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Biomedical subjects

V Shane Pankratz

Publications and source records attributed to V Shane Pankratz.

At least 55 records · Page 3Linked to original sources
PubMed2004

A prospective clinical practice intervention to improve osteoporosis management following distal forearm fracture.

Secondary prevention of osteoporosis after fracture is underutilized, despite cost-effective therapies. This clinical practice intervention aimed to improve osteoporosis care of the postfracture patient. Residents of Olmsted County, Minnesota, USA, > or = age 45 who sustained a moderate trauma distal forearm fracture were identified, and participants received educational materials, referral for bone densitometry and physician consultation to address osteoporosis in January 1999 through October 2000. Osteoporosis educational materials were provided to patients at the time of recruitment, and primary care physicians provided osteoporosis practice guidelines. Outcomes included: completion of bone densitometry, acceptance of interventions at the first postfracture primary care physician visit, and adherence to advice at 6 months. There were 105 patients identified (80% women), but only 58 agreed to participate (88% women). Women with lower T-scores (< -1.5) had an 89% initial treatment rate, and 67% were adherent to treatment at 6 months. All women with normal bone density (T-score above -1.5) were advised by their primary care physicians about antiresorptive treatment, and 100% adhered to these recommendations, even though they were not eligible for such treatment based on the National Osteoporosis Foundation (NOF) guidelines. None of the men accepted the treatments offered, despite T-scores that fell at or below the NOF treatment threshold. Bone densitometry and consultation improved osteoporosis interventions after index fracture from a 16% baseline rate in the population (1993-1997) to a 45% overall rate for the study population. In summary, while referral for bone densitometry and discussion by a physician about postfracture osteoporosis preventive treatments did increase treatment rate, the majority of patients at highest risk did not accept interventions. Further initiatives are needed to overcome both system and patient barriers.

Absorptiometry, Photon↗
PubMed2004

Survey of regional health care providers on selection of treatment for bulimia nervosa.

OBJECTIVE: To determine which treatments clinicians currently recommend for patients with bulimia nervosa (BN), to find out if they recommended evidence-based treatments, and to assess availability and clinician satisfaction with treatment options. METHODS: Surveys were sent to 1,263 health care providers in Minnesota, Iowa, and Wisconsin who were likely to encounter patients with BN. These health care providers comprised all primary care clinicians, physician assistants, advanced practice nurses, and all mental health/chemical dependency clinicians (MDs, Clinical Nurse Specialist (CNS), social workers, doctoral and masters-level therapists, and chemical dependency (CD) counselors) affiliated with the Mayo Clinic in Rochester, Minnesota. RESULTS: Evidence-based treatments for BN are recommended consistently and are generally perceived to be available, at least to practitioners affiliated with a large medical center in the Midwest. Clinician satisfaction with treatment options is modest. DISCUSSION: Clinicians are recommending evidence-based treatments for BN patients and find them to be generally available. Modest satisfaction with available treatments may reflect a realistic understanding of treatment options, which need further development.

Bulimia↗
PubMed2004

Centrilobular necrosis after orthotopic liver transplantation: association with acute cellular rejection and impact on outcome.

Several studies have linked centrilobular necrosis (CN) to acute cellular rejection (ACR) following liver transplantation. However, it may be difficult to establish the diagnosis of ACR when the classic portal features are absent. The aim of the present study was to identify specific features that would help to recognize ACR in biopsies with CN. One hundred and forty liver biopsies with CN were identified from 97 patients who underwent liver transplantation. The following histopathologic features were assessed: CN, steatosis, lobular inflammation, cholestasis, endothelialitis, and fibrosis. CN was graded semiquantitatively. A number of clinical and biochemical parameters were also recorded. Biopsies with CN were assessed for the presence or absence of ACR and divided into two groups accordingly. The associations of the biochemical, pathologic, and clinical features with ACR were assessed using a multivariate logistic regression model. The outcomes of patients with and without rejection were compared using the Cox proportional hazards regression model. Seventy-four biopsies (52.9%) showed evidence of ACR, and 52 patients (53.6%) had evidence of ACR at the first biopsy with CN. The multivariate analysis showed the presence of cholestasis, lobular inflammation, the ALT level, and time since liver transplantation to be independent predictors of the presence of ACR in biopsies with CN. Patients with ACR on their first biopsy with CN were significantly more likely to experience graft loss compared with patients without ACR. In conclusion, the presence of cholestasis and lobular inflammation on biopsies with CN appeared helpful in predicting its association with ACR.

