 Nov 13;41(10):1531-4. Epub 2005 Oct 13.

Michael E. Debakey Veterans Affairs Medical Center, Houston, Texas, USA.

This prospective, randomized, placebo-controlled, double-blind pilot trial examined the efficacy of bacterial interference in preventing urinary tract infection (UTI) in 27 patients with spinal cord injury. Patients whose bladders became colonized with Escherichia coli 83972 were half as likely (P=.01) than noncolonized patients to develop UTI during the subsequent year.
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http://dx.doi.org/10.1086/497272DOI Listing
November 2005

Functional outcome for children with thumb aplasia undergoing pollicization.

Plast Reconstr Surg 2005 Oct;116(5):1314-23; discussion 1324-5

HealthSouth, Baylor College of Medicine, St. Luke's Episcopal Hospital, Houston, Texas, USA.

Background: Hand function is difficult to evaluate in young patients. It is helpful to assess young children after surgery for trauma or congenital anomaly to see how they cope as they progress through their developmental milestones.

Methods: Functional outcome in 10 children (12 upper extremities) who had previous pollicization for a congenitally absent or severely hypoplastic thumb were evaluated by standard radiographs, thumb total active range of motion, grip and pinch strength, parent questionnaire, modified Jebsen functional testing, and a pegboard Functional Dexterity Test.

Results: Grip strength was significantly less (p = 0.008) in the hands that had been operated on (mean, 2 kg) compared with the hands that had not been operated on (mean, 5.6 kg). Pinch strength was also significantly less (p = 0.008) in the hands that had been operated on (mean, 1.0 kg) compared with those that had not been operated on (mean, 2.1 kg). In most, hands that had been operated on and those that had not been operated on tested outside the 2-SD range of age-matched normals for pinch and grip strength and also for the Functional Dexterity Test. In contrast, total Jebsen Hand Function Test time was not significantly different from hands that had not been operated on, except that some subtests were significantly different, such as checker stacking (p = 0.016; mean difference, 7.2 seconds) and page turning (p = 0.031; mean difference, -10 seconds). The total active range of motion in hands that had been operated on and those that had not been operated on was also not significantly different. All children used their reconstructed thumbs in a normal pattern. Parent questionnaires revealed satisfaction with appearance and good social interactions. Functional activities showed greatest difficulty handling small objects, especially when simultaneous pinch strength was required, such as fastening buttons and small snaps.

Conclusions: This study demonstrates the importance of evaluating multiple aspects of functional outcome for congenital hand problems and of using comparative age-appropriate validated norms. Pollicization is a rewarding procedure for children with thumb aplasia.
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http://dx.doi.org/10.1097/01.prs.0000181820.36306.a0DOI Listing
October 2005

Longitudinal study of quality of life in patients with localized prostate cancer undergoing radiotherapy.

J Rehabil Res Dev 2005 May-Jun;42(3):391-9

Michael E. DeBakey Department of Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX 77030, USA.

This study prospectively evaluated quality of life (QOL) in localized prostate cancer patients undergoing radiotherapy, and it examined the relationships between QOL, depression, fatigue, and sleep disturbance. Instruments that were used are Functional Assessment of Cancer Therapy for Prostate (FACT-P), Beck Depression Inventory (BDI), Piper Fatigue Scale (PFS), and Epworth Sleepiness Scale (ESS). We evaluated patients at preradiotherapy (PRT), midway radiotherapy (MRT), completion of radiotherapy (CRT), follow-up radiotherapy (4 to 8 wk) (FRT), and long-term follow-up radiotherapy (FRT2) (12 mo or more). Forty participants with a mean age of 67.8 yr were studied. Duration of radiotherapy was 7-8 wk. Mean long-term follow-up period post-CRT was 16.2 mo (range 12- 24 mo). All patients had clinical T1c to T2b prostate cancer. Prostate Cancer Specific (PCS) and Physical Well-Being (PWB) subscales of FACT-P, scores at MRT and CRT were significantly lower than at PRT. At FRT2, PWB scores declined further, while PCS scores increased. PFS median scores were significantly higher at CRT and at FRT2 as compared with PRT. Patients scoring higher on PFS were more likely to report a poorer QOL and PWB as measured with FACT-P questionnaire. No significant changes were noted in the BDI and ESS scores during the study periods. The PWB declined during and at CRT and worsened at FRT2. Decline in PCS subscale scores during and at CRT reflects worsening of urinary symptoms and appearance of bowel problems. The scores improved at long-term follow-up. A relationship was found to exist between physical well-being and fatigue.
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http://dx.doi.org/10.1682/jrrd.2004.06.0071DOI Listing
January 2006

