Publications by authors named "Raj Mehta"

24 Publications

  • Page 1 of 1

Prostate minimally invasive procedures: complications and normal vs. abnormal findings on multiparametric magnetic resonance imaging (mpMRI).

Abdom Radiol (NY) 2021 May 11. Epub 2021 May 11.

Department of Radiological Sciences, University of California, Irvine, Orange, CA, 92868-3201, USA.

Minimally invasive alternatives to traditional prostate surgery are increasingly utilized to treat benign prostatic hyperplasia and localized prostate cancer in select patients. Advantages of these treatments over prostatectomy include lower risk of complication, shorter length of hospital stay, and a more favorable safety profile. Multiparametric magnetic resonance imaging (mpMRI) has become a widely accepted imaging modality for evaluation of the prostate gland and provides both anatomical and functional information. As prostate mpMRI and minimally invasive prostate procedure volumes increase, it is important for radiologists to be familiar with normal post-procedure imaging findings and potential complications. This paper reviews the indications, procedural concepts, common post-procedure imaging findings, and potential complications of prostatic artery embolization, prostatic urethral lift, irreversible electroporation, photodynamic therapy, high-intensity focused ultrasound, focal cryotherapy, and focal laser ablation.
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http://dx.doi.org/10.1007/s00261-021-03097-6DOI Listing
May 2021

Exogenous exposure to dihydroxyacetone mimics high fructose induced oxidative stress and mitochondrial dysfunction.

Environ Mol Mutagen 2021 Mar 6;62(3):185-202. Epub 2021 Feb 6.

Department of Physiology and Cell Biology, University of South Alabama, College of Medicine, Mobile, Alabama.

Dihydroxyacetone (DHA) is a three-carbon sugar that is the active ingredient in sunless tanning products and a by-product of electronic cigarette (e-cigarette) combustion. Increased use of sunless tanning products and e-cigarettes has elevated exposures to DHA through inhalation and absorption. Studies have confirmed that DHA is rapidly absorbed into cells and can enter into metabolic pathways following phosphorylation to dihydroxyacetone phosphate (DHAP), a product of fructose metabolism. Recent reports have suggested metabolic imbalance and cellular stress results from DHA exposures. However, the impact of elevated exposure to DHA on human health is currently under-investigated. We propose that exogenous exposures to DHA increase DHAP levels in cells and mimic fructose exposures to produce oxidative stress, mitochondrial dysfunction, and gene and protein expression changes. Here, we review cell line and animal model exposures to fructose to highlight similarities in the effects produced by exogenous exposures to DHA. Given the long-term health consequences of fructose exposure, this review emphasizes the pressing need to further examine DHA exposures from sunless tanning products and e-cigarettes.
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http://dx.doi.org/10.1002/em.22425DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7954877PMC
March 2021

A Solution for Guideline Overkill-More Guidelines or Shared Understanding?

JAMA Intern Med 2020 Nov;180(11):1508-1509

Institute of Applied Health Research, University of Birmingham, Birmingham, England.

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http://dx.doi.org/10.1001/jamainternmed.2020.3969DOI Listing
November 2020

High PD-1/PD-L1 Checkpoint Interaction Infers Tumor Selection and Therapeutic Sensitivity to Anti-PD-1/PD-L1 Treatment.

Cancer Res 2020 10 27;80(19):4244-4257. Epub 2020 Aug 27.

FASTBASE Solutions S.L, Astondo bidea, Derio, Spain.