Adolescent↗
PubMed2004

The contribution of HLA class I antigens in immune status following two doses of rubella vaccination.

The variability of humoral and cellular immune responses modulated by human leukocyte antigen (HLA) genes is a significant factor in the protective effect of rubella vaccines. We performed HLA class I typing in a group of 346 healthy schoolchildren and young adults who previously received two doses of measles-mumps-rubella-II vaccine. Rubella virus-specific humoral (serum antibody) immunity and cell-mediated immunity (lymphocyte proliferation) were assessed. Median values for antibody levels and stimulation indices (SI) were 38.63 IU/ml and 2.29 IU/ml, respectively. The alleles that provided suggestive, but not conclusive, evidence of HLA association with rubella seropositivity were HLA-B*2705 (median, 24.68 IU/ml; p = 0.160), B*4501 (median, 61.22 IU/ml; p = 0.098), Cw*0303 (median, 30.34 IU/ml; p = 0.102) and Cw*0704 (median, 26.58 IU/ml; p = 0.144). These alleles approach, but do not achieve, statistical significance. Of all the alleles analyzed, HLA-B*3503 (median SI, 3.00; p = 0.031) and HLA-Cw*1502 (median SI, 3.19; p = 0.035) were positively associated with lymphoproliferative responses to rubella virus antigens, whereas the HLA-B*3901 (SI, 1.34; p = 0.066) allele was negatively associated. This suggests that class I HLA alleles may have limited associations with humoral and cellular immune responses to rubella vaccine. These data may facilitate our understanding of immune response variation in a genetically outbred heterogeneous population.

Adolescent↗
PubMed2004

Confrontation naming does not add incremental diagnostic utility in MCI and Alzheimer's disease.

As the incidence of dementia increases, there is a growing need to determine the diagnostic utility of specific neuropsychological tests in the early diagnosis of Alzheimer's disease (AD). In this study, the relative utility of Boston Naming Test (BNT) in the diagnosis of AD was examined and compared to the diagnostic utility of other neuropsychological measures commonly used in the evaluation of AD. Individuals with AD (n = 306), Mild Cognitive Impairment (MCI; n = 67), and cognitively normal subjects (n = 409) with at least 2 annual evaluations were included. Logistic regression analysis suggested that initial BNT impairment is associated with increased risk of subsequent AD diagnosis. However, this risk is significantly less than that imparted by measures of delayed recall impairments. A multivariate Cox proportional hazards regression analysis suggested that BNT impairment imparted no additional risk for subsequent AD diagnosis after delayed recall impairments were included in the model. Although BNT impairment occurred in all severity groups, it was ubiquitous only in moderate to severe dementia. Collectively these results suggest that although BNT impairments become more common as AD progresses, they are neither necessary for the diagnosis of AD nor particularly useful in identifying early AD.

Aged↗
PubMed2004

Decisional capacity of depressed elderly to consent to electroconvulsive therapy.

The purpose of this article is to determine the abilities of severely depressed elderly to consent to electroconvulsive therapy (ECT) and to investigate the impact of educational intervention on their capacity. Forty severely depressed adults referred for ECT, with Mini-Mental State Examination scores greater than 20, were recruited. Using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), decisional capacities were assessed at baseline and reassessed after education. Between the 2 assessments, all subjects received standard education, and half of the group was subsequently randomized to receive further education. At baseline, the geriatric group scored lower on understanding, reasoning, and choice and higher on appreciation. After education, all MacCAT-T scores increased for both age groups. Depressed elderly in the sample, as a group, had adequate decisional capacities to consent to ECT. They showed greater improvement in decisional capacity with education. The findings highlight the importance of providing education to the elderly to optimize their ability to give informed consent.

