Biomedical subjects

John O'Leary

Publications and source records attributed to John O'Leary.

6 recordsLinked to original sources

PubMed2007

Low-level genomic instability is a feature of papillary thyroid carcinoma: an array comparative genomic hybridization study of laser capture microdissected papillary thyroid carcinoma tumors and clonal cell lines.

CONTEXT: Previous chromosomal comparative genomic hybridization (CGH) studies of papillary thyroid carcinoma (PTC) have demonstrated a low prevalence of aberrations, with the majority of tumors showing no evidence of chromosomal instability. The technique of CGH can be optimized, however, using array CGH and laser capture microdissection to ensure pure cell populations for analysis. OBJECTIVE: To assess PTC using array CGH applied to laser capture microdissected tumor cells and pure cell cultures. DESIGN: Well-characterized PTC (known ret/PTC and BRAF mutation status), including samples from 5 tumors with classic morphology, 3 follicular variant tumors, and 3 clonal PTC cell lines, were analyzed. RESULTS: Copy gain and loss occurred in all of the tumor cases and cell lines examined. The most common recurrent aberrations involved gains on chromosomes 1, 5, 7, 11, 15, 17, and 22, with recurrent deletions occurring on chromosomes 4, 18, and 19. Analysis of the data from the 8 tumor samples showed that amplifications of TP73 (1p36.33), SNRPN (15q12), and PDGFB (22q13.1) occurred exclusively in tumors with a wild type BRAF. CONCLUSIONS: This study shows a higher prevalence of aberrations detected using array CGH allied to laser capture microdissection than previously described in the literature, and it appears that the combination of laser capture microdissection and arrayed clones optimizes studies utilizing CGH. Copy gain of PDGFB occurs in a subset of tumors showing no evidence of mutated BRAF or rearranged ret, suggesting that copy gain of PDGFB may underlie the increased expression of platelet-derived growth factor described recently in the literature.

Adult↗

PubMed2006

Changes in prognostic awareness among seriously ill older persons and their caregivers.

PURPOSE: To examine changes in patients' and caregivers' understanding of prognosis with progression of the patient's illness. SUBJECTS AND METHODS: Community-dwelling persons 60 years of age and older who were seriously ill with cancer, congestive heart failure, or chronic obstructive pulmonary disease and their caregivers were interviewed every 4 months and more frequently with a decline in the patient's status for up to one year. We examined responses to, "If you had to take a guess, how long do you think that (you/the patient) might have to live?" at baseline and at the interview closest to death. RESULTS: Among 218 patients, 87 died within 1 year. At their initial interview 46% were uncertain about their life expectancy (LE) and 9% believed LE was 1 year or less; at their final interview, 55% were uncertain and 17% believed LE was 1 year or less. At the caregiver's initial interview, 29% were uncertain about the patient's LE and 20% believed LE was 1 or less; at their final interview, 30% were uncertain and 34% believed LE was 1 year or less. Among those interviewed within 30 days of the patient's death, 31% of patients and 52% of caregivers believed LE was 1 year or less. Patients' estimates of the LE did not differ according to their diagnosis. CONCLUSIONS: There was little change in prognostic awareness over time. Even close to death, a large proportion of patients and caregivers were uncertain about prognosis, and few believed the patient had a limited life expectancy. Whether or not patients should know their prognosis is the subject of active debate; the persistence of prognostic misperception suggests that prognostic awareness may be difficult to change.

Aged↗

PubMed2003

Prognosis communication in serious illness: perceptions of older patients, caregivers, and clinicians.

OBJECTIVES: To examine agreement between patients, caregivers, and clinicians regarding prognosis communication and to examine patients' and caregivers' desire for prognostic information. DESIGN: Cross-sectional survey. SETTING: Participants' homes. PARTICIPANTS: Two hundred fourteen persons aged 60 and older with a limited life expectancy secondary to cancer, congestive heart failure, or chronic obstructive pulmonary disease; caregivers; and clinicians. MEASUREMENTS: Patient-clinician and caregiver-clinician agreement about the occurrence of prognosis discussions and patient and caregiver desire for prognostic information. RESULTS: In 46% of patient/clinician and 34% of caregiver/clinician pairs, the clinician reported saying that the patient could die of the underlying disease, whereas the patient or caregiver reported no discussion. In 23% of patient/clinician and 30% of patient/caregiver pairs, the clinician reported discussing an approximate life expectancy, whereas the patient or caregiver reported no discussion. Of 205 patients who reported no life expectancy discussion, 40% did not want this discussion. Whereas 83% of those believing they had 1 year or less to live wanted to discuss prognosis, 79% of those believing they had 1 to 2 years, 53% of those believing they had 2 to 5 years, and 50% of those believing they had more than 5 years or who were unwilling to answer wanted this discussion (P=.007). CONCLUSION: Although clinicians report that they are discussing prognosis, patients and caregivers frequently do not corroborate these reports. Furthermore, many patients do not want prognostic information. Despite previous reports concluding that patients want full disclosure about their illness, many seriously ill older persons and caregivers may not be ready or able to receive prognostic information.