Many cancers are termed immunoevasive due to expression of immunomodulatory ligands. Programmed death ligand-1 (PD-L1) and cluster of differentiation 80/86 (CD80/86) interact with their receptors, programmed death receptor-1 (PD-1) and cytotoxic T-lymphocyte antigen-4 (CTLA-4), respectively, on tumor-infiltrating leukocytes eliciting immunosuppression. Immunotherapies aimed at blocking these interactions are revolutionizing cancer treatments, albeit in an inadequately described patient subset. To address the issue of patient stratification for immune checkpoint intervention, we quantitatively imaged PD-1/PD-L1 interactions in tumor samples from patients, employing an assay that readily detects these intercellular protein-protein interactions in the less than or equal to 10 nm range. These analyses across multiple patient cohorts demonstrated the intercancer, interpatient, and intratumoral heterogeneity of interacting immune checkpoints. The PD-1/PD-L1 interaction was not correlated with clinical PD-L1 expression scores in malignant melanoma. Crucially, among anti-PD-1-treated patients with metastatic non-small cell lung cancer, those with lower PD-1/PD-L1 interaction had significantly worsened survival. It is surmised that within tumors selecting for an elevated level of PD-1/PD-L1 interaction, there is a greater dependence on this pathway for immune evasion and hence, they exhibit more impressive patient response to intervention. SIGNIFICANCE: Quantitation of immune checkpoint interaction by direct imaging demonstrates that immunotherapy-treated patients with metastatic NSCLC with a low extent of PD-1/PD-L1 interaction show significantly worse outcome.
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http://dx.doi.org/10.1158/0008-5472.CAN-20-1117DOI Listing
October 2020

Dissolution at acidic pH, and not dermatoscopy, is the preferred method to test the quality of itraconazole pellets.

J Am Acad Dermatol 2019 Oct 9. Epub 2019 Oct 9.

Department of Dermatology & STD, North Delhi Municipal Corporation Medical College & Hindu Rao Hospital, New Delhi - 110007, India.

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http://dx.doi.org/10.1016/j.jaad.2019.10.013DOI Listing
October 2019

Top 20 POEMs Should Provide Better Context of Study Quality and Scope.

Am Fam Physician 2019 01;99(2):74-76

Toronto, Ontario, Canada.

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January 2019

An office-based evaluation of various itraconazole brands.

J Am Acad Dermatol 2019 05 23;80(5):e113-e114. Epub 2018 Nov 23.

Department of Dermatology, ESI Post Graduate Institute of Medical Science and Research, New Delhi, India.

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http://dx.doi.org/10.1016/j.jaad.2018.11.030DOI Listing
May 2019

Allergy and Asthma: Food Allergies.

Authors:
Raj Mehta

FP Essent 2018 Sep;472:16-19

Florida Hospital Family Medicine Residency, 133 Benmore Drive, Winter Park, FL 32792.

Food allergies are immune-mediated allergic adverse reactions that occur after exposure to specific foods. The most commonly recognized food allergies are immunoglobulin E (IgE)-mediated reactions (eg, urticaria, angioedema, anaphylaxis) that result from exposure to milk, egg, peanut, tree nuts, shellfish, fish, wheat, or soy. However, other foods can cause food allergies. Oral allergy syndrome is a common but underrecognized condition characterized by transient oropharyngeal symptoms that result from ingestion of uncooked fruits or vegetables. Non-IgE-mediated food allergies manifest with more delayed symptoms than IgE-mediated food allergies, and predominately cause gastrointestinal symptoms. Food allergies often are overreported because they may be confused with food intolerances or nonimmunologic adverse food reactions (eg, lactose intolerance, food poisoning, caffeine intolerance). Food allergies are diagnosed using IgE skin tests, IgE serum tests, or oral food challenge tests. These allergies are best managed by avoidance of the food or foods related to the allergy because they require ingestion rather than contact to precipitate symptoms. Injectable epinephrine should be prescribed for patients at risk of anaphylaxis. Careful food label reading and food preparation, awareness, and education are keys to prevention.
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September 2018

Allergy and Asthma: Allergic Rhinitis and Allergic Conjunctivitis.

Authors:
Raj Mehta

FP Essent 2018 Sep;472:11-15

Florida Hospital Family Medicine Residency, 133 Benmore Drive, Winter Park, FL 32792.

Allergic rhinitis and allergic conjunctivitis are among the most common conditions seen in family medicine practice. Most cases are due to seasonal allergens, such as pollens, or year-round allergens, such as dust mites, mold, and animal dander. The clinical diagnosis can be made when symptoms of nasal congestion, sneezing, rhinorrhea, nasal or ocular pruritus, or eye tearing are present along with physical findings, such as clear rhinorrhea, pale nasal mucosa, or red watery eyes. Patients should be assessed for any comorbid conditions, such as asthma or eczema, and for symptoms that indicate impaired quality of life, such as poor sleep, daytime somnolence, or irritability. Prevention involves allergen avoidance and environmental controls. Monotherapy with oral antihistamines, intranasal steroids, or intranasal antihistamines are the initial management options for nasal and ocular symptoms. Antihistamine eye drops are fast-acting and safe for management of ocular symptoms; intranasal antihistamines are effective for nasal symptoms. Current guidelines recommend against combining intranasal steroids and oral antihistamines, as this provides no additional benefit. Select patients also may benefit from allergy skin testing or consideration for allergen immunotherapy.
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September 2018

Left Main Coronary Artery Thrombosis With Acute Myocardial Infarction: A Management Dilemma.