Adult↗
PubMed2004

Desmoplastic melanoma of the head and neck: histopathologic and immunohistochemical study of 28 cases.

Studies of the immunohistochemical profiles and clinical course of desmoplastic melanoma have produced conflicting results. We identified 28 cases of desmoplastic melanoma after a search of our files for spindle cell neoplasms of the head and neck from 1960 through 1995. The 17 male (61%) and 11 female (39%) patients averaged 65 years of age. The cheek was the most common location (12 cases, 43%). The average length of follow-up was 5 years. Overall 5-year survival rate was 46%. Melan A and tyrosinase positivity (P = 0.0195), smooth muscle actin positivity (P = 0.0328), tumor size (P = 0.0297), and tumor thickness (P = 0.0419) were significantly associated with local progression-free survival. No histologic or immunohistochemical marker was associated with overall or metastasis-free survival.

Adult↗
PubMed2004

Safety of electroconvulsive therapy in patients receiving long-term warfarin therapy.

OBJECTIVE: To investigate the safety of electroconvulsive therapy (ECT) in patients receiving long-term warfarin therapy. PATIENTS AND METHODS: Retrospective data were reviewed for 35 consecutively hospitalized patients who received long-term warfarin therapy and ECT at the Mayo Clinic in Rochester, Minn, between January 1, 1994, and December 31, 2001. RESULTS: A total of 300 ECT treatments were administered to the 35 patients. Of 284 ECT treatments for which data were available, no ECT-related complications due to anticoagulation occurred despite increases in blood pressure and pulse rate. One patient experienced ventricular tachycardia, resulting in transfer to a cardiology service for temporary monitoring. No other serious ECT-related adverse effects were noted. The rate of intertreatment delirium was similar to that reported in other studies. CONCLUSIONS: Electroconvulsive therapy in patients receiving long-term warfarin therapy appears to be safe. Although no major adverse effects were identified in our case series, additional prospective evaluation is warranted.

Adult↗
PubMed2004

Autopsy results after surgery for non-small cell lung cancer.

OBJECTIVE: To determine the percentage of metastatic and unexpected residual lung cancer at autopsy in patients considered for curative resection of non-small cell lung cancer during a time when computed tomography was available as a preoperative staging tool. MATERIAL AND METHODS: Clinical data and surgical and autopsy slides of all patients who underwent curative resection of nonsmall cell lung cancer at the Mayo Clinic in Rochester, Minn, between 1985 and 1999 and who underwent autopsy within 30 days of surgery were reviewed retrospectively for the presence of residual or metastatic disease. RESULTS: The study group consisted of 25 men and 7 women, with a mean age of 70 years. A pulmonary metastasis was identified at surgery in 1 patient (3%). Metastases were found in an additional 5 patients (16%) at autopsy, 1 of whom had 2 sites involved. These sites included the liver in 2 and lung, epicardium, adrenal gland, and kidney in 1 each. The average diameter of metastases was 1.6 cm. No factor studied was found to be significantly associated with the presence of unrecognized metastatic disease at autopsy. CONCLUSION: The advent of computed tomography as a staging tool has decreased the percentage of patients with undiagnosed metastatic disease at surgery; however, preoperative understaging in lung cancer remains a problem.

Aged↗
PubMed2004

Sensitivity and specificity of the semiquantitative latex agglutination D-dimer assay for the diagnosis of acute pulmonary embolism as defined by computed tomographic angiography.

