Effect of Evaluating a Recitals Course

This article was published in the Fall 2009 issue of the Journal of Undergraduate Researc

Prevalence and Predictors of Social Support Utilization among Cancer Patients Undergoing Treatment

Background. The purpose of this study was to quantify the prevalence of cancer patients utilizing social support services while undergoing treatment and to identify patient and clinical factors associated with utilization of such services. Methods. This was a cross-sectional study. Surveys were distributed to three cancer clinics at 11 locations in the greater Kansas City metropolitan area in 2010. Study inclusion criteria included being at least 18 years old and undergoing treatment for cancer at the time of survey completion. Results. A total of 465 oncology patients completed surveys. Two-thirds (67.5%, n = 314) were undergoing treatment for cancer and were included in the final analysis. More than half (63.7%, n = 198) were female, and the average age was 58.9 ± 13.3 years. More than one-third (37.4%, n = 117) reported using cancer-related social support services. Additionally, 22% (n = 69) reported not using support services but were interested in learning more about those services. Patients had increased odds of having used support services if they were female (OR = 2.67; 95% CI = 1.47, 4.82), were younger adults, or had stage I-III (OR = 2.67; 95% CI 1.32, 5.26) or stage IV cancer (OR = 2.3; 95% CI 1.14, 4.75) compared to those who did not know their cancer stage. Conclusions. More than one-third of patients reported using social support services. A substantial portion of participants reported not using support services but were interested in learning more about those services. Increasing social support service utilization might be especially important to explore for men, those who do not know their cancer stage, and older adults

Diagnosing fibrotic lung disease: When is high-resolution computed tomography sufficient to make a diagnosis of idiopathic pulmonary fibrosis?

Idiopathic pulmonary fibrosis (IPF), a progressive and fatal diffuse parenchymal lung disease, is defined pathologically by the pattern of usual interstitial pneumonia (UIP). Unfortunately, a surgical lung biopsy cannot be performed in all patients due to comorbidities that may significantly increase the morbidity and mortality of the procedure. High-resolution computed tomography (HRCT) has been put forth as a surrogate to recognize pathological UIP. The quality of the HRCT impacts the ability to make a diagnosis of UIP and varies based on the centre performing the study and patient factors. The evaluation of the HRCT includes assessing the distribution and predominance of key radiographical findings, such as honeycomb, septal thickening, traction bronchiectasis and ground glass attenuation lesions. The combination of the pattern and distribution is what leads to a diagnosis and associated confidence level. HRCT features of definite UIP (subpleural, basal predominant honeycomb with septal thickening, traction bronchiectasis and ground glass attenuation lesions) have a high specificity for the UIP pathological pattern. In such cases, surgical lung biopsy can be avoided. There are caveats to using the HRCT to diagnose IPF in isolation as a variety of chronic pulmonary interstitial diseases may progress to a UIP pattern. Referral centres with experience in diffuse parenchymal lung disease that have multidisciplinary teams encompassing clinicians, radiologists and pathologists have the highest level of agreement in diagnosing IPF.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75246/1/j.1440-1843.2009.01626.x.pd

My approach to interstitial lung disease using clinical, radiological and histopathological patterns

The complex world of interstitial lung disease presents nearly insurmountable challenges to the general surgical pathologist faced with a lung biopsy in this setting. The pathology is often inflammatory and always requires clinical and radiological context for a relevant and clinically useful histopathological diagnosis. A pattern-based histopathological approach to interstitial lung disease provides a “map” for the general pathologist to navigate this area successfully, especially so when used with aid of the clinical and radiological patterns of presentation

994-99 Can Late Saphenous Vein Graft Closure Be Predicted by Quantitative Angiographic Analysis Before the Clinical Event?