Am J Med Sci 2017 06 16;353(6):597-602. Epub 2016 Jun 16.

Division of Cardiology, St. John Hospital & Medical Center, Detroit, Michigan.

Left main coronary artery (LMCA) thrombosis with acute myocardial infarction is a rare condition with very high mortality. The low incidence of this condition and exclusion of patients with LMCA thrombosis from clinical trials prevent the development of optimal management strategy in these patients. Therefore, there are no clear-cut guidelines describing an evidence-based approach for this condition. We describe a patient with LMCA thrombosis presenting with acute myocardial infarction, who was found to have hypercoagulable state related to homocysteinemia on further work-up. This case highlights the challenges faced during the management of this rare condition due to lack of clear-cut guidelines describing an evidence-based approach.
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http://dx.doi.org/10.1016/j.amjms.2016.04.022DOI Listing
June 2017

The Use of Evidence-Based, Problem-Oriented Templates as a Clinical Decision Support in an Inpatient Electronic Health Record System.

Appl Clin Inform 2016 08 17;7(3):790-802. Epub 2016 Aug 17.

Raj Mehta, M.D., Division of Hospital Medicine, Department of Medicine, University of Florida, P.O. Box 100238, Gainesville, FL 32610, Phone: (352) 594-3589, Fax: (352) 265-0379, Email:

Background: The integration of clinical decision support (CDS) in documentation practices remains limited due to obstacles in provider workflows and design restrictions in electronic health records (EHRs). The use of electronic problem-oriented templates (POTs) as a CDS has been previously discussed but not widely studied.

Objective: We evaluated the voluntary use of evidence-based POTs as a CDS on documentation practices.

Methods: This was a randomized cohort (before and after) study of Hospitalist Attendings in an Academic Medical Center using EPIC EHRs. Primary Outcome measurement was note quality, assessed by the 9-item Physician Documentation Quality Instrument (PDQI-9). Secondary Outcome measurement was physician efficiency, assessed by the total charting time per note.

Results: Use of POTs increased the quality of note documentation [score 37.5 vs. 39.0, P = 0.0020]. The benefits of POTs scaled with use; the greatest improvement in note quality was found in notes using three or more POTs [score 40.2, P = 0.0262]. There was no significant difference in total charting time [30 minutes vs. 27 minutes, P = 0.42].

Conclusion: Use of evidence-based and problem-oriented templates is associated with improved note quality without significant change in total charting time. It can be used as an effective CDS during note documentation.
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http://dx.doi.org/10.4338/ACI-2015-11-RA-0164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5052550PMC
August 2016

Determining the Role of Thiamine Deficiency in Systolic Heart Failure: A Meta-Analysis and Systematic Review.

J Card Fail 2015 Dec 20;21(12):1000-7. Epub 2015 Oct 20.

Division of Cardiology, University of Florida, Gainesville, Florida.

Background: Approximately 5.7 million Americans carry the diagnosis of systolic heart failure (HF), a major health care burden. HF is a known manifestation of thiamine deficiency (TD). HF patients are at unique risk for developing TD, which may contribute to further altered cardiac function and symptoms.

Methods And Results: We performed a systematic review of the literature and a meta-analysis to evaluate the prevalence of TD in HF patients, risk factors for and mechanisms of development of TD in HF population, and outcomes of thiamine supplementation in HF patients. We found 54 studies that met our selection criteria, 9 of which were suitable for meta-analysis. TD is more common in HF patients than control subjects (odds ratio 2.53, 95% confidence interval 1.65-3.87). Diuretic use, changes in dietary habits, and altered thiamine absorption and metabolism were identified as possible mechanisms of TD in HF patients. Small observational studies and randomized control trials suggest that thiamine supplementation in HF population may improve ejection fraction and reduce symptoms.