OBJECTIVE: To determine the sensitivity and specificity of the semiquantitative latex agglutination plasma fibrin D-dimer assay for the diagnosis of acute pulmonary embolism by using computed tomographic (CT) angiography as the diagnostic reference standard. PATIENTS AND METHODS: From January 1, 1998, to June 26, 2000, patients who had both semiquantitative latex agglutination plasma fibrin D-dimer testing and CT angiography for suspected acute pulmonary embolism were selected for the study. A D-dimer value greater than 250 ng/mL was considered positive for thromboembolic disease. Diagnosis of acute pulmonary embolism was based solely on the interpretation of the CT angiogram. The D-dimer assay results were then compared with the CT angiographic diagnoses. RESULTS: Of 946 CT studies, 172 (18%) were positive for acute pulmonary embolism. The D-dimer assay was positive for 612 (65%) of the 946 patients. For acute pulmonary embolism, the D-dimer assay had a sensitivity of 0.83 (95% confidence interval [CI], 0.76-0.88), a specificity of 039 (95% CI, 036-0.43), a negative likelihood ratio of 0.44 (95 % CI, 032-0.62), and a negative predictive value of 0.91 (95% CI, 0.87-0.94). CONCLUSIONS: The semiquantitative latex agglutination plasma fibrin D-dimer assay had moderate sensitivity and low specificity for the diagnosis of acute pulmonary embolism. When used alone, the results of this test were insufficient to exclude this serious and potentially fatal disorder. Approximately two thirds of our patients had positive D-dimer assays and required further evaluation to exclude acute pulmonary embolism.

Adolescent↗
PubMed2003

Cat red blood cell thiopurine S-methyltransferase: companion animal pharmacogenetics.

A common genetic polymorphism for thiopurine S-methyltransferase (TPMT) is a major factor responsible for individual variation in the toxicity and therapeutic efficacy of thiopurine drugs in humans. We set out to determine whether inheritance might also influence the level of TPMT activity in the domestic cat, Felis domesticus. As a first step, red blood cell (RBC) TPMT activity was measured in blood samples from 104 cats. The average level of cat RBC TPMT activity was lower than that observed in humans and was not related to either age or sex of the animal. We then cloned and characterized the F. domesticus TPMT cDNA and gene. Genotype-phenotype correlation analysis was performed by resequencing the cat TPMT gene using DNA samples from 12 animals with high and 12 with low levels of RBC TPMT activity. Thirty-one single nucleotide polymorphisms (SNPs) were observed in these 24 DNA samples, including five that altered the encoded amino acid, resulting in nine allozymes (six observed and three inferred). Twelve of the 31 feline TPMT SNPs were associated, collectively, with 56% of the variation in level of RBC TPMT activity in these 24 animals. When those 12 SNPs were assayed in all 89 cats for which DNA was available, 30% of the variation in level of RBC TPMT activity was associated with these 12 polymorphisms. After expression in COS-1 cells, five of the eight variant cat allozymes displayed decreased levels of both TPMT activity and immunoreactive protein compared with the wild-type allozyme. These observations are compatible with the conclusion that inheritance is an important factor responsible for variation in levels of RBC TPMT activity in the cat. They also represent a step toward the application of pharmacogenetic principles to companion animal thiopurine drug therapy.

Animals↗
PubMed2003

The association of class I HLA alleles and antibody levels after a single dose of measles vaccine.

Despite the success of the current measles vaccine in controlling disease in industrialized countries, the importance of vaccine failure has become increasingly apparent. Our objective was to determine if associations exist between seronegativity after measles vaccination and class I human leukocyte antigen (HLA) alleles. We undertook a cross-sectional observational study in Rochester, Minnesota, with 242 school-age children previously recruited from a communitywide seroprevalence study. We studied two groups of subjects: 72 were seronegative (EIA < or =0.8 after a single dose of measles vaccine) and 170 were seropositive (enzyme immunoassy [EIA] > or =1.0 after one dose). We used the resources of Mayo Clinic's tissue typing laboratory for serotyping class I HLA-A and HLA-B alleles via microlymphocytotoxicity assays. We found no statistically significant associations with class I HLA-A but did find associations with class I HLA-B, which includes alleles associated with seronegativity (B8, B13, and B44) and those associated with seropositivity (B7 and B51). Elucidation of the specific peptide-HLA complex interactions that lead to varying or failed immune responses may provide fertile groundwork for improved vaccines that can overcome limitations of the current live, attenuated measles vaccine.