Does resident hours reduction have an impact on surgical outcomes?

J Surg Res 2005 Jun;126(2):167-71

Michael E. DeBakey Veteran Affairs Medical Center, and Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.

Background: We assessed the impact of restricting surgical resident work hours as required by the Accreditation Council for Graduate Medical Education (ACGME), on postoperative outcomes.

Materials And Methods: The divisions of General and Vascular Surgery at the Michael E. DeBakey Houston Veteran Affairs Medical Center implemented a limited work hours schedule effective October 1, 2002. We compared the rate of postoperative morbidity and mortality before and after the new schedule. Clinical data were collected by the VA National Surgical Quality Improvement Program (NSQIP) for the periods of October 1, 2001 to September 30, 2002 (preintervention), and October 1, 2002 to September 30, 2003 (postintervention). We assessed risk-adjusted observed to expected (O/E) ratios of mortality and prespecified postoperative morbidity for each study period.

Results: In the preintervention period, there were 405 general surgery and 202 vascular surgery cases as compared to 382 and 208 cases, respectively in the postintervention period. There were no significant differences in mortality O/E ratios between the pre- and postintervention periods (0.63 versus 0.60 in general surgery; 0.78 versus 0.81 in vascular surgery; P = 0.90 and 0.94, respectively) or in morbidity O/E ratios (1.06 versus 1.27 in general surgery; 1.47 versus 1.50 in vascular surgery; P = 0.20 and 0.90, respectively).

Conclusion: The restricted resident work hour schedule in general and vascular surgery in our facility did not significantly affect postoperative outcomes.
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http://dx.doi.org/10.1016/j.jss.2004.12.024DOI Listing
June 2005

MRI identifies MCI subtypes: vascular versus neurodegenerative.

J Neurol Sci 2005 Mar 15;229-230:121-9. Epub 2004 Dec 15.

Department of Neurology, Baylor College of Medicine, Houston, Texas 77030, USA.

As life expectancy increases worldwide, pandemics of cognitive impairment and dementia are emerging as major public health problems. Mild cognitive impairment (MCI), prodromal for dementia, is a descriptive term used for those clinical states showing early and subtle cognitive decline among the elderly, preceding the dementias. Psychometric screening combining Mini-Mental Status (MMSE) and Cognitive Capacity Screening (CCSE) Examinations, when combined now called CMC with C standing for Combined, M for MMSE, and C for CCSE, confirms diagnosis of MCI. Individuals identified with MCI are at increased risk for dementia of Alzheimer's type (DAT), vascular dementia (VAD) and other rare neurodegenerative dementias, including Lewy body dementia (LBD), fronto-temporal dementia (FTD) and Parkinson's disease dementia (PDD). Depending on different clinical compositions of cohorts studied, and MCI criteria used, between 19% and 50% of MCI progress to dementia within 3-5 years, two thirds to Alzheimer's (DAT) and one third to vascular types (VAD) in the United States. Not all Parkinsonians become demented, but PDD develops in 20-30%, however, PDD subjects were excluded from the present study, as were LBD and FTD. The incidence of MCI in those over age 70, with confirmed cognitive declines when tested 2 years later, is around 23%, but some spontaneously improve.
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http://dx.doi.org/10.1016/j.jns.2004.11.012DOI Listing
March 2005

Ethnicity, control appraisal, coping, and adjustment to chronic pain among black and white Americans.

Pain Med 2005 Jan-Feb;6(1):18-28

Houston VA Medical Center, Houston, Texas 77030, USA.