Conclusions: Thiamine deficiency is more prevalent in the HF population, and its supplementation may be beneficial. The therapeutic role of thiamine in HF warrants further study.
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http://dx.doi.org/10.1016/j.cardfail.2015.10.005DOI Listing
December 2015

A case of syringocystadenoma papilliferum on lower leg: a rare location.

Indian J Dermatol 2013 Sep;58(5):405

Department of Dermatology and Venereology, Hindu Rao Hospital, Delhi, India.

An 18 years old male presented with a slowly increasing multiple papulonodular lesions on his left leg since birth. No definite diagnosis was made on clinical ground. But verrucous epidermal naevus with secondary change and appendageal tumor was suspected on clinical examination. Histopathological examination revealed syringocystadenoma papilliferm (SCAP). SCAP is very rare on lower leg. Only one case of SCAP on lower leg has been reported in literature so far, which was superimposed on an organoid nevus. The case is reported for unusual location and unusual presentation.
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http://dx.doi.org/10.4103/0019-5154.117306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3778789PMC
September 2013

Schizophrenia and borderline personality disorder: similarities and differences in the experience of auditory hallucinations, paranoia, and childhood trauma.

J Nerv Ment Dis 2010 Jun;198(6):399-403

Department of Clinical Neurosciences, University of Southampton, Royal South Hants Hospital, Southampton, United Kingdom.

This study investigated similarities and differences in the experience of auditory hallucinations, paranoia, and childhood trauma in schizophrenia and borderline personality disorder (BPD). Patients with clinical diagnoses of schizophrenia or BPD were interviewed using the Structured Clinical Interviews for DSM-IV. Axes 1 and 2 and auditory hallucinations, paranoia, and childhood trauma were assessed. A total of 111 patients participated; 59 met criteria for schizophrenia, 33 for BPD, and 19 for both. The groups were similar in their experiences of voices, including the perceived location of them, but they differed in frequency of paranoid delusions. Those with a diagnosis of BPD, including those with schizophrenia comorbidity, reported more childhood trauma, especially emotional abuse. BPD and schizophrenia frequently coexist, and this comorbidity has implications for diagnostic classification and treatment. Levels of reported childhood trauma are especially high in those with a BPD diagnosis, whether they have schizophrenia or not, and this requires assessment and appropriate management.
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http://dx.doi.org/10.1097/NMD.0b013e3181e08c27DOI Listing
June 2010

Effectiveness of brief cognitive-behavioral therapy for schizophrenia delivered by mental health nurses: relapse and recovery at 24 months.

J Clin Psychiatry 2009 Feb 10;70(2):201-7. Epub 2009 Feb 10.

School of Neurology, Neurosciences and Psychiatry, Newcastle University, Royal Victoria Infirmary, Newcastle upon Tyne, UK.

Background: Evidence of the efficacy of cognitive-behavioral therapy (CBT) for schizophrenia is increasing. There are very few studies of effectiveness, especially in the medium term.

Objective: To evaluate the durability of the effect of brief CBT provided by mental health nurses in community-based patients with schizophrenia (diagnosed according to ICD-10 research criteria), using time to relapse as primary outcome and days hospitalized and occupational recovery as secondary outcomes at 24-month follow-up.

Method: A 2:1 randomized trial, conducted from 1999 to 2003, was performed to evaluate the effects of brief CBT delivered by mental health nurses trained over 10 days with ongoing supervision compared to treatment as usual (TAU), with measurement performed by raters blind to treatment allocation.

Results: 205 (79.8%) of 257 CBT patients and 125 (75.8%) of 165 TAU patients could be followed up at 24 months. Of 205 patients in the CBT group, 64 (31.2%) relapsed, versus 57 (45.6%) of 125 patients in the TAU group (p = .02). Patients rehospitalized from the CBT group spent a total of 6710 days in hospital (mean = 32.7 days), while those from the TAU group were inpatients for 6114 days (mean = 48.9 days) (p < .05). Twenty-one (10.2%) of 205 patients made an occupational recovery in the CBT group, and 17 (13.6%) of 125, in the TAU group (chi(2) test not significant). Mean time to relapse was 356.8 days (SD = 241.9 days) for the CBT group and 296.1 days (SD = 215.7 days) for the TAU group (OR = 1.592, 95% CI = 1.038 to 2.441, p = .033).