Alleles↗
PubMed2003

Prospective evaluation of a screen for complex discharge planning in hospitalized adults.

OBJECTIVES: To test the predictive ability of the Probability of Repeated Admission (PRA) screen for nonroutine discharge planning (requiring new referrals for formal services). DESIGN: Prospective cohort. SETTING: Two hospitals within a large Midwestern, tertiary care, referral-based system. PARTICIPANTS: Nine hundred ninety-one hospitalized adults identified using a systematic sampling strategy. MEASUREMENTS: The PRA screen was administered, and use of nonroutine discharge planning resources and nonroutine discharge disposition were determined using observation and open record review. Prolonged length of stay was determined by comparing the actual length of stay with the combined average length of stay for diagnosis-related groupings. RESULTS: Significant differences in PRA scores existed in two of three endpoints, but the differences were small, and the ranges of scores overlapped almost completely. Using, logistic regression, items predicting use of nonroutine discharge-planning resources were self-rated health, caregiver availability, age, and sex (chi-square (chi2) = 105.7, df = 9, P <.001), accounting for 17.9% of the variability and area under receiver operating characteristic curve (AUC) of 0.74. Self-rated health and sex predicted prolonged length of stay (chi2 = 15.3, df = 5, P =.009), but only explained 2.2% of the variability, with an AUC of 0.58. The predictors of nonroutine discharge disposition were self-rated health, caregiver availability, age, sex, and diabetes mellitus (chi2 = 125.8, df = 11, P <.001), accounting for 23.0% of the variability, with an AUC of 0.79. CONCLUSION: The clinical utility of using the PRA as a screen for early identification of persons who use nonroutine discharge planning is limited, although certain individual items may be useful.

Aged↗
PubMed2003

Serial Doppler assessment of diastolic function before and after the Fontan operation.

Serial Doppler echocardiography was used to evaluate the effects of the Fontan operation (FO) on diastolic ventricular function in 55 patients with univentricular heart. Examinations were performed before operation, before postoperative discharge, and 6 months to 6 years postoperatively. Preoperatively, early diastolic atrioventricular valve (E) flow was reduced and deceleration times prolonged relative to healthy children. All pulmonary vein diastolic flow variables, except diastolic velocity, were increased relative to control subjects. After FO, E/atrial velocity and E/atrial time velocity integral ratios were decreased whereas deceleration and isovolumic relaxation time remained constant. Diastolic pulmonary vein forward flow increased after FO. These data suggest inherently abnormal ventricular relaxation in the univentricular heart and that changes in flow patterns observed postoperatively were subtle and likely a result of reduced ventricular preload after FO. Overall, diastolic function most probably remained stable after FO. This information can be used as a benchmark for further diastolic function assessment in patients with surgically palliated univentricular heart.

Adolescent↗
PubMed2003

Evaluating an instrument for the peer review of inpatient teaching.

The purpose of this study was to assess an instrument for the peer review of inpatient teaching at Mayo. The Mayo Teaching Evaluation Form (MTEF) is an instrument, based on the Stanford seven-category educational framework, which was developed for the peer review of inpatient teaching. The MTEF has 28 Likert-scaled items derived from the Stanford Faculty Development Program form (SFDP-26), the Mayo electronic evaluation form and three additional items. In this study three physician-evaluators used the MTEF to evaluate 10 attending physicians on the Mayo general internal medicine hospital services. Cronbach's alphas were used to assess the internal consistency of the MTEF, and Kendall's coefficient of concordance was used to summarize the inter-rater reliability. Results of this study reveal that the MTEF is internally consistent, based on average ratings across all evaluators (Cronbach's alpha=0.894). Stanford categories with the highest alphas are Self-Directed Learning, Learning Climate, Communication of Goals, and Evaluation. Categories with lower alphas are Feedback, Understanding and Retention, and Control of Teaching Session. Additionally, the majority of items on the MTEF show significant agreement across all evaluators, and teacher enthusiasm was among the most reliable items. In conclusion, the MTEF is overall internally consistent for the peer review of inpatient teaching at Mayo. Hence, the MTEF may be a useful element in the peer evaluation of teaching at our institution.