Angiographic parameters predicting the likelihood of late occlusion of saphenous vein grafts (SVG) have been infrequently described. The Post-CABG Study, a 5-year trial aimed at reducing SVG closure in minimally symptomatic patients 1–11 years Post-CABG, offers a unique view into this event since this study requires an angiogram to document baseline graft patency. In this preliminary study we performed quantitative angiographic analysis (QAA Reiber) comparing the baseline Post-CABG study angiogram to an unscheduled “clinically driven” angiogram. Of 1253 enrolled patients with at least one patent SVG, 35 developed MI or unstable angina associated angiographically with a changed SVG lesion and either total or subtotal occlusion. Average patient age was 58±2 (SEM)years; 97% were male. Years since SVG placement to baseline angiogram averaged 6.5±0.4 (range 2–14). Time from the baseline to the unscheduled angiogram was 22±2 mo (range 3–47). In 28 patients the involved graft was single and in 7 sequential. The SVG insertion segments involved the LCX in 17, RCA in 15 and LAD in 10.ResultsThe initial lesion diameter at the site of the subsequent inciting lesion for all 35 patients averaged 2.58±0.17 mm, or 29.5±3.6% diam. stenosis. (This was defined as the most severe stenosis in any part of the graft in patients with subsequent total graft occlusion, and the exactly matched graft site in those with subtotal occlusion.) In 8 patients the baseline SVG was entirely normal. The initial lesion was >50% stenosis in only 4 patients. At the time of the clinical event, the lesion had progressed to 87±2.6% diam stenosis (N=35). In 16 patients the causal lesion was subtotal, while in 19 the SVG was totally occluded. The mean native vessel — responsible graft anastomotic diameter was 2.33±0.12mm.ConclusionQAA of SVG in asymptomatic patients may not predict subsequent graft closure associated with acute coronary syndromes. The initial site of the lesion is typically of mild-moderate severity, and only later exhibits rapid progression to occlusion

Difficulties in recruitment for a randomized controlled trial involving hysterosalpingography

BACKGROUND: The usefulness of hysterosalpingography (HSG) as routine investigation in the fertility work-up prior to laparoscopy and dye had been assessed in a randomized controlled trial. Recruiting subjects to the study was more difficult than anticipated. The objective of this study was to explore possible reasons for non-participation in the trial. METHODS: All newly referred subfertile women admitted to the Reproductive Medicine Clinic of Leiden University Medical Centre between 1 April 1997 and 31 December 1999, were eligible for the study. The reasons for non-participation were evaluated by scrutinizing the medical records. RESULTS: Out of 759 women, a total of 127 (17%) agreed to participate in the trial. The most important reason for non-participation was because of exclusion criteria (73%). Other reasons were inattentive clinicians (3%) and patient-associated reasons (24%). Patient refusal and indecisiveness to enroll in the study were the most common patient-associated reasons. The most frequently stated reason for trial refusal was reluctance to undergo laparoscopy and dye mainly due to issues related to anesthesia and scheduling of procedure. CONCLUSION: Almost three-quarters of recruitment difficulties in this study were due to unavoidable reasons. To overcome the remaining avoidable reasons for non-participation, attention should be paid to appropriate instruction of the study protocol to the participating doctors and to provide adequate information, in layman's terms, to the patients. Reminding patients by notes or telephone calls for attending the clinic are helpful. It may be contingent upon tracing the reasons of clinicians and patients for non-participation to improve enrollment during a trial

Polymorphisms in IL12A and cockroach allergy in children with asthma

<p>Abstract</p> <p>Background</p> <p>IL12A has been implicated in T-cell development and may thus influence the development of atopy and allergic diseases.</p> <p>Methods</p> <p>We tested for association between four linkage disequilibrium (LD)-tagging SNPs (rs2243123, rs2243151, rs668998, and rs17826053) in <it>IL12A </it>and asthma and allergy-related (serum total and allergen-specific IgE, and skin test reactivity [STR] to two common allergens) phenotypes in two samples: 417 Costa Rican children with asthma and their parents, and 470 families of 503 white children in the Childhood Asthma Management Program (CAMP). The analysis was conducted using the family-based association test (FBAT) statistic implemented in the PBAT program.</p> <p>Results</p> <p>Among Costa Rican children with asthma, homozygosity for the minor allele of each of two SNPs in <it>IL12A </it>(rs2243123 and rs2243151) was associated with increased risks of STR to American cockroach (P ≤ 0.03 for both SNPs), STR to German cockroach (P ≤ 0.01 for both SNPs), and having a positive IgE to German cockroach (P < 0.05 for both SNPs). Among children in CAMP, homozygosity for the minor allele of SNP rs2243151 in <it>IL12A </it>was inversely associated with STR to German cockroach (P = 0.03) and homozygosity for the minor allele of SNP rs17826053 in <it>IL12A </it>was associated with increased risks of STR to American cockroach (P = 0.01) and STR to German cockroach (P = 0.007). There was no significant association between any SNP in <it>IL12A </it>and asthma, STR to dust mite, or total IgE in Costa Rica or CAMP.</p> <p>Conclusion</p> <p>Our findings suggest that variants in <it>IL12A </it>influence cockroach allergy among children with asthma.</p