Conclusion: Beneficial effects on relapse and rehospitalization following brief CBT delivered by mental health nurses in community-based patients with schizophrenia are maintained at 24-month follow-up. Occupational recovery is not improved by brief CBT.
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http://dx.doi.org/10.4088/jcp.07m03990DOI Listing
February 2009

Bioaugmenting anaerobic digestion of biosolids with selected strains of Bacillus, Pseudomonas, and Actinomycetes species for increased methanogenesis and odor control.

Appl Microbiol Biotechnol 2006 Dec 15;73(4):960-6. Epub 2006 Sep 15.

Civil and Environmental Engineering Department, Villanova University, Villanova, PA 19085, USA.

The objective of this study was to evaluate the effects of bioaugmenting anaerobic biosolids digestion with a commercial product containing selected strains of bacteria from genera Bacillus, Pseudomonas, and Actinomycetes, along with ancillary organic compounds containing various micronutrients. Specifically, the effects of the bioaugment in terms of volatile solids destruction and generation and fate of odor-causing compounds during anaerobic digestion and during storage of the digested biosolids were studied. Two bench-scale anaerobic digesters receiving primary and secondary clarifier biosolids from various full-scale biological wastewater treatment plants were operated. One of the digesters received the bioaugment developed by Organica Biotech, while the other was operated as control. The bioaugmented digester generated 29% more net CH(4) during the 8 weeks of operation. In addition, the average residual propionic acid concentration in the bioaugmented digester was 54% of that in the control. The monitoring of two organic sulfide compounds, methyl mercaptan (CH(3)SH) and dimethyl sulfide (CH(3)SCH(3)), clearly demonstrated the beneficial effects of the bioaugmentation in terms of odor control. The biosolids digested in the bioaugmented digester generated a negligible amount of CH(3)SH during 10 days of post-digestion storage, while CH(3)SH concentration in the control reached nearly 300 ppm(v) during the same period. Similarly, peak CH(3)SCH(3) generated by stored biosolids from the bioaugmented digester was only 37% of that from the control.
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http://dx.doi.org/10.1007/s00253-006-0548-6DOI Listing
December 2006

Outcomes of an effectiveness trial of cognitive-behavioural intervention by mental health nurses in schizophrenia.

Br J Psychiatry 2006 Jul;189:36-40

School of Neurology, Neurosciences and Psychiatry, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne NE1 4LP.

Background: Little is known about the medium-term durability of cognitive-behavioural therapy (CBT) in a community sample of people with schizophrenia.

Aims: To investigate whether brief CBT produces clinically important outcomes in relation to recovery, symptom burden and readmission to hospital in people with schizophrenia at 1-year follow-up.

Method: Participants (336 of 422 randomised at baseline) were followed up at a mean of 388 days (s.d. = 53) by raters masked to treatment allocation (CBT or usual care).

Results: At 1-year follow-up, participants who received CBT had significantly more insight (P = 0.021) and significantly fewer negative symptoms (P = 0.002). Brief therapy protected against depression with improving insight and against relapse; significantly reduced time spent in hospital for those who did relapse and delayed time to admission. It did not improve psychotic symptoms or occupational recovery, nor have a lasting effect on overall symptoms or depression at follow-up.

Conclusions: Mental health nurses should be trained in brief CBT for schizophrenia to supplement case management, family interventions and expert therapy for treatment resistance.
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http://dx.doi.org/10.1192/bjp.bp.105.010884DOI Listing
July 2006

Prognostic significance of cyclooxygenase-2 (COX-2) expression in patients with surgically resectable adenocarcinoma of the oesophagus.

BMC Cancer 2006 May 19;6:134. Epub 2006 May 19.

Department of Gastroenterology, Southampton University Hospital, Southampton, SO166YD, UK.

Background: COX-2 expression in tumour cells has been associated with poor prognosis in gastrointestinal and non-gastrointestinal cancers. The aim of our study was to test the hypothesis that higher levels of COX-2 expression are prognostically related to poor clinico-pathologic features in adenocarcinoma of the oesophagus.