Aged↗

PubMed2003

Ret/PTC chimeric transcripts in an Irish cohort of sporadic papillary thyroid carcinoma.

Ret rearrangements are common in papillary thyroid carcinoma (PTC), with ret/PTC-3 commonly seen in children exposed to ionizing radiation. In this context ret/PTC-3 has been correlated with solid variant morphology, poorer prognosis, and aggressive tumor behavior. We aimed to assess the prevalence of the common ret chimeric transcripts (ret/PTC-1 and ret/PTC-3) in a group of sporadic PTC and correlate them with tumor morphology. Thyroid follicular cells were laser capture microdissected from sections of archival PTC (n = 28). Total RNA was extracted and analyzed for expression of glyceraldehyde 3-phosphate dehydrogenase, ret/PTC-1, and ret/PTC-3 using TaqMan PCR. Ret/PTC rearrangements were detected in 60% of PTCs. Specifically transcripts of ret/PTC-1 and ret/PTC-3 were detected in 43% and 18% of PTCs, respectively. Ret/PTC-3 was detected in only follicular variant subtype (60%) and was not detected in classic PTC. One case of tall cell variant demonstrated chimeric expression of both ret/PTC-1 and ret/PTC-3 transcripts within the same tumor. This study demonstrated a high prevalence of the two common ret rearrangements in an Irish cohort of PTCs. A correlation of tumor morphology with these common ret rearrangements is suggested.

Carcinoma, Papillary↗

PubMed2002

Evaluation of restorative care vs usual care for older adults receiving an acute episode of home care.

CONTEXT: Illness and hospitalization often trigger functional decline among older persons. Home care services implemented for functional decline provide an opportunity to intervene to improve outcomes. OBJECTIVE: To compare functional status and the likelihood of remaining at home for persons receiving restorative care vs usual home care. DESIGN AND SETTING: Intervention using prospective individual matching conducted between November 1, 1998, and April 30, 2000. Six offices of a home care agency in Connecticut were used. One branch office served as the restorative care unit and the other 5 served as usual care offices. PARTICIPANTS: Patients receiving home care through the restorative care office who were 65 years or older; in receipt of Medicare-covered home care lasting at least 7 days; with absence of severe cognitive impairment; and not terminal, bedridden, or requiring total care were matched with patients from 1 of the usual care offices. The matching factors included age, sex, race, baseline self-care function, cognitive status, whether hospitalization preceded the home care episode, and date of the home care episode. Of the 712 eligible restorative care patients, 691 (97%) were matched with a usual care patient. INTERVENTION: Restorative care, provided by the home care agency nursing, therapy, and home health aide staff, was based on principles from geriatric medicine, nursing, rehabilitation, and goal attainment. MAIN OUTCOME MEASURES: Remaining at home, functional status at completion of the home care episode, and duration and intensity of home care episode. RESULTS: Compared with usual care, and after adjusting for baseline characteristics and other factors, restorative care was associated with a greater likelihood of remaining at home (82% vs 71%; odds ratio [OR], 1.99; 95% confidence interval [CI], 1.47-2.69) and a reduced likelihood of visiting an emergency department (10% vs 20%; OR, 0.44; 95% CI, 0.32-0.61). Home care episodes were shorter (mean [SD], 24.8 [26.8] days vs 34.3 [44.2] days; S = -17 821; P<.001). Restorative care patients had better mean (SD) scores than usual care patients in self-care (11.0 [2.1] vs 10.7 [2.5]; P =.07 after adjustment), home management (9.5 [2.9] vs 9.2 [3.0]; P =.05 after adjustment), and mobility (3.3 [0.8] vs 3.2 [0.9]; P =.02 after adjustment). CONCLUSIONS: This trial suggests that reorganizing the structure and goals of home care can enhance health outcomes of older patients without increasing health care utilization.

Activities of Daily Living↗

PubMedDate not supplied

Implementation and evaluation of a new automated interactive image analysis system.

OBJECTIVE: To compare automated interactive screening using the ThinPrep Imaging System with independent manual primary screening of 12,000 routine ThinPrep slides. STUDY DESIGN: With the first 6,000 cases, the Review Scopes (RS) screening results from the 22 fields of view (FOV) only were compared to independent manual primary screening. In the next 6,000 cases, any abnormality detected in the 22 FOV resulted in full manual screening on the cytotechnologist's own microscope. Sensitivity and specificity together with their 95% CIs were calculatedfor each method. RESULTS: In the first set of 6, 000 cases, diagnostic sensitivity and specificity of the imager were 85.19% and 96.67%, respectively. The diagnostic sensitivity and specificity of manual primary screening were 89.38% and 98.42%. This highersensitivity and specificity of manual primary screening were found to be statistically significant. The second set of 6,000 cases demonstrated no significant statistical difference in sensitivity or specificity between the sets of data. CONCLUSION: The results from our study show that the sensitivity and specificity of the imager technology are equivalent to those of manual primary screening. The system is ideally suited to the rapid screening of negative cases, allowing increased laboratory productivity and greater throughput of cases on a daily basis.

Carcinoma↗