Objective: To identify similarities and differences among non-Hispanic black and white patients in pain appraisal, beliefs about pain, and ways of coping with pain. We also examined the association between these factors (i.e., appraisals, beliefs, coping) and patient perception or subjective experience of their functioning in each ethnic group.

Design: Cross-sectional survey of patients with chronic pain at pretreatment assessment.

Setting: Integrated pain management program at a Veterans Affairs Medical Center in Texas.

Patients: A total of 128 non-Hispanic black Americans and 354 non-Hispanic white Americans completed self-report measures of pain appraisal, coping, and adjustment that included the Multidimensional Pain Inventory, Survey of Pain Attitudes, Coping Strategies Questionnaire, and Chronic Pain Coping Inventory.

Results: Although the analyses indicated many similarities between the two groups concerning pain-related beliefs and coping, the black patients reported lower perceived control over pain, more external pain-coping strategies, and a stronger belief that others should be solicitous when they experience pain. The black patients also reported significantly higher levels of depression and disability, even after controlling for pain severity. Regression analyses revealed that the coping and appraisal factors predicting physical and psychological functioning were the same for both white and black patients, with ethnicity accounting for a nonsignificant amount of the total variance.

Conclusions: The current findings suggest similarities as well as differences between non-Hispanic black and white patients in the ways they view and cope with pain. However, the association between psychological factors (attitudes and beliefs, coping responses) and adjustment to chronic pain was comparable for both ethnic groups. If replicated, the findings suggest that specific tailoring of cognitive behavioral therapies to different racial/ethnic groups may not be needed to maximize treatment outcome.
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http://dx.doi.org/10.1111/j.1526-4637.2005.05008.xDOI Listing
May 2005

Further validation of the chronic pain coping inventory.

J Pain 2005 Jan;6(1):29-40

Pain Section, Anesthesiology and Mental Health Care Line, VA Medical Center, Houston, TX 77030, USA.

Unlabelled: Multidisciplinary treatment programs for chronic pain typically emphasize the importance of decreasing maladaptive and encouraging adaptive coping responses. The Chronic Pain Coping Inventory (CPCI), developed to assess coping strategies targeted for change in multidisciplinary pain treatment, is a 64-item instrument that contains 8 subscales: Guarding, Resting, Asking for Assistance, Relaxation, Task Persistence, Exercising/Stretching, Coping Self-Statements, and Seeking Social Support. A previous validation study with 210 patients in a Canadian academic hospital setting supported an 8-factor structure for the CPCI. The current study was undertaken to validate the CPCI among 564 veterans with a more extended history of chronic pain. Patients completed the study questionnaires before multidisciplinary treatment. A confirmatory factor analysis was used to examine the factor structure of the 64-item CPCI. A series of hierarchical multiple regression analyses were performed with depression, pain interference, general activity level, disability, and pain severity as the criterion variables and the 8 CPCI factors as the predictor variables, controlling for pain severity and demographic variables. The confirmatory factor analysis results strongly supported an 8-factor model, and the regression analyses supported the predictive validity of the CPCI scales, as indicated by their association with measures of patient adjustment to chronic pain.

Perspective: This article validated the 8-factor structure of the CPCI by using a confirmatory factor analysis and a series of linear regressions. The results support the applicability and utility of the CPCI in a heterogeneous population of veterans with severe chronic pain treated in a tertiary teaching hospital. The CPCI provides an important clinical and research tool for the assessment of behavioral pain coping strategies that might have an impact on patient outcomes.
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http://dx.doi.org/10.1016/j.jpain.2004.09.006DOI Listing
January 2005

Validation of the Brief Pain Inventory for chronic nonmalignant pain.

J Pain 2004 Mar;5(2):133-7

Pain Section, Anesthesiology and Mental Health Care Line Substance Dependence Treatment Program, Houston VA Medical Center, and Department of Anesthesiology, Baylor College of Medicine, TX 77030, USA.