Methods: We reviewed the records of 100 consecutive patients undergoing resection for adenocarcinoma of the oesophagus to collect data on T-stage, N-stage, tumour recurrence and survival. T & N-stage was further confirmed by histological examination. COX-2 protein expression was assessed by immunohistochemistry in all patients and COX-2 m-RNA expression was measured by quantitative RT-PCR in a small group of patients.

Results: Higher levels of COX-2 expression were associated with higher T stage (p = 0.008), higher N stage (p = 0.049), increased risk of tumour recurrence (p = 0.01) and poor survival (p = <0.001). A COX-2 score of >200 was associated with a median survival of 10 months compared to 26 months with a score of <200 (p = <0.001).

Conclusion: Higher levels of COX-2 expression are associated with poor clinico-pathologic features and poor survival in patients with oesophageal adenocarcinoma.
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http://dx.doi.org/10.1186/1471-2407-6-134DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1481577PMC
May 2006

In vitro and in vivo assessment of intraintestinal bacteriotherapy in chronic kidney disease.

ASAIO J 2006 Jan-Feb;52(1):70-9

Kibow Biotech Inc., 3701 Market Street, Philadelphia, PA 19104, USA.

Chronic kidney disease may progress to end-stage renal disease, which requires dialysis or kidney transplantation. No generally applicable therapies to slow progression of renal disease are available. Bacteriotherapy affords a promising approach to mitigate uremic intoxication by ingestion of live microbes able to catabolize uremic solutes in the gut. The present study evaluates the nonpathogenic soil-borne alkalophilic urease-positive bacterium Sporosarcina pasteurii (Sp) as a potential urea-targeted component for such "enteric dialysis" formulation. Data presented herein suggest that Sp survives through exposure to gastric juice retaining the ability to hydrolyze urea. In vitro, 10 cfu (colony forming units) of Sp removed from 21 +/- 4.7 mg to 228 +/- 6.7 mg urea per hour, depending on pH, urea concentration, and nutrient availability. Beneficial effects of Sp on fermentation parameters in the intestine were demonstrated in vitro in the Simulator of the Human Intestinal Microbial Ecosystem (SHIME) inoculated with fecal microbiota. Enumeration of marker organisms suggested that presence of Sp does not disturb microbial community of the SHIME. Additionally, a pilot study in 5/6th nephrectomized rats fed 10 cfu of live Sp daily throughout the study demonstrated that the tested regimen reduced blood urea-nitrogen levels and significantly prolonged the lifespan of uremic animals.
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http://dx.doi.org/10.1097/01.mat.0000191345.45735.00DOI Listing
April 2006

EQ-5D versus SF-6D in an older, chronically Ill patient group.

Appl Health Econ Health Policy 2004 ;3(2):91-102

Health Care Research Unit, University of Southampton, Southampton General Hospital, Southampton, UK.

Choosing between preference-based instruments of health-related quality of life (HR-QOL) in particular situations is an important area for research. Even where instruments can be assumed to be measuring the same thing, they may not be interchangeable. The study presented investigates the extent to which EQ-5D and SF-6D instruments are interchangeable in an older, chronically ill patient group undergoing haemodialysis. Head-to-head comparisons were made using 'practicality', 'descriptive validity', 'empirical validity', mean utilities and associated distributions. Overall it was difficult to choose between instruments on the basis of descriptive or empirical validity, since both performed similarly. Important differences were, however, found relating to practicality: a significantly higher response rate in favour of EQ-5D; and lower levels of missing data to derive health states. Non-response was significantly associated with age and co-morbidity of respondents. We suggest that in patients undergoing haemodialysis, and potentially other older chronically ill patient groups, EQ-5D is the primary preference-based generic HR-QOL instrument.
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http://dx.doi.org/10.2165/00148365-200403020-00005DOI Listing
May 2011

A clinical and cost evaluation of hemodialysis in renal satellite units in England and Wales.

Am J Kidney Dis 2004 Jul;44(1):121-31

Health Care Research Unit, University of Southampton, Southampton General Hospital, Southampton, UK.

