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Biomedical subjects

Robert Cook

Publications and source records attributed to Robert Cook.

11 recordsLinked to original sources
PubMed2006

Alcohol problems and health care services use in human immunodeficiency virus (HIV)-infected and HIV-uninfected veterans.

BACKGROUND: Although alcohol problems are common in human immunodeficiency virus (HIV)-infected patients, their impact on health care services use in HIV-infected patients is not well understood. OBJECTIVE: We sought to examine the association between alcohol problems and health care services use in HIV-infected and HIV-uninfected patients. DESIGN, SETTING, AND SUBJECTS: We undertook a prospective analysis of 16,048 HIV-infected veterans and 32,096 age-, race-, gender-, and region-matched HIV-uninfected controls identified through the national Veterans Affairs electronic administrative medical record database. We identified subjects with alcohol problems using ICD-9-CM codes for alcohol diagnoses and/or alcohol-related complications. MAIN OUTCOME MEASURES: We measured outpatient visits, emergency department visits, and inpatient hospitalizations over 12 months of follow-up. RESULTS: In adjusted analyses, HIV-infected veterans with alcohol problems were significantly more likely than HIV-uninfected veterans without alcohol problems to have at least 1 outpatient visit and at least 1 inpatient hospitalization and, among those with any health services use, to have significantly greater rates for outpatient visits (Incidence rate ratio [IRR] 2.17; 95% confidence interval [CI] 2.06-2.28; P < 0.001), emergency department visits (IRR 1.46; 95% CI 1.35-1.58; P < 0.001), and inpatient hospitalizations (IRR 1.46; 95% CI 1.30-1.64; P < 0.001). The incidence rates for outpatient visits, mental health visits, emergency department visits, and inpatient hospitalizations were significantly higher in HIV-infected veterans with alcohol problems than in HIV-infected veterans without alcohol problems. We did not find a consistent interaction effect between alcohol problems and HIV status. CONCLUSION: Alcohol problems are associated with greater outpatient, emergency department, and inpatient health care utilization in HIV-infected and HIV-uninfected veterans. However, alcohol does not appear to have a stronger effect on health services use in HIV-infected veterans compared with HIV-uninfected veterans.

Adult↗
PubMed2005

High prevalence of occult endobronchial malignancy in high risk patients with moderate sputum atypia.

Early stage radiographically occult lung cancer has a high cure rate, but comprises a small fraction of all lung cancer. Abnormal sputum cytology is one indication for bronchoscopy in patients with chest imaging that is not suspicious for lung cancer. While there is good evidence that sputum cytologic findings of carcinoma, carcinoma in situ or severe atypia predict high rates of diagnosis of lung cancer, less is known of the frequency in which lung cancer is diagnosed in bronchoscopies carried out for the indication of moderate sputum atypia. One small series, published in abstract form only, reported an 8% rate of diagnosis of lung cancer in subjects bronchoscoped for moderate atypia. We tested the hypothesis that moderate sputum atypia is an indicator of occult central airway cancer in a retrospective analysis of a group of high risk subjects, defined as current or former smokers with >30 pack-years tobacco smoking and airflow obstruction with moderate atypia sputum cytology. Seventy-nine such subjects with no evidence of malignancy on chest radiograph at the time bronchoscopy was scheduled underwent white light and autofluorescence bronchoscopy. Lung cancer was found in five subjects; three had invasive squamous cell carcinomas and two had carcinoma in situ. Seven additional subjects had severe dysplasia found on endobronchial biopsy. Moderate sputum atypia may be an important marker of risk for occult endobronchial malignancy in high risk subjects.

Aged↗
PubMed2005

The peak to mean pressure decrease ratio: a new method of assessing aortic stenosis.

BACKGROUND: The ratio of peak to mean pressure decrease is a new measure of transaortic continuous waveform shape that could be useful for grading aortic stenosis. METHODS: We retrospectively analyzed echocardiograms in 163 patients with all grades of aortic stenosis as assessed by the continuity equation. RESULTS: The peak to mean pressure decrease ratio was 1.75 (0.14) in mild stenosis, 1.66 (0.13) in moderate stenosis, 1.56 (0.10) in severe stenosis, and 1.57 (0.07) in severe aortic stenosis with left ventricular ejection fraction less than 40%. Receiver operating characteristic curve analysis showed that a threshold of less than 1.50 gave a specificity of 94% against continuity area whereas a ratio less than 1.75 gave a sensitivity of 96%. CONCLUSION: The peak to mean pressure decrease ratio is a simple and quick cue to the likelihood of severe aortic stenosis in patients with low left ventricular ejection fraction when transaortic pressure decreases appear only moderate.

Aged↗
PubMed2004

The Veterans Aging Cohort Study: observational studies of alcohol use, abuse, and outcomes among human immunodeficiency virus-infected veterans.

This article represents the proceedings of a symposium at the 2003 annual meeting of the Research Society on Alcoholism in Fort Lauderdale, FL. The organizers/chairs were Joseph Conigliaro and Amy Justice. The presentations were (1) Introduction, by Joseph Conigliaro and Tamra Madenwald; (2) Alcohol and HIV/AIDS: the importance of integrative and translational research, by Kendall Bryant; (3) Alcohol use and abuse among patients with HIV infection, by Joseph Conigliaro and Stephan Maisto; (4) Severity of comorbid alcohol use/abuse in HIV infection, by Amy Justice and Jeffrey Samet; (5) Estimating the impact of alcohol use on long-term HIV outcomes, by Scott Braithwaite and Amy Justice; (6) Homelessness, drug & alcohol use among HIV+ veterans, by Adam Gordon and Robert Cook; and (7) Hepatitis C & alcohol in the VACS 3 study, by Shawn Fultz and Kevin Kraemer. The symposium concluded with a discussion led and facilitated by Diedra Roach.

Aging↗
PubMed2004

Telling accounts of wound infections: avoidance, anomaly and ambiguity.

Drawing from an interpretive study this article reports on an investigation into the way that patients receive information about having a surgical wound infection. The study findings indicated that patients often struggle to gain this information and health professionals use a range of strategies to avoid rather than engage the patient in discussions about their infection. A sociological analysis of this avoidance draws upon the literature pertaining to issues of power/knowledge, shame and reluctance to engage in potentially distressing interactions. The findings also indicate that considerations of the success of surgery can relate more to the technical aspects of the operation rather than the patient health outcomes. This study demonstrates the clinical relevance of interpretive research and shows how this approach can produce knowledge to inform health service and patient care practices.

Anger↗
PubMed2003

Oral treatment of avian lead intoxication with meso-2,3-dimercaptosuccinic acid.

The efficacy of meso-dimercaptosuccinic acid (DMSA) (succimer) in treating avian lead intoxication was studied in a retrospective, nonrandomized, longitudinal study. Nineteen birds with moderate to high blood lead concentration and neurologic signs compatible with lead toxicity were treated with DMSA (30 mg/kg p.o., b.i.d.; n = 15) for a minimum of 7 days. In cases with severe neurologic signs, DMSA was supplemented with a single dose of edetate calcium disodium (<50.0 mg/kg of body weight i.m.; n = 4). Blood lead concentrations were measured two or more times (before and after treatment). Median blood lead concentration decreased (87%), neurologic signs were resolved, and there were no apparent adverse secondary effects.

Administration, Oral↗