Unlabelled: The Brief Pain Inventory (BPI; Cleeland and associates) has been used primarily to assess patients with cancer-related pain. Although it has been validated in many languages and is widely used, there has not yet been research published to validate its use for patients with chronic nonmalignant pain as the primary presenting problem. This study was designed to fill this gap by examining the psychometric properties of the BPI in 440 patients with chronic intractable pain referred to a chronic pain clinic at a metropolitan tertiary-care teaching hospital. Results indicated acceptable internal consistency (Cronbach alpha coefficients were.85 for the intensity items and.88 for the interference items). A factor analysis resulted in 2 distinct and independent factors, supporting the validity of the 2-factor structure of the BPI. Zero-order correlations indicated that the association with a measure of disability (the Roland-Morris Disability Questionnaire [RMDQ]) was significantly higher for BPI interference (r = 0.57) than for BPI intensity (r = 0.40, t = 5.71, P <.01) and that the correlation with BPI interference was not more than 0.80, supporting the conclusion that these scales assess related, but also distinct, dimensions. Finally, the finding that both BPI scales showed statistically significant improvement with treatment confirms the responsivity of BPI in detecting and reflecting improvement in pain over time.

Perspective: This paper validated the psychometric properties of a pain Assessment instrument (The Brief Pain Inventory) originally developed to assess cancer pain and extended its use for the chronic nonmalignant pain population. This provides an important and widely used diagnostic tool for the clinician treating chronic pain.
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http://dx.doi.org/10.1016/j.jpain.2003.12.005DOI Listing
March 2004

Measuring control appraisals in chronic pain.

J Pain 2002 Oct;3(5):385-93

Chronic Pain Center, VA Medical Center, Houston, TX 77030, USA.

Research has established a positive association between appraisals of control over pain and indexes of adaptive psychologic and physical functioning among persons with chronic pain. A number of measures of control appraisals have been used in the research literature. The current study sought to determine the number of factors or dimensions embedded in these commonly used measures of pain control appraisal. The study also sought to determine the association between the control appraisal construct(s) and measures of patient functioning. Two hundred fifty-two persons with chronic pain completed a questionnaire packet that included multiple measures of control appraisals. A factor analysis resulted in 6 factors: 1 factor representing beliefs about control over life in general, 1 representing perceived control over the effects of pain on one's life, and remaining 4 factors that appear to be more closely tied to perceived control over pain itself. Consistent with previous research, control appraisals made a significant contribution to the prediction of functioning (depression, disability, and pain interference). Most importantly, perceived control over the effects of pain on one's life and perceived control over life in general were more strongly associated with functioning than perceptions of control over pain itself.
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http://dx.doi.org/10.1054/jpai.2002.126609DOI Listing
October 2002

Candidemia in a tertiary care cancer center: in vitro susceptibility and its association with outcome of initial antifungal therapy.

Medicine (Baltimore) 2003 Sep;82(5):309-21

Department of Infectious Diseases, Infection Control and Employee Health, Unit 402, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.

Since the 1990s, changing trends have been documented in species distribution and susceptibility to bloodstream infections caused by Candida species in cancer patients. However, few data are available regarding the association between in vitro antifungal susceptibility and outcome of candidemia in this patient population. We therefore evaluated the association of in vitro antifungal susceptibility and other risk factors with failure of initial antifungal therapy in cancer patients with candidemia. Candidemia cases in cancer patients from 1998 to 2001 (n = 144) were analyzed retrospectively along with their in vitro susceptibility to amphotericin B, fluconazole, and itraconazole (National Committee for Clinical and Laboratory Standards M27-A method). Patients were evaluable for outcome analysis if they received continuous unchanged therapy with either fluconazole or amphotericin B for >/=5 days. We excluded cases of mixed candidemia. In vitro susceptibility testing data of the first Candida bloodstream isolate were analyzed. Appropriate therapy was defined as that using an active in vitro antifungal for >/=5 days. For fluconazole susceptible-dose dependent Candida species, we defined appropriate therapy as a fluconazole dose of >/=600 mg/day. The Candida species distribution was 30% Candida albicans, 24% Candida glabrata, 23% Candida parapsilosis, 10% Candida krusei, 9% Candida tropicalis, and 3% other. Overall, amphotericin B was the most active agent in vitro, with only 3% of the isolates exhibiting resistance to it (>1 mg/L). Dose-dependent susceptibility to fluconazole and itraconazole was seen in 13% and 21% of the isolates, respectively, while resistance to fluconazole and itraconazole was seen in 13% and 26%, respectively.Eighty patients were evaluable for outcome analysis. In multivariate analysis, the following factors emerged as independent predictors of failure of initial antifungal therapy: leukemia (p = 0.01), bone marrow transplantation (p = 0.006), and intensive care unit stay at onset of infection (p = 0.02). Inappropriate antifungal therapy, as defined by daily dose and in vitro susceptibility, was not shown consistently to be a significant factor (it was significant in multivariate analysis, p = 0.04, but not in univariate analysis), indicating the complexity of the variables that influence the response to antifungal treatment in cancer patients with candidemia.
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http://dx.doi.org/10.1097/01.md.0000091182.93122.8eDOI Listing
September 2003