Background: The prevalence rate of renal replacement therapy in the United Kingdom has increased significantly, particularly by long-term hemodialysis (HD) therapy in renal satellite units (RSUs). These are largely nurse-run units linked to main renal units (MRUs). We compared outcomes, processes of care, and costs in RSUs with those in MRUs.

Methods: A cross-sectional comparison was performed of HD patients from a representative sample of 12 RSUs in England and Wales and HD patients in the linked MRUs deemed suitable by the senior nurse for RSU care. Data for patient characteristics, clinical process and outcome measures, health-related quality of life (HRQoL), and patient satisfaction were collected. A partial analysis of National Health Service and social care costs was undertaken. Geographic access was assessed by road time and distance traveled to dialysis sessions.

Results: Seven hundred thirty-six of 895 eligible patients (82%) participated. RSU patients were older (mean age, 63 versus 57 years), but had comorbidity similar to that of MRU patients. There were no significant differences in most processes of care or clinical outcomes; achievement of standards for adequacy of dialysis (urea reduction ratio) was significantly greater in RSU patients and hospitalization in the last year was less frequent. Patient HRQoL was similar, but patient satisfaction was greater in RSU patients. RSU patients potentially saved 19 minutes traveling for each dialysis session. Costs for routine dialysis and health/social care were similar.

Conclusion: RSUs appear to be as effective as main HD units for a wide spectrum of patients, improve geographic access, and are more acceptable to patients. There is evidence that they are as cost-effective as main units.
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http://dx.doi.org/10.1053/j.ajkd.2004.03.031DOI Listing
July 2004

Short-term effect of epidermal growth factor on glucose uptake in endoscopic biopsies.

Dig Dis Sci 2003 Aug;48(8):1614-8

Alfred I. duPont Hospital for Children, Wilmington, Delaware 19899, USA.

Epidermal growth factor (EGF) up-regulation of glucose absorption via increased Na+/glucose co-transporter (SGLT-1) activity has previously been described in rabbit jejunal brush-border membrane and in differentiated Caco-2 cells. The goal of the present study was to assess the in vitro effect of EGF (200 ng/ml) on glucose uptake in human mucosal specimens, and we describe a simple procedure that uses endoscopic biopsies for short-term gludose uptake measurements. Uptake values for the EGF-treated biopsies ranged from 2.7 to 29.0, with a mean uptake of 10.65, while uptake values for the untreated biopsies ranged from 0.9 to 17.5, with a mean uptake of 7.99 (P < 0.05, paired t test). This early effect of EGF on human enterocytes may have important therapeutic implications. A role in increasing the rate of internal rehydration is suggested.
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http://dx.doi.org/10.1023/a:1024780226875DOI Listing
August 2003

Acute myocardial infarction in the young--The University of Michigan experience.

Am Heart J 2002 Jan;143(1):56-62

University of Michigan Heart Care Program and the Consortium for Health Care Outcomes, Innovation, and Cost Effectiveness Studies, Ann Arbor, Mich, USA.

Background: The purpose of this study was to assess frequency, risk factors, treatment, and complications of very young patients with acute myocardial infarction (MI) at the University of Michigan Medical Center (UMMC).

Methods: From a database of 976 consecutive patients admitted to the UMMC with acute MI between 1995 and 1998, we compared care and outcomes of patients divided into 3 age categories: <46 years, 46-54 years, and >54 years. Risk factors, presenting symptoms, type of MI, management, complications, and hospital outcomes of the 3 groups were evaluated.

Results: Young patients represented >10% of all patients with acute MI, and >25% of these individuals were women, a number considerably higher than seen in previous studies. This group of young patients was more likely to have Q-wave MI and risk factors such as family history and tobacco use and less likely to have a history of angina. Although all 3 groups received similar inpatient treatment, there was more attention paid to risk factor modification such as smoking cessation and referral to cardiac rehabilitation in younger individuals. Young patients had fewer in-hospital complications and a lower mortality rate.

Conclusions: At the University of Michigan, >1 in 10 with acute MI is <46 years old. Data suggest that current management and aggressive risk factor modification are quite good in this particular group, and overall the mortality rate is very low.
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http://dx.doi.org/10.1067/mhj.2002.120300DOI Listing
January 2002