Education, Medical↗
PubMed2003

Decisional capacity of severely depressed patients requiring electroconvulsive therapy.

OBJECTIVE: The decisional capacity of severely depressed people frequently comes into question. The ability to improve this decisional capacity through educational efforts alone is not known. Our study aimed to determine the decisional capacity of severely depressed people requiring electroconvulsive therapy (ECT), and whether educational interventions improve their ability to provide informed consent for ECT. MATERIALS AND METHODS: Forty subjects with severe depression were recruited. Using the MacArthur Competence Assessment Tool for Treatment instrument, decisional capacity was assessed at baseline and reassessed after education. All of the subjects received standard education. Additionally, half were blindly randomized to receive an experimental educational intervention. RESULT: SAt baseline, there was no statistical difference in the decisional capacity between the standard and experimental intervention groups. After educational interventions, all four areas of decisional capacity improved for both groups (understanding p < 0.001, reasoning p < 0.001, appreciation p = 0.031, choice p = 0.006). However, there was no measurable additional improvement in scores for those randomized to receive additional education. CONCLUSION: Our findings indicate that this group of severely depressed people had good decisional capacities to give informed consent. Education improved their decisional capacity. There is an endpoint beyond which additional educational intervention does not result in measurable improvement in decisional capacity.

Adult↗
PubMed2003

Lymphocyte-rich gastric cancer: associations with Epstein-Barr virus, microsatellite instability, histology, and survival.

Lymphocyte-rich gastric carcinomas may have a better prognosis than cancers without a pronounced host inflammatory response. Two subsets of gastric cancer-Epstein-Barr virus-positive and microsatellite instability high-have been associated with a lymphocyte-rich phenotype. We assessed relationships between tumor-infiltrating lymphocytes, Epstein-Barr virus status, microsatellite instability status, and cancer-specific survival in 110 resected gastric cancers. Seven patients had Epstein-Barr virus-positive cancer, including 4 (3.7%) of 107 consecutive patients. Tumors from 17 patients (16%) were designated microsatellite instability high on the basis of negative immunohistochemical staining for MLH1; all tumors had intact expression of MSH2 and MSH6. Epstein-Barr virus-positive cancers had increased tumor-infiltrating lymphocytes compared with Epstein-Barr virus-negative cancers (median 450/10 HPF versus 21/10 HPF, P <.001). Microsatellite instability-high cancers also had increased tumor-infiltrating lymphocytes compared with non-microsatellite instability-high cancers (median 150/10 HPF versus 20/HPF, P <.001). Microsatellite instability-high cancers affected older patients and were more likely to be intestinal in the Lauren classification and expanding in the Ming classification. By univariate analysis, decreased risk of death from gastric cancer was significantly associated with low tumor stage, expanding growth pattern, increasing tumor-infiltrating lymphocyte count, and microsatellite instability-high status. High tumor-infiltrating lymphocyte count and microsatellite instability-high status retained statistical significance as favorable prognostic factors after adjustment for tumor stage in multivariate analysis. Tumor-infiltrating lymphocyte count retained statistical significance as a favorable prognostic factor after adjustment for microsatellite instability-high status; but microsatellite instability-high status did not remain a significant independent prognosticator after adjustment for tumor-infiltrating lymphocyte count. The association between microsatellite instability-high cancers and high tumor-infiltrating lymphocyte counts may account for the association of microsatellite instability-high gastric cancers with improved survival.

Adenocarcinoma↗