Sternal wound debridement and muscle flap reconstruction: functional implications.

Ann Plast Surg 2003 Aug;51(2):115-22; discussion 123-5

Division of Plastic Surgery, Baylor College of Medicine, Houston, TX, USA.

The mortality rate for poststernotomy infection, which occurs in as many as 5% of median sternotomy incisions after cardiovascular surgery, was 37.5% until sternal debridement with muscle or omental flap reconstruction became the standard treatment for this postoperative complication and lowered the mortality rate to just more than 5%. There are few reports in the literature of physical functional deficits and long-term outcome resulting from such reconstruction. The authors evaluated two groups of patients who had undergone coronary bypass surgery at least 6 months earlier. One group had no postoperative complications; the other group had developed marked sternal wound infections that required debridement and pectoralis major or rectus abdominis muscle reconstruction. Both groups underwent pectoralis and rectus muscle strength testing, evaluation of pain and ability to perform those activities of daily living that are dependent on pectoral and rectus muscle function, and completed self-assessment questionnaires. Differences between the two groups were significant (p<0.05) with regard to pain and patient satisfaction with appearance and general functional capacity. Pectoral muscle function and strength were significantly different in patients in whom that muscle was transposed. Rectus muscle strength was not affected by the transposition of a single rectus muscle. Physical morbidity and loss of strength seemed to be related directly to loss of sternal stability stemming from marked infection and debridement rather than from loss of the muscles used in reconstruction.
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http://dx.doi.org/10.1097/01.SAP.0000058497.92264.E2DOI Listing
August 2003

Response of human immunodeficiency virus-infected patients receiving highly active antiretroviral therapy to vaccination with 23-valent pneumococcal polysaccharide vaccine.

Clin Infect Dis 2003 Aug 22;37(3):438-47. Epub 2003 Jul 22.

Baylor College of Medicine, Houston, Texas, USA.

Whether highly active antiretroviral therapy (HAART) impacts responses to 23-valent pneumococcal polysaccharide vaccine (PV) is not known. Immunoglobulin G (IgG) levels for 6 capsular polysaccharides in human immunodeficiency virus (HIV)-infected patients who had received > or =6 months of HAART were measured either after their first dose of PV (n=46) or after revaccination (n=41); control subjects had never received HAART and had received the first dose of PV (n=38). There were no significant differences in pre- or postvaccination IgG levels among these groups but for 1 capsular polysaccharide. The 3 groups had significant postvaccination increases in IgG levels to all capsular polysaccharides. The control group had a greater number of 2-fold responses than did the combined HAART groups (P<.05). Patients with a CD4 cell count of > or =200 cells/mm3 had a greater number of 2-fold responses than did those with a CD4 cell count of <200 cells/mm3 (P<.05). For revaccinated patients, postvaccination IgG levels were correlated with the CD4 cell count at the initial vaccination. The immunogenicity of PV among patients receiving long-term HAART is modest. It seems best to immunize HIV-infected patients early in the course of disease.
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http://dx.doi.org/10.1086/375841DOI Listing
August 2003
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